Paging Dr. Mankoski

For the discriminating chronic pain patient, you have options when it comes to ranking your agony.

Not for you, the bland, blase pain scale.

Oh, no. You can opt for dramatic descriptions*, complete with your drug of choice for your (implied) relief.

Your doctor won’t use the information for anything—save to make note of addiction to various narcotics. But it’s fun to use vocabulary words in place of standard numbers and cartoon images. (Variety is the spice of life. Or so the inspirational posters of the world would have you believe)

0. Pain-Free

What genius conceived of a pain scale with a 0? What individual with a pain condition has ever experienced a day without twinges, twitches, or twangs throughout SOME part of their body?

Oh, there are a few blissful moments upon waking when the nerves remain in their hibernation state. You ENTERTAIN the possibility of going forth as a normal, functional individual. But then reality sets in.

You are a broken, corrupted (not in a good way), malfunctioning human being. And your body hates you.

1. Very Minor Annoyance (No Meds)

The days at 1 are the most dangerous. They lead you to believe you can conquer lengthy To-Do Lists, family vacations, and nights out with friends.

A decided lack of muscle tightness and joint stiffness tricks the brain into behaving like a rational individual. (Woe betide the idiot who follows through on such nonsense) It’s a trap laid by Flares, lurking in the wings to catapult you further down the scale the moment you stretch, exercise, and laugh.

No amount of water, sunshine, or yoga can save you from the endeavors of a 1 day.

2. Minor Annoyance (No Meds)

Your 2 is the irritating scratch that refuses to go away—regardless of how much Benadryl ointment you smear on. (It doesn’t count as medication; it’s the equivalent of a placebo) It’s the prickling, burning, and crawling sensation under the top five layers of your skin you can’t quite reach.

But it doesn’t STAY throughout the day. (That’s where the “annoyance” comes in) It comes and goes as you carry on with the irritating tasks you’re so determined to set for yourself. And always at the most inopportune moments. A spark through the arch of the foot as you attempt to stop at a red light; a caterpillar crawl up the spine in the middle of an important meeting.

You’d happily down a concoction to battle these attacks—assuming one existed.

3. Distracting Annoyance (Ibuprofen Level)

Welcome to your first trip to the medicine cabinet! The 3 represents your break in tolerance, where the aches, gripes, and pains finally annoy you enough to drive you to seek relief.

You still feel a measure of dignity as you dump pills into your palm—the colored jewels of your sanity. Everything on a day 3 is manageable from across the counter, sans doctor. You even feel confident enough not to abuse your stomach by double-fisting a pile of ibuprofen.

That will come later.

4. Working Annoyance (Redosing Ibuprofen)

The mark of any chronic pain patient is tolerance. How long—hours, minutes, seconds—can you ignore the monster gnawing on your bones before you have to resort to analgesia?

If you focus your brain on concentration, will it give up processing the signals from the spinal cord? That’s the constant debate in the recesses of your thoughts as you shake fingers and toes. And it works—to some small extent.

But only for a few hours at a time.

5. Intruding Pain (Constant Ibuprofen)

Your 5 is the pivot point on the scale. You find yourself standing in front of rows of pill bottles, wavering, bargaining, and arguing with rational thought.

You’re past the point of distraction; “pain demands to be felt.” The window on action will dwindle the longer you debate the merits of ibuprofen versus acetaminophen (or both; why choose one when two is always better?). Of course, you’re “smart” enough to continue thinking.

As if you and your brain aren’t trapped in the same dysfunctional body.

6. Constant Pain (Hydrocodone Level)

You are a complete idiot. Despite the constant input of grinding, twisting, and tearing from your limbs, you venture out into the world to reassure your friends and family that you are a functional human being.

This is where you move beyond colored capsules (liqui-gels are always your friend) to the stark white tablets of opioids. No oblivion for YOU, though. You’re lucky if the distilled essence of the poppy can even manage to keep up with your destructive tendencies.

If you had half the sense you attempted to demonstrate, you’d curl up with a heating pad in bed and STAY there.

7. Barely Functional Pain (Morphine Level)

The 7 day is a challenge for the chronic pain patient. It saps the ability to sleep, destroys concentration, and interrupts the flow of everyday activities.

But does it give you pause? Does it convince you to take stock of your surroundings and reconsider the insanity on your schedule for even a moment? Will it prevent you from tipping back a smooth white pill so you can venture into the world?

Not you. You are a fucking rock star. (And equally stupid)

8. Nausea-Accompanying Pain (Redosing Morphine)

Well, genius, now what do you plan to do? Your brain has achieved a crippling level of blinding, nauseating, and dizzying pain.

Concentration goes out the window. If you can string a complete sentence together of more than three words, it’s an accomplishment. And walking? Well, let’s hope one of those friends or family members you were so determined to impress with your social calendar hung around to prop you up.

Just remember—there’s a warning on that orange bottle about dosing frequency for a reason. (It probably helps to have a functional nervous system when you read it)

9. Delerium (Hydrocodone Level)

The 9 day is what happens when you go overboard on your 1 day. Your body enacts every bit of delightful, hateful, and evil vengeance for those chores.

If you were smart (let’s remember who we’re talking about), you engaged someone to take care of you. Someone fluent in mumbling, crying, and moaning. A person who can parcel out your precise doses of those thriftily saved pills stashed in the back of the medicine cabinet.

If you weren’t smart, may the odds be in your favor.

10. Unconscious (NOTHING)

There’s an implication that oblivion is preferable to feeling agony. As if the pain doesn’t follow you down into the blank, empty, and STARING pit.

Nerve fibers continue to fire. You simply lack the capability to provide a voice (scream). Consciousness goes in and out; momentary fragments where you have seconds to describe the 12th level of hell. (As if anyone’s likely to believe you)

Good luck figuring out what’s likely to work. You were better off heading things off before this point.

It’s not like you didn’t have plenty of warning signs.

*Based on the Mankoski Pain Scale