Of all the questions patients are asked in the doctor’s office, one of the most difficult is “On a scale of 1 to 10…” and the nurse or clinical assistant points to a series of not-so smiley faces, and you’re expected to rate your pain.  This is problematic.  First of all, and this is for any patient, there is no common point of reference for that particular question.  If a nurse were to ask me, “With childbirth and kidney stone as 10, rate your pain,” I could answer because in my world, those are the two worst pains I have had.  Secondly, for fibromyalgia patients, there are a minimum of two different types of pain.  I always give two answers.  “Acute” pain (usually occurring with movement, sharp, sudden, and short in duration) can range from 5 to 9.  But sitting still and answering questions, it would possibly be zero.  “Chronic” pain (what I refer to as white noise pain, a constant low-level pain with or without movement) can range from 3 to 6.

More important than levels of pain, however, is the level of relentlessness of the pain.  Acute pain comes and goes, but chronic or white noise pain is relentless.  It is this relentlessness that is most important to me.  It is relentlessness that causes depression and fatigue, not the amount of pain.  Low-level, chronic pain would have a relentlessness score of 9 or 10.  Sharp, quick acute pain would have a relentlessness score of 2 or 3.  When the lower levels of white noise pain are reduced, my energy levels go up, my brain clears, and I can think and function again.  The acute pain is just a distraction.  Chronic pain has a subconscious element – I am not always aware of the low-level pain until it takes a break, and then I am conscious of it by its absence.

My question then is: Would it be helpful, in terms of looking for causes of and possibly treatments for fibromyalgia, to look at these two completely different types of pains separately?  Do they have different triggers or mechanisms?  Would they react to different treatments?