"On a scale of 1 to 10..."
The problem of determining pain treatment is complicated by how subjective people's self-reports are.
People respond differently to the pain-scale question. Young people, even ones with extensive injuries, almost never say "10." They're much more likely to say the pain is a 7 or 8. I think they take the pain scale very literally, and they figure something always could be a little more painful than what they're experiencing that moment.
Adults are different. They're aware of the subjectivity of pain. Many approach the pain scale as a means of communicating their experience, rather than assigning a literal value to what they're feeling. That's why a surprising number of adults answer my question with the number 12.
I'm going to admit something unflattering here. At first, when people said their pain was a 12 out of 10, it annoyed me. I hid my reaction, but I couldn't understand why people, when given a specific measurement scale, were trying to circumvent it. Why not just say 10?
[Aside: I don't think anyone has ever said their pain was an 11. I don't know if that's because they don't want to sound like Nigel in Spinal Tap, whose amps go to 11, or if there's some other reason.]
Then I really started thinking about why people were saying their pain was a 12 out of 10.
I began taking note of who was most likely to say 12. I don't claim this to be anything other than a series of anecdotal observations, but I noticed some patterns. Often it was someone with other medical problems (and experience with the medical system), whose pain was not associated with visible injuries. In other words, there was often little means of independently verifying that the patient was experiencing what they reported.
The explanation for 12 out of 10 pain is a little depressing. I think it's the patient's way of saying "I'm really in pain here," because their pain reports haven't been taken seriously in the past. The medical system has effectively taught them, through operant conditioning, that they have to push hard to get care. They were ignored or treated inadequately when they said their pain was a 5, or a 10. Maybe 12 will work. I suspect it does not; it may actually have the opposite effect.
Why were they ignored? My sense is we haven't yet mastered when and how to treat pain, especially in the absence of verifiable clinical signs. Emergency Rooms don't just administer the maximum dose of narcotics to everyone who says they're hurting; that would be unsafe, not to mention economically unsustainable. So we ask people to tell us how much they hurt, but don't always take them at their word. If we're going to ignore their response, why ask them at all?
I keep asking the question, of course. And when people say their pain is a 12 out of 10, I see it as an unfortunate response to our own uncertainty about how to fix a problem that's entirely subjective, all in our head... and totally real.