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Signs, symptoms, and laboratory findings are used to evaluate disability. Signs and symptoms are objective, e.g., X-Rays, BP readings, and blood chemistry. Symptoms are subjective, i,e., the impaired person's medical complaints. One of these is pain.
Even today, many medical sources ask us to describe their pain on the basis of 1 through 10. Not exactly scientific.
Individuals experience pain differently. You may have e.g., two individuals of the same age with very similar objective medical findings, and each will describe the severity of their pain experiences much differently from the other . Psychological evaluation reveals that the indivdual who describes agonizing pain is not exaggerating for secondary gain. He genuinely feels the pain.
So until technology comes up with an accurate way(s) to gauge pain, evaluators are limited to using these "tools"
(i) Your daily activities;
(ii) The location, duration, frequency, and intensity of your pain or other symptoms;
(iii) Precipitating and aggravating factors;
(iv) The type, dosage, effectiveness, and side effects of any medication you take or have taken to alleviate your pain or other symptoms;
(v) Treatment, other than medication, you receive or have received for relief of your pain or other symptoms;
(vi) Any measures you use or have used to relieve your pain or other symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and
(vii) Other factors concerning your functional limitations and restrictions due to pain or other symptoms.
Another thing I would add is the physician or practitioner using his/her experience based on treating other individuals with the same condition or diagnosis.
If, for example, a surgeon has done hundreds of cases to correct X, and a patient comes to their post op appointment describing their pain as "8", when that physician's past experience over the years has been that most people at the same point describe it at an average of only 2 or 3, then that might raise red flags. Either there could be a potential complication or environmental factor that needs to be considered, or conversely, the patient is being disingenuous.
Measured objectively? Everyone has their pain issues, as do they have their tolerance for pain and just what they want to do to TRY to live with less pain. I deal with chronic bodywide OA pain and it's advanced in the last year since my knee disaster but I refuse to take anything stronger than I do for pain. So for me the supps I take for some pain relief help me and I know many do not follow what I do.
I had one day of great relief with two meds some yrs back: 1 day of LDN and never again and 1 day of Dilantin and never again. So I do not try to work with the drugs anymore.
Another thing I would add is the physician or practitioner using his/her experience based on treating other individuals with the same condition or diagnosis.
If, for example, a surgeon has done hundreds of cases to correct X, and a patient comes to their post op appointment describing their pain as "8", when that physician's past experience over the years has been that most people at the same point describe it at an average of only 2 or 3, then that might raise red flags. Either there could be a potential complication or environmental factor that needs to be considered, or conversely, the patient is being disingenuous.
Pain is such a subjective variable, one person's "8" description might be another person's 2 or 3, depending on the pain tolerance ofnthe individual, and each one's own perception of that pain. Not sure how pain could ever be measured subjectively, but it would be a medical breakthrough if it could.
I think the number scale for pain was an attempt to at least sort of quantify pain( at least its reporting) by individuals, but as I can see it that's useful mostly to compare pain at different times for a given individual, although they use it as a measure of pain overall for different patients.
Those number scales for pain actually do come with descriptions of what each of the numbers actually mean, for various conditions, as providers attempt to use such scales to assess their patient's pain.
Another thing I would add is the physician or practitioner using his/her experience based on treating other individuals with the same condition or diagnosis.
If, for example, a surgeon has done hundreds of cases to correct X, and a patient comes to their post op appointment describing their pain as "8", when that physician's past experience over the years has been that most people at the same point describe it at an average of only 2 or 3, then that might raise red flags. Either there could be a potential complication or environmental factor that needs to be considered, or conversely, the patient is being disingenuous.
Treating physician's opinion is also considered in the evaluation process. There's a body of regulations on TPO's to accompany the pain regs. as outlined in the OP.
Pain is such a subjective variable, one person's "8" description might be another person's 2 or 3, depending on the pain tolerance ofnthe individual, and each one's own perception of that pain. Not sure how pain could ever be measured subjectively, but it would be a medical breakthrough if it could.
Yes, and exactly why using pain and pain control as a measure of performance for the physician and hospital is fraught with problems, and why it's contributed, in part, to the opioid crisis we have now. JCAHO and then others advocating the well intentioned, but unrealistic, goal of eliminating pain led to inclusion of pain control on patient satisfaction surveys, reimbursement rates being partially based on these standards etc. Tell physicians they aren't controlling pain well and need to do more or else, so the prescriptions ensued, and now the pendulum has swung the other way and they are being criticized for prescribing too much.
And yes, like you, I can see how using the scale can be useful in assessing one individual's improvement, or lack thereof, over time.
I would like to see more emphasis on understanding how pain impacts objective measures like heart rate and blood pressure. Some self reports are clearly bogus - my sister will tell her doctor she's at an "8" when a few minutes prior we were laughing and joking together. As soon as she's in their office she will start acting and talking differently. When I'm in pain I often breathe differently and I'm pretty sure my heart rate goes up, for example. At least compared to your own baseline, it could prove useful.
Doctors need to ask for specific descriptions of the pain to help sort out malingers. If the condition the patient supposedly has almost always presents as an aching, ebbing and flowing pain and the patient says it is an excruciating stabbing pain that could mean something.
Pain is such a subjective variable, one person's "8" description might be another person's 2 or 3, depending on the pain tolerance ofnthe individual, and each one's own perception of that pain. Not sure how pain could ever be measured subjectively, but it would be a medical breakthrough if it could.
I think the number scale for pain was an attempt to at least sort of quantify pain( at least its reporting) by individuals, but as I can see it that's useful mostly to compare pain at different times for a given individual, although they use it as a measure of pain overall for different patients.
Those number scales for pain actually do come with descriptions of what each of the numbers actually mean, for various conditions, as providers attempt to use such scales to assess their patient's pain.
I found the "amputation of digit" interesting. I 95% cut off my right index finger on a machine with a faulty guard that pulled my glove in. Funny thing about it is that it really didn't hurt any worse than a bad cut would, but it hurt something terrible after they re-attached it. That finger throbbed miserably for a month and a half and I couldn't take anything for it because I was pregnant at the time. LOL talk about wonderful timing It is fully functional but hurts when it gets cold to this day and that was back in 1999 when I nearly cut it off.
I do also think that pain is going to always be a subjective experience because of individual tolerance and even individual physiological differences between people. It might also even depend on other types of pain they have experienced before as to whether what they are experiencing is something they describe as "pain" or simply "discomfort".
A standardized scale would be ideal if there is a way to do it.
I'd imagine that they'll have diagnostic methods in the future that will allow them to correlate brain activity to pain severity. They'll take some sort of MRI, run a few algorithms, and give an objective indication of the pain level. It is quite possible that part of pain level may be someone's ability to deal with pain, so something that may even objectively be the same sensation may cause significantly more discomfort in the individual that is unable to cope with or is unused to that level of pain.
Hopefully in the future they'll also have ways of reducing or eliminating pain without strong drugs (or maybe without drugs at all). That may be in the much more distant future, though.
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It is fully functional but hurts when it gets cold to this day and that was back in 1999 when I nearly cut it off. 
