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Describing your Pain

davedave Posts: 860
edited 06/11/2012 - 7:46 AM in Chronic Pain
Describing your pain to your doctor seems to be a surprisingly difficult task. Each of us experiences our pain differently, making it highly subjective—and that makes it a challenge for a doctor to evaluate.

Many doctors use a 0-to-10 pain scale. A 0 rating means you have no pain, 10 is worst pain that you can imagine, I-can't-stand-it agony. This can be a good starting point. But it has its limitations. One person's 8 can be another person's 4.

We have a lot of words for pain and you should use all of them. Note the type of pain (burning, dull, sharp?) and the triggers (environment, activity). It's a lot to remember, and a pain diary is one solution.

The American Pain Foundation provides a very useful method in communicating the pain that you feel called the LOCATES scale.

Location of the pain and whether it travels to other body parts.
Other associated symptoms such as nausea, numbness, or weakness.
Character of the pain, whether it's throbbing, sharp, dull, or burning.
Aggravating and alleviating factors. What makes the pain better or worse?
Timing of the pain, how long it lasts, is it constant or intermittent?
Environment where the pain occurs, for example, while working or at home.
Severity of the pain. Use a 0-to-10 pain scale from no pain to worst ever.

It's important to accurately describe your pain to your doctor. Minimizing or exaggerating it will not get you the help that you need and the bottom line is to be taken seriously.

Dave
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1

Comments

  • That scale bothers me because as you said, it is such a subjective thing.

    How I answer is exactly like this: "Well, from what I have read, a 10 is supposed to be a gunshot wound. Well, I have never been shot before and can only tell you it is the worst and most dibilitating pain I have ever been in. Where does that fit on your 0-10 scale?"

    At this point their eyes usually just glaze over and we move on.

    It is such a ridiculous question to ask.
  • I always have trouble describing my pain. I know that 0 is no pain and 9-10 is where you aren't capable of functioning on any level and must be hospitalized.

    But aside from that, I always have trouble with "does your pain radiate" or "what side is it on". It's almost as if my pain is not so specific that I can pinpoint exactly what is happening.

    After my last cervical MRI and CT scan, my surgeon's PA called and we talked about my neck pain. I could only tell him that my neck hurt and he asked if it was more on the right side than the left. Well, I don't really know. If my pain were like a paper cut, I could tell you exactly how it feels, but when it's radiating from within, it seems impossible for me to be specific.

    Maybe this is just me. Maybe most or all of you can pinpoint your pain down to exactly how it hurts, where it hurts, at what level it hurts, etc. I can only say how much it hurts, what triggers it, and generally where it is. I simply can't specify it to the degree that doctors want. But I guess I'll keep trying.

    Maybe this comes from someone who doesn't concentrate on their pain, I just let it come and go and live with it so I don't try hard enough to find the exact particulars of my pain.

    Dave, your LOCATES scale is a good one and I can answer most of those questions, so I'm glad to read that.

    Cath
  • I beg to differ that the exercise in describing your pain is a ridiculous question to ask. Rating your pain without any additional information is an incomplete question at best. Most likely your doctor will ask questions to determine what you feel and how it correlates to any diagnostic results they have. How you carry yourself in their presence is also a big indicator of how you feel.

    Answering the way you are saying comes across as confrontational. When you see your doctor, are you there to argue or figure things out?

    Dave
  • Hey Dave, forgive my arrogance on this. My Dr and I have a very rare relationship. I have no issue describing my pain, where it is located, I walk so he can see the crooked limp.

    I do describe it to the best of my ability. I think the 0-10 scale is ridiculous only. The reason is because to me, it is the worst pain I have ever been in. Therefore, to me, it is 10. How can I imagine the "worst pain imaginable" when what I experience is the worst pain imagineable because it is the worst pain I have ever felt? Does that make sense?



  • dilaurodilauro ConnecticutPosts: 10,059
    I have for a long time here talked about the current pain scales used by most Hospital and Doctors. As Dave described, pain can be very subjective.

    The current scale also can cause potential other problems. Many people think that IF they put their pain scale rating high, that the will get additional pain medications and treatments. Trouble with that is, that most doctors can see right through that.

    On the other hand, we have members who underplay their pain levels. When asked, they say 1 or 2, but yet the clinical observation of them clearly indicates that they are in a much higher pain level.

