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IAN: September 12, 2025 Pain scales and fatigue. [1]

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Date: 2025-09-11

Happy Friday! I don’t have any big plans today except to tackle some cleaning if I have the spoons and enough of a lack of pain. Today we’re going to talk about the effect of fatigue and pain together. Also, the chronic pain scale vs. the ‘traditional’ pain scale.

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First let’s talk about the emoji pain scale pictured above. This is the most vague pain scale, in my opinion. In this pain scale, judging by the pictures, my baseline would be a 6, my good days a 4, and my bad pain days a ten, because often I’m sitting here rocking and in tears at that point. This scale doesn’t have a number for my WORST pain days when it hurts too much to move or, the couple of times when I was injured and passed out from the pain. Not to mention labor, or gall bladder attacks. Or broken noses, those are really bad too. See what I mean about the most vague pain scale? There’s no objective point here, only subjective, and what a doctor thinks of as a ten is probably not what I think of as a ten.





Descriptive pain scale

This one is a little better. It gives a more detailed description about the level of pain, and it’s more obviously a range rather then a set number. On this scale my baseline is a 5 or 6, it can alternate a bit through the day between the two. A good day is a 3-4. A bad day is an 8 or 9, and my really bad days are a 10, though I don’t bother going to the ER because they won’t do anything anyway. It still doesn’t cover my worst pain, but it’s a lot more accurate, and is more objective due to the descriptions. This gives doctors a better view of where I am in my daily pain, or why I’m at the doctor concerning an abnormal more severe pain (like when my gall bladder was bad).



Here is a video showing the difference between the pain scales, and another descriptive scale, that’s even more objective. It’s better for acute pain rather than chronic, but still works objectively rather than subjectively, especially at the higher levels.





The Chronic illness pain scale is more descriptive, and it goes higher. Why go higher? Because when you live with chronic pain, you adjust to it. That isn’t to say we don’t feel it, but we learn how to function at higher levels of pain.

This one goes higher than the ‘normal’ pain scale.

On this scale a 3 or 4 on the right-hand scale is my normal. A 1 or 2 is a good day. The negative numbers I’ve reached while on pain meds in the hospital, usually by IV. My bad days are 6-8. The worst days? When I barely get out of bed at all because of pain, are an 8-10. Usually if I’m at a 10 there is something else wrong and contributing (gall bladder pre-removal, umbilical hernia, infection or sprain, etc.) That’s when I go to the ER to make sure nothing is actually wrong, and usually something is. These are my “is it a heart attack/appendicitis” etc. moments.

Now we get to factor in another chart. That of fatigue. How severe fatigue is will affect how badly you can manage the pain that day. Fatigue is a problem in and of itself. It makes it harder to focus, harder to be able to get up and do anything, harder to move. When combined with pain, it makes it more difficult to distract from the pain. If you can’t focus, can’t get lost in a book, or a game or even a tv show, you notice the pain more. You’re exhausted, bored out of your mind, focusing more on the pain which makes it subjectively worse, and frustrated that you can’t get done what you feel you should be doing. Often you can’t get out of bed for long, and can’t move around as much, which also can make the pain feel a lot. Pain and fatigue combined make it harder to push through.

Fatigue scale. My good day here is a 2-3. My normal is a 4-5, and bad days are a 8-9.

For me, fatigue varies a lot through the day. I can wake up at a 2, but as soon as I get one thing done, suddenly I’m at 7. I can be at a 6 all morning, then devolve to a 9 and end up in bed all afternoon. I can also wake up at a 9 or 10, stay in bed a few extra hours and be at a 6, then end up at a 5 or back to a 10 by dinner. Sometimes I can be at a 7 and have to go out anyway and push through, but then range from a 9-10 for two days after. If you’ve had severe pneumonia, flu or covid you’ve experienced the higher ends of this scale. Before my chronic illnesses got bad, a 2-3 would be my normal after a bad day at work. A 1 would be a normal after work. Just for perspective.



Once you add pain into the fatigue, everything gets worse. Pain makes the fatigue worse, and the fatigue makes the pain worse. If I come on saying I’m tired today… that means my fatigue scale is probably about a 6 or 7. If I’m in a full on flare, I’ll be at an 8-10, and I probably won’t get on here until later in the day (and some days I think I posted but never did).



Part of the reason chronic illness causes depression is all the things you can’t manage to do that you used to be able to do and/or that society insists you should do. I never taught Bit to ride a bike because of my chronic illnesses. By the time she was old enough, I couldn’t move well enough and I got tired too quickly to really teach her. I couldn’t keep up. Things like that cause guilt, and that leads to depression. I worked a lot to remind myself that I made up for it in other ways, like homeschooling her, cooking with her, playing games with her on the Wii, or board games or on the computer.



Often times I sit here looking outside and I think.. “We have a self-propelling mower, I should be able to go out there and get at least a little of it done.” and then I get up and go to the bathroom and almost fall over and have to grab the wall and the bathroom counter, and think “nope, not going to happen.” Or I try to walk across the house with my walker and can’t breathe and get that heavy weight in my chest, and I’m in less humidity and heat than I would be outside. And that causes depression as well. In a society where things are measured by what you do, it’s hard to feel like you’re ‘pulling your weight’ when you can only do a fraction of what you could, or feel you should do.



Here is an entirely different scale that should remind me that I can only do what I can. That it’s unreasonable for me to blame myself for not being able to do things:



This is a helpful scale.

But even then, when I was in labor with Draco, I did laps around Lake Eola park. It was hard, but I did them and breathed through the pain hoping to get it closer to delivery because I had really bad Braxton-Hicks pain. I can’t do that with the fibro pain, especially when you factor in fatigue.



So where are you at on the fatigue and pain scales? Are you at 0 most often or higher? The last time I was at a 0 on the pain scale, I was on post-surgery meds in recovery and while in the hospital. Next time you need to use the pain scale, remember the more descriptive scale, rather than just the emoji faces. Everyone deals with pain a little differently, and the more accurate the scale, the better they can help.

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