05/27/2026
Pain isn’t actually “mild” if it never stops.
Persistence can turn a small pain into a nightmare. Duration multiplies pain intensity, so chronic pain is usually undersold by rating its intensity alone.
People talk about pain INTENSITY all the time, healthcare professionals ask about it, and studies focus on it. We do our best to quantify it, with mixed results, because the traditional pain scale is a one-dimensional measurement of a multi-dimensional, highly subjective experience — there is no objective pain-meter. There are a lot of reasons why people don’t like to try to put a number on their pain.
But it’s especially odd the way we try to rank pain with barely even a nod to DURATION — which is arguably more important than the intensity at any given moment.
Everyone knows that a toe stub is surprisingly intense, but we also know that the misery is brief. If you had a pain just like that in your noggin, you’d think your head was exploding (an aneurysm). Most headache pain is way less intense than a toe stub, but we also know it’s probably going to last the rest of the day, and most people would prefer the toe stub. Get it over with!
So it’s not that we don’t get this. We talk about it imprecisely and indirectly all the time.
The concept even exists in the science. It’s an old tool in analgesic trial methodology (summed pain intensity difference, or SPID), precisely because trialists realized a snapshot pain score might not capture treatment benefit over time. Used … but only in for certain kinds of trials, and debated even there: “SPID does not appear to add anything” (Tfelt-Hansen et al). Just last year Chukka et al. set out to “validate SPID’s reliability and clinical utility in orthopaedic surgical cohorts” (and they say they did). And then there are some competitors … all barely used. † So the literature acknowledges the problem and researchers have proposed solutions, but pain-over-time is still mostly missing from most pain research, clinical assessment, and patient communication.
So the literature acknowledges the problem and researchers have proposed solutions, but pain-over-time is still mostly missing from most pain research, clinical assessment, and patient communication. It’s ia good example of what I mean about pain medicine being surprisingly primitive and improvisational.
And it’s weird because describing pain well so clearly involves BOTH intensity AND time (among other things, but let’s stay focussed); you truly can’t express the experience of chronic pain when the time thing has been downgraded to a footnote!
For an awful lot of chronic pain patients, being asked mainly about pain INTENSITY is a little awkward — because the reality is that a lot of chronic pain is actually NOT very intense, and it doesn’t sound so “impressive” when the real story is buried in an addendum: BUT IT NEVER LETS UP.
The persistence of pain should never be an “asterisk” on your report. As a pain patient, you should not feel like you need a qualifying “but” after giving your pain a number. If the pain intensity alone doesn’t tell the story — AND IT OFTEN DOESN’T — then emphasize what does: intensity TIMES duration. When talking to professionals, try to explain how “much” pain there is, and LEAD WITH the “area under the curve.”
And if you’re a professional, please make it easy: ASK about the persistence and pattern of the pain, as well as its intensity.
What else contributes to pain-awfulness, but tends to get back-burnered when “rating” and describing pain? What is there OTHER than the intensity?
This post is part of a developing series on pain rating. Previously (see comments for links):
👉🏻 What are the worst kinds of chronic pain?
👉🏻 There will never be a pain-o-meter — and maybe that’s a good thing
~ Paul Ingraham, PainScience.com publisher
† Other pain scoring systems that try to incorporate duration: (1) In 2014, Salamon et al developed a score to "capture pain intensity along with frequency and duration" — the descriptively named pain frequency-severity-duration scale (PFSD). (2) In 2016, the National Institute on Drug Abuse developed the Pain Frequency, Intensity, and Burden Scale (P-FIBS) scale. (3) In 2020, anaesthesiologists Lang-Illievich et al tackled another method, an "area under the curve" analysis of the graph of pain over time.None of these have seen much (any?) use.
