Do We Need a Reliable & Consistent Method to Objectively Quantify Pain?
Anyone who suffers pain knows what it is like to go to the doctor and be shown the image above and asked where on that scale their pain falls. This is frustrating to patients because they don’t know if the doctor means right now, when their pain is at its worst or an average of the two. It is difficult for chronic pain patients to quantify their pain even with the images on this or similar scales. Now matter what they report, they are reporting their subjective pain– it is a subjective report. It is the pain the feel in the moment and it can change over time, sometimes very quickly. A patient will frequently report one number upon arrival at the doctor’s office and that number can go up significantly by the time they leave which can be 2-3 hours later. It can change significantly from day to day as well depending on a number of factors. So to summarize, there is no stability in subjective pain, it is not scientific (stable and reproducible over time and with different raters) and therefore, it doesn’t tell us very much.
Objective pain, on the other hand is very useful. The objective pain scale (hereinafter referred to as the Dung Objective Pain Scale or DOP scale) developed by Dr. Houchi Dung, our resident acupuncture guru, is reliable, repeatable and reproducible over time and over different raters, thus it is very helpful to the individual chronic pain sufferer, their family, the doctor treating them and could be very helpful to insurance companies in the future as well.
What is the Objective Pain Scale?
Through Dr. Dung’s work as a PhD. level anatomist and his 40 years with an acupuncture clinic in San Antonio, he has gathered data that proves that peripheral nerves in the body become tender or sore in a certain sequence. Dr. Dung has written 6 books and authored numerous articles and scholarly papers on pain and acupuncture. Dr. Dung named the sequence that nerves become tender, the Objective Pain Scale and divided it into 4 categories:
- Primary (1-3 degrees)
- Secondary (4-6 degrees)
- Tertiary (7-9 degrees)
- Non-specific (10-12 degrees)
He then assigned equal degrees (12 in all) to each of those categories and calculated where each peripheral nerve fell within each of the 12 degrees. He then calculated how many individuals in the population that he treated had tenderness or soreness upon palpitation of each of those sensory nerves.
Why Is It Important to Know My DOP Scale Number
To know where you fall on the DOP scale (Dung Objective Pain Scale) is very advantageous. The manageability of subjective pain is very much dependent on the quantity of objective pain a person has. The more the objective pain the person has (the higher degree), the harder the subjective pain will be to manage. Knowing where you fall:
- provides a useful way to communicate about pain between doctor and patient
- patients will understand how easy or difficult it will be to manage their pain
- patients will know what kind of therapies will be beneficial to manage their pain
- patients will know whether or not they are a good candidate for certain surgeries and when to have them
- whether their pain will have a probability for relapse and in how long a time
- patients will understand the importance of proper care for their body and be more compliant
There are endogenous (coming from within the body) and exogenous (coming from outside the body) events that cause objective pain to accumulate within the body. First, there are four major groups of endogenous causes.
- Hormonal imbalances: If you are a woman who had had irregular menstrual symptoms, such as endometriosis, pelvic inflammation, menstrual cramping, too short or too long a menstrual period, you can be said to have experienced dysmenorrhea and you will have a number of nerves in the tender or sore (referred to as passive) phase. In other words, you will be higher on the DOP scale. Diabetes is another example of hormone imbalance. People with diabetes or pre-diabetes will also be higher on the DOP scale and will be susceptible to have peripheral neuropathies. Finally, thyroid hormone is another example, either hypo or hyper-thyroidism have been found to have many peripheral nerves tender (passive) and be higher on the DOP scale.
- Infections: We have studied infections in our study of nutrition and know that many people have cavitated infections n their bodies for long periods of time. Dr. Dung’s research shows that these type infections, as well as acute and auto-immune disorders also add to the number of peripheral nerves that become passive and therefore put a person higher on the DOP scale.
- Ischemia: Poor blood flow to an area of the body is the definition of ischemia and can make the peripheral nerves sensitive. Leg cramping due to arteriosclerosis is a commonly encountered example among seniors. Individuals with very low blood pressure can suffer chronic pain in the shoulder region and the back of the head.
- Degeneration: Normal aging is a degenerative process. Nephropathy, asthma, emphysema, joint deterioration, heart failure, poor digestion can all be possible results of aging degeneration. Degenerative diseases of the central nervous system, such as multiple sclerosis and amyotrophic lateral sclerosis, have the potential to turn peripheral nerves to sensitive.
There are two main exogenous sources that cause hidden pain to accumulate in the body, physical trauma and cognitive trauma (emotional and mental stress). Often, these two causes go hand in hand.
- Physical trauma can include any accident, injury, broken bones, surgeries and even childbirth. Also the conditions of poor nutrition such as anorexia, bulimia and obesity can cause accumulated hidden pain in the peripheral nerves.
- Cognitive trauma such as PTSD (post traumatic stress disorder) from any situation where a person was put through much trauma; horrible events with emotional charge including, conditions of war, rape, car accidents, tornadoes, floods, and dysfunctional or abusive relationships can increase objective pain.
Finding Your Number
There are several areas on the body where primary, secondary, tertiary and non-specific sites line up and can serve as a short cut to find the level of hidden pain in a body without having to check all acupoints on the body. One such place is the radial nerve in either arm.
Find the deep radial primary point on your own arm and gently apply 2-3 pounds of pressure. Notice if that point is tender or sore. If it is, you are said to be in the Primary level of pain (1-3 degrees on the DOP scale) 99.5% of the people who have sought out acupuncture treatment, are found to have this point passive (tender or sore). Move down to the deep radial II secondary point as shown in the photo and gently apply 2-3 pounds of pressure and note if that point is tender or sore. Of the people who have sought out acupuncture treatment, 74.2% of people are found to have this point be passive (4-6 degrees on the DOP scale). The next point is the tertiary level of pain, deep radial III and 27.7% of people that Dr. Dung has tested have been found to have this point passive (7-9 degrees of pain on the DOP scale). Finally the non-specific point is the deep radial IV and 6.8% of the people treated were found to fall into this category (10-12 degrees of pain on the DOP scale).
It is possible to have no report of subjective pain and be measured to have tertiary or non-specific level on the DOP scale. I have a lady in her 80’s I work with who is 10 degrees on the DOP scale, yet reports very little subjective pain. This same lady has done yoga for over forty years, diligently eats a very clean diet, keeps her stress low, participates in meditation daily and has a strong support system. This illustrates the importance of a healthy lifestyle to manage high objective pain. With time, it is possible to reduce her objective pain through anatomical acupuncture.
This is a very simplistic explanation of course and your best method of calculating where you fall on the DOP scale is to be assessed by a professional trained in the method. For more information on how to make an appointment for an assessment, call 956-542-0902.
If you or someone you love suffers from chronic pain, or you are a healthcare professional who works with chronic pain, please leave a comment below and tell us how you think the DOP scale would be beneficial to you.
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