When you’re in pain, it’s often difficult to find just the right words to describe it. But it’s worth the effort. Accurately describing the “quality” of your pain is one of the most important—yet underappreciated—steps in getting the best treatment.
Now: Pain specialists are giving pain sufferers new methods to help them communicate exactly how they are feeling.
What you need to know…
Beyond the 0-to-10 Scale
It’s no surprise that there’s huge variability in how pain is experienced. One person’s low-back pain, for example, might be “dull and bearable,” while another’s might be “sharp and unbearable.” That’s why telling your doctor that you have “low-back pain” is not descriptive. Rather, you must be specific when describing your pain.
While the location of pain is a useful starting point, indicating whether it radiates, what makes it start and stop and describing the quality of the pain are often important clues in determining the source—and planning a way to treat the underlying cause. Seven key elements to describe…
• The intensity of your pain. The most common way to describe pain intensity is with the classic 0-to-10 pain intensity scale—with 0 being no pain…1 to 3, mild…4 to 6, moderate…and 7 to 10, severe (10 being the worst pain possible). Unfortunately, far too many people rely solely on this pain scale. This is where your pain description should start, not end.
Both patients and doctors tend to overuse this tool, overlooking more effective ways to verbally describe pain with stories and words (see below). The 0-to-10 scale has only “modest accuracy,” according to a study published in Journal of General Internal Medicine.
Also, using the 0-to-10 scale leads patients and doctors to both underestimate and overestimate pain. A person with high pain tolerance may say that his/her pain is a “3”—but that pain should be treated. On the other hand, a person who says, My pain is 30 out of 10, isn’t accurately communicating the level of his pain—he is communicating that he urgently wants the pain treated. What’s more, that exaggeration poses a real danger—a well-intentioned clinician might try to help with a pain medication that’s stronger than needed.
Interesting recent finding: Researchers from McGill University and University of Toronto conducted experiments that showed that men—not women, as previously believed—are more stressed by pain and more hypersensitive to repeated pain. This study was published in Current Biology.
• What your pain feels like. Words and stories about pain give your doctor important clues as to the pain’s real cause and optimal treatment. In fact, your doctor should ask you to tell your story about your pain—because you most likely have something you want to say…and you want to get better. Telling your story meets both needs.
Example: I’ve had an aching back for more than a decade that started after a car accident. Last week, I had a sudden sharp pain in my back—and then the back pain went away! But right after that, I started to have stabbing leg pain. This story tells the doctor that it’s likely you have a herniated disk in your spine.
Some of the most descriptive pain words to use in your story include: Burning…sharp…dull…throbbing…sore…stabbing…shooting…aching…cramping…tingling…stinging…gnawing…dragging…unbearable…intermittent…brief…steady…and constant.
Also, tell your doctor if you have nonpain symptoms that accompany your pain, such as nausea, numbness or weakness. Such symptoms often help clarify the cause of your pain.
• The location of your pain. Tell your doctor exactly where the pain occurs…or if it travels from its site of origin to other parts of your body.
Example: Say, I have a pain in my back that moves into my right buttock, right knee and right foot. Or I have a pain on the left side of my neck that goes down into the top of my left arm.
Helpful: Ask your doctor for a “Body Chart” that shows front, back and side views of the body—and make marks on the chart that show exactly where you experience pain.
What not to do: In describing the location of your pain, don’t diagnose yourself by saying, for example, I have sciatic pain or I think I have a hernia. It’s actually dangerous to use words such as “sciatica” that you may have read on the Internet or heard from a health professional—they may be wrong and may lead the doctor to a misdiagnosis.
• The duration of your pain. Tell the doctor whether your pain has been occurring for days, weeks or months at a time. If it’s chronic, does it come and go throughout the day or is it constant? Is it more severe during the week than on the weekend? Has it worsened over time?
• What makes your pain better and what makes it worse. This information is very useful to your doctor in creating a personalized protocol to control and relieve your pain.
Examples: I have pain every time I walk on a hard surface. I have pain when I stand up. I always feel better while sitting. My pain is worse (or better) when I—drink alcohol…eat…have a cup of coffee…go out in cold weather…get a massage…feel tense…go to work…exercise…am fatigued…or don’t sleep well.
Also tell the doctor the environments where your pain occurs—for example, while at work or at home.
• The psychological impact of your pain. This tells your doctor what pain means to you—that is, how much it makes you suffer, which can vary significantly in people who have the same type and degree of pain. With this information, your doctor can determine what additional treatments might be beneficial for you, such as psychological or medical support for depression and anxiety (both of which are common in people with chronic pain).
• The medications you’re taking. Tell the doctor each medication you’re taking for pain—the dose, how long you’ve been taking it and the extent to which each medication helps with the pain. You should also talk about any pain medication you’ve tried and discontinued…and why you stopped it—either because it didn’t help or because of side effects. Also: Be sure to mention any other medication you’re taking, which could interact with pain medication.
Keeping a Pain Diary
Keeping a pain diary for at least a week before your doctor appointment is another important way to clearly communicate the details of your pain to your doctor. You should note the following factors…
When the pain occurs…where it hurts…what it felt like…what you were doing when the pain hit…how severe the pain was on a 0-to-10 scale…what you did to try to reduce the pain…and the result of what you did.
A common mistake: Logging too many entries. It’s important to keep your diary focused. If you describe every incident of pain, hour by hour, day after day, your doctor will have a hard time making sense of your diary.
Better: Set a specific interval for making diary entries about your pain—a few times a day (Example: morning, afternoon and evening) or once a day.
Important: If you have pain, it’s always best to start with your primary care doctor. If necessary, he will refer you to a pain specialist.
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