“It’s really sore,” my (Josh’s) five-year-old daughter said, cradling her broken arm in the emergency department.

“But on a scale of zero to ten, how do you rate your pain?” asked the nurse.

My daughter’s tear-streaked face creased with confusion.

“What does ten mean?”

“Ten is the worst pain you can imagine.” She looked even more puzzled.

As both a parent and a pain scientist, I witnessed firsthand how our seemingly simple, well-intentioned pain rating systems can fall flat.

What are pain scales for?

The most common scale has been around for 50 years. It asks people to rate their pain from zero (no pain) to ten (typically “the worst pain imaginable”).

This focuses on just one aspect of pain – its intensity – to try and rapidly understand the patient’s whole experience.

How much does it hurt? Is it getting worse? Is treatment making it better?

Rating scales can be useful for tracking pain intensity over time. If pain goes from eight to four, that probably means you’re feeling better – even if someone else’s four is different to yours.

Research suggests a two-point (or 30%) reduction in chronic pain severity usually reflects a change that makes a difference in day-to-day life.

But that common upper anchor in rating scales – “worst pain imaginable” – is a problem.

A narrow tool for a complex experience

Consider my daughter’s dilemma. How can anyone imagine the worst possible pain? Does everyone imagine the same thing? Research suggests they don’t. Even kids think very individually about that word “pain”.

People typically – and understandably – anchor their pain ratings to their own life experiences.

This creates dramatic variation. For example, a patient who has never had a serious injury may be more willing to give high ratings than one who has previously had severe burns.

“No pain” can also be problematic. A patient whose pain has receded but who remains uncomfortable may feel stuck: there’s no number on the zero-to-ten scale that can capture their physical experience.

Increasingly, pain scientists recognise a simple number cannot capture the complex, highly individual and multifaceted experience that is pain.

Who we are affects our pain

In reality, pain ratings are influenced by how much pain interferes with a person’s daily activities, how upsetting they find it, their mood, fatigue and how it compares to their usual pain.

Other factors also play a role, including a patient’s age, sex, cultural and language background, literacy and numeracy skills and neurodivergence.

For example, if a clinician and patient speak different languages, there may be extra challenges communicating about pain and care.

Some neurodivergent people may interpret language more literally or process sensory information differently to others. Interpreting what people communicate about pain requires a more individualised approach.

Impossible ratings

Still, we work with the tools available. There is evidence people do use the zero-to-ten pain scale to try and communicate much more than only pain’s “intensity”.

So when a patient says “it’s eleven out of ten”, this “impossible” rating is likely communicating more than severity.

They may be wondering, “Does she believe me? What number will get me help?” A lot of information is crammed into that single number. This patient is most likely saying, “This is serious – please help me.”

In everyday life, we use a range of other communication strategies. We might grimace, groan, move less or differently, use richly descriptive words or metaphors.

Collecting and evaluating this kind of complex and subjective information about pain may not always be feasible, as it is hard to standardise.

As a result, many pain scientists continue to rely heavily on rating scales because they are simple, efficient and have been shown to be reliable and valid in relatively controlled situations.

But clinicians can also use this other, more subjective information to build a fuller picture of the person’s pain.

How can we communicate better about pain?

There are strategies to address language or cultural differences in how people express pain.

Visual scales are one tool. For example, the “Faces Pain Scale-Revised” asks patients to choose a facial expression to communicate their pain. This can be particularly useful for children or people who aren’t comfortable with numeracy and literacy, either at all, or in the language used in the health-care setting.

A vertical “visual analogue scale” asks the person to mark their pain on a vertical line, a bit like imagining “filling up” with pain.

What can we do?

Health professionals

Take time to explain the pain scale consistently, remembering that the way you phrase the anchors matters.

Listen for the story behind the number, because the same number means different things to different people.

Use the rating as a launchpad for a more personalised conversation. Consider cultural and individual differences. Ask for descriptive words. Confirm your interpretation with the patient, to make sure you’re both on the same page.

Patients

To better describe pain, use the number scale, but add context.

Try describing the quality of your pain (burning? throbbing? stabbing?) and compare it to previous experiences.

Explain the impact the pain is having on you – both emotionally and how it affects your daily activities.

Parents

Ask the clinician to use a child-suitable pain scale. There are special tools developed for different ages such as the “Faces Pain Scale-Revised”.

Paediatric health professionals are trained to use age-appropriate vocabulary, because children develop their understanding of numbers and pain differently as they grow.

A starting point

In reality, scales will never be perfect measures of pain. Let’s see them as conversation starters to help people communicate about a deeply personal experience.

That’s what my daughter did — she found her own way to describe her pain: “It feels like when I fell off the monkey bars, but in my arm instead of my knee, and it doesn’t get better when I stay still.”

From there, we moved towards effective pain treatment. Sometimes words work better than numbers.

Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology Sydney; Dale J. Langford, Associate Professor of Pain Management Research in Anesthesiology, Weill Cornell Medical College, Cornell University, and Tory Madden, Associate Professor and Pain Researcher, University of Cape Town

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Allergies happen when your immune system overreacts to a normally harmless substance like dust or pollen. Hay fever, hives and anaphylaxis are all types of allergic reactions.