    No system is fool proof, the biggest factor is knowing that the patient is telling the truth about their pain. I was in physical therapy this morning, and their was one patient who told the therapist that their pain level was 20 and more!
    When I left therapy, I saw this same patient, walk easily out to his Jeep and easily jumped into the front seat to take off.

    We had a member about a year ago, that stated every day she was in 10++ pain. However, she continued to stay logged on to Spine-Health for 10 or more hours making many post.

    Many times, I have put up my own pain scale:

    Ok, I am feeling ok, not too much bothering me

    I am beginning to feel not that great. I wish this pain would go away

    Whoooaaa, this pain is killing me! I cant sleep, I cant eat, I can do .....

    When I see my physiatrist, she asks me how my pain is. We always talk about it in terms of how it impacts my day to day routines and never in terms of a number
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I know that my doctor uses the 0-10 scale in conjunction with other diagnostic tools to assess my pain. One reason for this is for comparison with prior visits and to see if there is an established pattern.

    My doctor makes his patients fill out two full body charts, one that we color with markers to depict areas of pain. Each color means a different feeling; stabbing, burning, aching, etc. The second chart is done in ink and little circles, slashes, arrows, etc are used for the same purpose as the colors. I think this also is done for comparison and also it gives people 2 options to describe their pain and location. Some people aren't so good at reading or drawing, so the coloring can be more beneficial for those patients.

    Any doctor who would only use the 0-10 scale in treating and assessing a patients pain is doing a disservice to that patient. It is only on tool in group of many. That, along with physical assessment and diagnostic testing should be what any doctor would do to figure out, then be of help to the patient. It would be just the same as treating a patient ONLY according to radiological findings.
  • We've had many discussions here about the issue that back pain being described as a "10" being a warning sign to pain management doctors of drug seeking. However, as Ashtona said, for many people it is the worst pain they have ever experienced, and that is how they explain the pain scale (although I think it is "the worst pain you can imagine," not "the worst pain you've ever felt.")

    On the other hand, my pain was due to an accident, which came with a lot of pain. The pain afterward was really not on the same level as the pain I experienced in the hospital, so I kept saying "5" and not getting treatment, even though the pain was severe enough to interfere with my daily living.

    Anyway, glad to have my current PM doctor who sees when I'm not myself and admonishes me to use my mediations when I need them. Hi upped my MS-Contin yesterday in hopes of getting me more active again after this awful year.

    So the 1-10 scale really depends on what you've experienced. My 10 is being strapped to a backboard for 2 hours in an emergency room with 6 broken bones and no pain meds. Some people's 10 is a sprained ankle.

    (FWIW, in the hospital I told them it was a 9. I can always imagine something worse. LOL!)
  • Exactly! I have never experienced that pain, the car accident, so your imaginable pain is much higher than mine.

    I have felt my lower spine feel like it is vibrating and grinding together... Blinding pain. To me, that is a 10.

    But that is the trap. The question is worded in such a way that legit patients get confused and kicked to the curb.

    My Dr, even though we are not seeing eye to eye lately, is very accustomed to seeing me in pain. The second he sees me, he grabs my arm and helps me sit.

    He upped my dose of MS-Contin when all I asked for was a lower dose of something different.

    In the end, we can blame the drug seekers for all of this because without them, we wouldn't be having this dicussion. :)
  • Is one of the assessment tools an ER Nurse uses to assess pain also at triage to gather data for the Dr. It is more descriptive and includes a scale from 0-10 which is also used. When I go to the PM Dr. I have to fill out the same assessment paper so the Dr. can assess if the injections have helped me in the past weeks.

    When I awake in the morning and stand up and go and make coffee my pain is a 5-6 and then take medication and for about two hours then my pain goes down to a 4 where I usually stay throughout the day. Two nights ago my pain went to an 8. I was sweating, couldn't find a comfortable position and got right in the hot bathtub before I went to ER but I didn't go because the pain went down to 5-6 after heat and a break through pain med.

    When I brush my teeth and bend over to rinse the pain shoots up to a 7 and I cry out. One Neurosurgeon I saw says I have all the symptoms of stenosis but the MRI doesn't show it.

    If the pain is an 8 I try every tool I have as Ron(Dilauro) describes in http://www.spine-health.com/forum/spine-health-announcements/blend including heat, ice. Unrelenting pain at an 8 it's hard to think and your goal if continued means you need to get a Drs assistance. Hopefully we can avoid going to the ER unless the pain is an 8 or there's a sudden onset of urinary retention, incontinence or loose stools which may indicate Cauda Equina a medical emergency.

