UC San Diego researcher studies the gap between patient pain narratives and clinical scores

Tannistha Sarkar, a PhD candidate in sociology at the UC San Diego School of Social Sciences, is investigating the limitations of the standard zero-to-ten pain scale used in medical settings. Her research focuses on how patients experience and communicate physical trauma and how clinicians interpret those accounts. Sarkar argues that the numerical score serves only as an initial point of contact between provider and patient, rather than a complete representation of the injury.

The study begins with the routine practice of asking patients to rate their pain. While vital signs like blood pressure are objective, pain is subjective and cannot be measured directly. Sarkar notes that a single digit often obscures the complex reality of what a person is feeling, the circumstances of the injury, and the impact on their daily life. In her initial fieldwork, she found that patients generally understood the purpose of the scale but did not view their pain as a static figure. They frequently assigned different scores to different stages of recovery, such as immediately after an injury versus later during rehabilitation.

Sarkar’s work extends beyond the numerical value to examine how acute injuries disrupt a person’s sense of self. While much existing research in medical sociology focuses on chronic conditions, she is interested in whether acute pain produces a similar rupture in a person’s identity. An injury can prevent someone from working, caring for family, or participating in activities central to their self-image. For a cyclist, the primary concern may not be the pain itself but the timeline for returning to the sport. For a manual laborer, the fear may be the loss of professional capability.

The researcher also explores how social and cultural backgrounds influence pain reporting. Two patients with similar injuries may report different levels of pain based on their medical history and previous experiences. Sarkar observes that people interpret new injuries by comparing them to past events. This context is often lost in the brief clinical encounter where a short-form pain narrative is required. In her interviews, she distinguishes between this focused medical account and the long-form narrative that emerges in extended conversations, allowing her to see what patients emphasize and what they omit.

Recent findings indicate a growing skepticism among healthcare workers regarding the accuracy of pain scales. Sarkar encountered this suspicion among the staff she interacted with during her project. She is currently examining the specific role the scale plays within the clinic and how it fits into the broader medical encounter. Her goal is to identify the invisible forces that shape how pain is understood and treated.

The research also addresses the behavioral changes that follow an injury. While some individuals, such as older adults who have fallen, become cautious and avoid the activity that caused the harm, others return to it. Athletes and dancers often continue their pursuits despite repeated injuries because the activity is integral to their identity. For these individuals, the injury is a temporary setback rather than a permanent change in routine.

Sarkar notes that the meaning of an injury varies depending on the context. An injury sustained during a sport may be tied to a specific goal, such as recovering for the next competition. An unexpected injury at work may require the patient to first make sense of the event and determine if ordinary life feels safe again. Hope, according to her findings, takes different forms depending on whether the injury was part of a risk-taking activity or a random occurrence.

Her next steps involve further analysis of how patients orient themselves to a changed body. She is studying how individuals adjust to a life that temporarily does not function as before. Sarkar positions her work as a bridge between the personal experience of pain and the clinical interpretation of that experience.

The research is part of the School of Social Sciences' broader inquiry into health innovation. Sarkar continues to collect data to understand the relationship between medicine and society in the context of acute pain.