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One of the hardest things about chronic pain is that only you know how bad the pain feels. There's no blood test that can show much you're suffering. There's often no outward sign, like a bandage or a cast. There's just the pain.

"Pain is always personal," says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. "It's invisible to other people looking at you -- and that can lead to a lot mistrust and difficulties in relationships."

Whether you have low back pain, or migraines, or nerve pain, people might not understand or believe what you're going through. That suspicion might not only be shared by your in-laws or your boss, but even your doctor -- and that can have serious repercussions, preventing you from getting the pain treatment you need.

To get good control of your chronic pain -- and your life -- it's not enough to tell your doctor it hurts. You need to learn how to talk about pain: how it feels, how it rates on a pain scale, and how the pain affects you.

What Is a Pain Scale?

Everyone feels pain differently. Some people have conditions that should cause great pain, but don’t. Others have no sign of a physical problem, but are in great pain. Your level of chronic pain can’t be assessed in a scientific test or screening.

To help compensate for this problem, many doctors rely on pain scales to get a more concrete sense of a person's pain. You might have seen a pain scale in your doctor's office before. One common type shows a series of numbered cartoon faces moving from 0 (smiling and pain-free) to 10 (weeping in agony.) A doctor would ask a person in pain which face matched up with what they were feeling.

They might seem simple. But pain scales have a lot of good research behind them, says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore. As chronic pain has shifted from being seen as a mere symptom to a serious condition in itself, pain scales have caught on as a tool to evaluate and monitor pain. While they're helpful for anyone in pain, they're crucial for some.

"Pain scales are especially important for people who might have trouble communicating clearly," says Cohen. That could include children and people with cognitive impairments.

Using the Pain Scale

Of course, one inherent problem with using a pain scale is that it's still subjective. A stoic person might describe their pain as a 2 on the pain scale, while another person would describe the same pain as a 6.  

For a doctor to get a good sense of your chronic pain, just pointing to a single face or number isn't enough. Your doctor will need some context, says Seddon R. Savage, MD, incoming president of the American Pain Society and an adjunct associate professor of anesthesiology at Dartmouth Medical School in Hanover, N.H.

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