Function Over Pain

If you've been treated for chronic pain at any point in the last decade, you've probably been asked the same question more times than you can count.

On a scale of one to ten, how would you rate your pain?

It's a useful number. It's how providers track whether someone is getting better. It's how insurance companies decide what to cover. It's how most outcome studies measure success.

It's also, on its own, not enough.

The longer we spend talking to patients with chronic pain, the more we keep coming back to a simpler observation.

What patients want isn't always a lower number. It's the ability to do things again.

What "function" actually means

Function is a clinical term for what the rest of us would call "what you can do."

Can you stand long enough to cook dinner? Can you sleep through the night? Can you pick up your kid without bracing? Can you walk for thirty minutes without paying for it later? Can you sit at your desk through a full workday?

Pain might be the symptom you feel. But function is the thing the pain takes from you. And function is what you actually want back.

The published research on chronic pain increasingly tracks this. Validated tools like PROMIS-29, the Oswestry Disability Index, and the Neck Disability Index focus on function specifically. They ask questions like: how much does your back interfere with normal work? How much does your pain affect sleep? Can you walk a quarter mile? These are the questions that map onto what daily life actually looks like.

Why function and pain don't always move together

One of the patterns we keep noticing is that pain and function don't track perfectly.

Someone can have a low pain score and still struggle to function — because they've been afraid to move, because they've stopped trying, because the pain rebounds whenever they do.

Someone can have a higher pain score but better function — because they've learned how to manage it, when to push through, what to avoid, what to pace.

Pain alone, on a single number, misses most of this.

That's part of why outcome studies that look only at pain reduction can miss what's actually changing. A program that reduces pain by 30 percent but doesn't restore function hasn't actually given the patient their life back. A program that holds pain steady while function improves significantly might be doing more for the patient than the pain score suggests.

What we're starting to think is that the goal of treatment shouldn't be a number. It should be a return.

What this looks like in practice

When function becomes the measure that drives the plan, a few things change.

The check-in conversations are different. Instead of "is your pain better," it's "what could you do this week that you couldn't last week."

The plan adjustments are different. If function stalls but pain is okay, the plan still has work to do. If function improves but pain stays the same, the plan is probably working — even if it doesn't look that way on a 0-to-10 scale.

The escalation criteria are different. Pain that doesn't change but function that's collapsing is a flag the system would otherwise miss.

The relationship between you and your care team is different. The conversation moves from "how do you feel" to "what are we getting back."

None of this is novel. Most experienced clinicians already think this way. The published instruments already measure it. The Lancet's 2018 series on low back pain made it explicit. What's missing isn't the science. It's the operational layer that captures function week to week and feeds it into the conversation.

How to think about function on your own

If you're managing chronic pain and your conversations with your team haven't been function-focused, a few things might help.

Pick three things you used to do that you can't do now.

Be specific. Not "I want to feel better" — "I want to walk to the grocery store without sitting down halfway." Not "I want to be active again" — "I want to play with my kids for thirty minutes without bracing for the next day's pain."

Then track those specific things week to week. The good days and the bad ones. Whether they're moving in the right direction. Whether the plan you're on is actually helping you get them back.

That data is what your care team needs. It's also what you need.

What we've been working on

One of the things we keep coming back to while building 76 Health is making function tracking routine.

Not as an annual measurement. Not as a research instrument. As something captured at every check-in, fed back to the clinical team, and used to adjust the plan when the data says to adjust.

We don't think we've solved this. We're early. The first patients we're working with are helping us figure out what the right tracking cadence actually feels like — frequent enough to matter, light enough not to wear them out.

But the principle is consistent.

Pain is the symptom. Function is the goal. The plan should be measured against the goal, not against the symptom.

That's the part we keep working on.

Sources: The Lancet Low Back Pain Series (2018); validated outcome instruments PROMIS-29, Oswestry Disability Index, Neck Disability Index.