Self Test: How Much Does Pain Affect Your Quality of Life?

Opioids work very well to reduce certain kinds of pain. However, these medications have serious side effects and risks and it’s important to make sure that the benefits of use outweigh the risks.

And this is doubly so for people in recovery or other people at elevated risk to develop an addiction problem.

There are many factors to consider when evaluating the suitability of opioid therapy; one important variable to think about is how pain affects your ability to function - and by extension, your general quality of life.

In this article you will learn how to:

• Rate your current ability to function on a scale of 0 to 10 (a standardized function rating scale).
• Learn how to evaluate changes to your ability to function over time (such as over the course of chronic opioid therapy).
  

By rating your ability to function and by updating your rating score (from 1 to 10) over time, you’ll gain a better sense of:

1. Whether starting opioid therapy makes sense for you – if you’re at high risk of addiction and your current pain doesn’t greatly compromise your ability to function, then you might decide that the risks of use outweigh the benefits of initiation.
2. Whether continuing with opioid therapy makes sense – if opioids don't cause any significant improvement in your ability to function, you may want to consider another form of pain management.
   

Ability to Function Self Test

The following rating scale was developed by the American Chronic Pain Association. Discuss your score with your prescribing doctor as one factor to consider in any decision on using or continuing to use opioid medications.¹

Select whichever of the following descriptions best matches your activity/energy level.

• 10 – Though you experience pain you are still able to go to work or school or volunteer each day as normal. You can also participate fully in other normal family, daily-life and social activities. 
• 9 – You can still work/volunteer/go to school for a full day as normal and participate fully in family life but your pain causes you to limit social activities a bit.
• 8 – You can work/volunteer/go to school each day but only for a three-quarter day. You still have enough energy for one weekday social outing per week and you’re normally active on weekends.
• 7 – You can work/go to school or volunteer for a few hours a day and can be active for about 5 hours each day. Only easy social activities on weekends.
• 6 – You can still participate in work/school/volunteering – but only on a limited basis. You only take part in occasional limited social activities on weekends.
• 5 – You can’t participate in outside activities (no school/work/volunteering) but you can still manage, with difficulty, your daily household responsibilities.
• 4 – You can manage to help a bit at home but not as much as you used to. No outside work/school or volunteering and only occasional limited outings beyond the home, once or twice a week.
• 3 – You still get dressed in the morning but you don’t leave the home. You can only engage in minimal activities at home and you basically keep in touch socially via phone or online.
• 2 – You get out of bed but don’t get dressed. You stay at home all day.
• 1 – You’re in bed at least half the day and don’t maintain any social contact.
• 0 – You stay in bed all day. You feel hopeless.

The lower your score, the more serious the situation. If you earn a low score then you may want to keep all pain management options on the table.

Should You Stop Taking Opioids?

If you’re on opioids and they help a bit – but not a lot – why not just continue to take them while you also pursue other forms of analgesia? After all, isn’t some pain reduction better than none at all?

Well, whether the opioids help you enough is a personal decision, but beyond the risk of addiction (which is pretty substantial) additional reasons to consider discontinuing opioid therapy include:²

• Opioids may have diminished efficacy over time.
• As tolerance and dosage increases, adverse side effects can worsen.
• There is a risk that opioids can induce hyperalgesia – worsened pain.
• Opioids interact with alcohol and with many different OTC and prescription medications. With interactions there is a substantial risk of fatal overdose, especially as tolerance drives your daily dose up. 

Rating Daily Activity Improvements

Sometimes it’s hard to recognize how much improvement you’re making – and by extension, whether opioids work well enough to justify their risks.

An exercise that can help with this is to take stock, on a regular basis, of how much trouble you’re having with common everyday activities. If you rate activity-difficulty before starting opioid therapy, and then update your activity ratings over time as you continue with it, you’ll have a visual record of your gains and an objective way to decide on future therapies.

Give yourself a numerical score for any of the following activities that you engage in on a regular basis.

• 1 = Pain prevents me from doing this.
• 2 = Pain makes it difficult to do this.
• 3 = It takes extra effort to do this because of pain.
• 4 = It takes a little extra effort to do this because of pain.
• 5 = I have no problem with this.

Here are some example activities that you can use to take stock of pain’s influence on your daily activities. To get the most out of this exercise, think about any everyday activities that give you trouble, and if they're not on the list now, add them on at the bottom. Using this measure, over time, you'll see how significantly opioids improve your functioning.³