How Much Is Your Pain Worth?

By Crystal Lindell

How much pain would you be willing to endure if someone paid you?

That’s the question an international team of researchers posed in an unusual new study looking for an alternative to the 1-10 pain scale.

In a series of experiments, they offered 330 healthy volunteers in Switzerland money to undergo mild electric shocks, heat pain or no pain at all. Someone opting for a painful stimulus was paid about $20, while those who opted for having no pain received only $10.

The idea behind putting a price on pain was to see if the responses would be a better way to measure pain than the subjective and much criticized pain scale, which has been used for decades to have patients self-evaluate their pain levels.

“We’ve all been asked to rate our pain from one to ten—but one person’s three might be another’s five, and those numbers can shift with experience. Our research proposes a better way: turning pain into money — not to commodify suffering, but to create a scale we can all share,” explained lead author Carlos Alós-Ferrer, PhD, a Professor of Economics at Lancaster University Management School in the UK. 

The study findings, published in the journal Social Science & Medicine, suggest that people’s willingness to accept money in exchange for pain is a more reliable way to measure discomfort than self-reported methods.

Researchers say their economic incentives “greatly outperformed” traditional pain scales. It helped them distinguish more clearly between different levels of pain; detect the effects of pain relief more consistently; and allowed for more meaningful comparisons between people.

Interestingly, no participant chose to avoid pain completely. Everyone had a price for pain if it was high enough.  

Different people put different prices on the same pain, but they had an easier time rating their pain than they did when using the 1-10 pain scale.

“As a result, measurements are more precise and the shift from low to high levels of pain is clearly reflected in the monetary scale,” Alós-Ferrer said. “This makes it useful for clinical trials to study the effectiveness of painkillers and treatments, because participants are randomly assigned to different groups.”

I believe if a money-incentivized pain scale is used only for research studies, it might be useful. Afterall, there is definitely a need for more accurate pain measurements in research, as well as treatment.

However, my concern is that it could be misused in a clinical setting, just like the pain scale is. Researchers said “inaccurate pain measurements can lead to inadequate pain management,” and pointed to emergency medical situations and quality of life issues for people with chronic pain.

However, in most cases, the reason pain is not adequately treated has nothing to do with the pain scale. It’s because doctors tend to dismiss people’s pain and then withhold one of the most effective treatments: opioids.

I’ve written before about why I don’t like the 1-10 pain scale, which doctors tend to ignore even if you say your pain is a 10. But I don’t think replacing it with a question about how much money you’d need to endure more pain is the answer.

Rather, the best solution I’ve seen from a patient perspective — at least when it comes to chronic pain — is a scale that asks how pain is impacting daily life activities, known as the Quality of Life Scale, (QOLS).

It's a reverse of the traditional pain scale, in that 0 is the worst pain, while 10 means you're doing pretty well.

It features descriptions like:

0: Stay in bed all day. Feel hopeless and helpless about life.

1: Stay in bed at least half the day. Have no contact with the outside world.

All the way up to:

10: Go to work/volunteer each day. Normal daily activities each day. Have a social life outside of work. Take an active part in family life.

While QOLS probably isn’t ideal for studies on acute pain, it is a great way to communicate pain levels between patient and doctor. In fact, I’d say it’s significantly better than trying to assign a monetary value to pain.

Because as anyone with severe chronic pain will tell you, there’s not enough money in the world to make me want to endure my pain even one second longer than I need to.