Many of those affected reach quickly for antihistamines to treat mild to moderate allergies (though adrenaline, not antihistamines, should always be used to treat anaphylaxis).

If you’re using oral antihistamines very often, you might have wondered if it’s OK to keep relying on antihistamines to control symptoms of allergies. The good news is there’s no research evidence to suggest regular, long-term use of modern antihistamines is a problem.

But while they’re good at targeting the early symptoms of a mild to moderate allergic reaction (sneezing, for example), oral antihistamines aren’t as effective as steroid nose sprays for managing hay fever. This is because nasal steroid sprays target the underlying inflammation of hay fever, not just the symptoms.

Here are the top six antihistamines myths – busted.

Myth 1. Oral antihistamines are the best way to control hay fever symptoms

Wrong. In fact, the recommended first line medical treatment for most patients with moderate to severe hay fever is intranasal steroids. This might include steroid nose sprays (ask your doctor or pharmacist if you’d like to know more).

Studies have shown intranasal steroids relieve hay fever symptoms better than antihistamine tablets or syrups.

To be effective, nasal steroids need to be used regularly, and importantly, with the correct technique.

In Australia, you can buy intranasal steroids without a doctor’s script at your pharmacy. They work well to relieve a blocked nose and itchy, watery eyes, as well as improve chronic nasal blockage (however, antihistamine tablets or syrups do not improve chronic nasal blockage).

Some newer nose sprays contain both steroids and antihistamines. These can provide more rapid and comprehensive relief from hay fever symptoms than just oral antihistamines or intranasal steroids alone. But patients need to keep using them regularly for between two and four weeks to yield the maximum effect.

For people with seasonal allergic rhinitis (hayfever), it may be best to start using intranasal steroids a few weeks before the pollen season in your regions hits. Taking an antihistamine tablet as well can help.

Antihistamine eye drops work better than oral antihistamines to relieve acutely itchy eyes (allergic conjunctivitis).

Myth 2. My body will ‘get used to’ antihistamines

Some believe this myth so strongly they may switch antihistamines. But there’s no scientific reason to swap antihistamines if the one you’re using is working for you. Studies show antihistamines continue to work even after six months of sustained use.

Myth 3. Long-term antihistamine use is dangerous

There are two main types of antihistamines – first-generation and second-generation.

First-generation antihistamines, such as chlorphenamine or promethazine, are short-acting. Side effects include drowsiness, dry mouth and blurred vision. You shouldn’t drive or operate machinery if you are taking them, or mix them with alcohol or other medications.

Most doctors no longer recommend first-generation antihistamines. The risks outweigh the benefits.

The newer second-generation antihistamines, such as cetirizine, fexofenadine, or loratadine, have been extensively studied in clinical trials. They are generally non-sedating and have very few side effects. Interactions with other medications appear to be uncommon and they don’t interact badly with alcohol. They are longer acting, so can be taken once a day.

Although rare, some side effects (such as photosensitivity or stomach upset) can happen. At higher doses, cetirizine can make some people feel drowsy. However, research conducted over a period of six months showed taking second-generation antihistamines is safe and effective. Talk to your doctor or pharmacist if you’re concerned.

Myth 4. Antihistamines aren’t safe for children or pregnant people

As long as it’s the second-generation antihistamine, it’s fine. You can buy child versions of second-generation antihistamines as syrups for kids under 12.

Though still used, some studies have shown certain first-generation antihistamines can impair childrens’ ability to learn and retain information.

Studies on second-generation antihistamines for children have found them to be safer and better than the first-generation drugs. They may even improve academic performance (perhaps by allowing kids who would otherwise be distracted by their allergy symptoms to focus). There’s no good evidence they stop working in children, even after long-term use.

For all these reasons, doctors say it’s better for children to use second-generation than first-generation antihistimines.

What about using antihistimines while you’re pregnant? One meta analysis of combined study data including over 200,000 women found no increase in fetal abnormalities.

Many doctors recommend the second-generation antihistamines loratadine or cetirizine for pregnant people. They have not been associated with any adverse pregnancy outcomes. Both can be used during breastfeeding, too.

Myth 5. It is unsafe to use higher than the recommended dose of antihistamines

Higher than standard doses of antihistamines can be safely used over extended periods of time for adults, if required.

But speak to your doctor first. These higher doses are generally recommended for a skin condition called chronic urticaria (a kind of chronic hives).

Myth 6. You can use antihistamines instead of adrenaline for anaphylaxis

No. Adrenaline (delivered via an epipen, for example) is always the first choice. Antihistamines don’t work fast enough, nor address all the problems caused by anaphylaxis.

Antihistamines may be used later on to calm any hives and itching, once the very serious and acute phase of anaphylaxis has been resolved.

In general, oral antihistamines are not the best treatment to control hay fever – you’re better off with steroid nose sprays. That said, second-generation oral antihistamines can be used to treat mild to moderate allergy symptoms safely on a regular basis over the long term.

Janet Davies, Respiratory Allergy Stream Co-chair, National Allergy Centre of Excellence; Professor and Head, Allergy Research Group, Queensland University of Technology; Connie Katelaris, Professor of Immunology and Allergy, Western Sydney University, and Joy Lee, Respiratory Allergy Stream member, National Allergy Centre of Excellence; Associate Professor, School of Public Health and Preventive Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.