    When I first had my back injury I had to go to the ER and get some pain medications as my Dr. was on vacation and the pain was an 8. The first ER Dr. gave me Toradol and it didn't help so I went to another hospital to get some medications until my Dr. came back. I'm glad my Primary GP Dr. gives my meds as I haven't been back to an ER since then. Anyways, good post in describing your pain.
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • dilaurodilauro ConnecticutPosts: 10,059
    is really something that can't be blamed only on drug seekers. Sure, there are those out there that use the scale to that end.

    One of the big problems I see is that the scale is way too subjective. Any one that has acute pain, can easily say how high up the scale that pain felt (ie having your thumb smashed by a hammer), but chronic pain, its much more difficult.

    Here is where the really effective doctors shine. They dont need to hear any number from their patient, just one look and they can see whats happening.

    And the one final true, never to fail test, is looking into one'e eyes. People may try to underplay or overplay their pain levels, and may do a pretty good job convincing others... But the eyes never lie.

    All it takes is one look into the eyes of a person dealing with chronic pain, and you could pinpoint their current level of pain.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • dilauro said:
    Here is where the really effective doctors shine. They dont need to hear any number from their patient, just one look and they can see whats happening.

    And the one final true, never to fail test, is looking into one'e eyes. People may try to underplay or overplay their pain levels, and may do a pretty good job convincing others... But the eyes never lie.

    All it takes is one look into the eyes of a person dealing with chronic pain, and you could pinpoint their current level of pain.

    Absolutely! I agree with this 100%.
  • Chronic pain that has been around a long time is very strange. Sometimes I forget I'm in pain until it goes away. Sometimes I have to think about it pretty hard to even figure out where it hurts.

    But that doesn't mean it isn't affecting my life. I still don't want to go to the store. I'm still looking for ways to distract myself. It's still a relief when I can relieve the pain.



  • Stacey, I think those picture charts are helpful too, I've had them shown to me. As for the
    number thing - to me - the days immediately following surgery were 10 - just the ultimate
    & I usually feel like I'm at a 4 - but towards
    the end of the day or a car trip across town
    I feel I could truly say it could be as high
    as 8 - but medication, ice / heat & laying
    down can make it better. I have heard people
    at physical therapy say they are at a 10 -
    & I always think, their 10 isn't necessarily
    my 10 - I frequently have said that on a normal
    day I am somewhere between extremely uncomfortable
    and just almost miserable - it is hard to describe!
  • The best pain chart I ever saw was 10+ years ago in an out-patient recovery. They held up a paper with pictures drawn on it. It went from a frown to a smiley face. That was easy to relate to.

    My concern is having the doctor understand that I don't feel as bad because I took my meds. If I take the neurontin and go to the doc first thing in the morning I will feel pretty good. But by lunch time when it wears off and I have driven or done just about anything my neck is hurting. Then I take another dose in the afternoon and it gets better but not as good as that first dose. And by evening I'm taking the percocet because everything hurts.

    So which pain do I tell him about? I guess the whole story but by the time I get half way through they are writing and not listening.

    HB I also forget what it felt like before the meds. Even taking a dose late is just a hint of that feeling and I know it's gotten much worse in the past 4 months. And when the doctor writes in his notes that I'm feeling pretty good what does disability think of that? Do they really understand what that means?

    I'm so tired of all this nonsense. I wish there was a device that they could attach to you to measure your pain.
  • Well, if a 10 is the worst pain imaginable, imagine having your arm ripped off by a piece of machinery or something. I doubt you'd be at physical therapy.

    Actually, if you google pain rating scales (I finally did so after deciding I was just not doing it right) most of them list 10 as "unbearable pain." or "worst possible pain."

    I like the descriptions on this page, but they are not necessarily used by all doctors.

    http://www.tipna.org/info/documents/ComparativePainScale.htm

    But I believe that most doctors consider this description of "10" pretty accurate.

    I use this. I stay at between 4 and 6 with medication.
  • I had the same question as Kris a couple of years ago, regarding the taking medication before an appointment, then questioned and I'm feeling pretty good because of that medicine. My PM told me to give him a number within the last 7 days of my very worst and my very best. That seemed to help. But I still feel the same way when I go into the office if I've taken my medicine beforehand. "I don't look like I'm in terrible pain, what if he doesn't believe me?". I always mention to them if I've taken my meds. I don't think it's necessary, but I still do it.

    Another indication of pain can be an increased blood pressure in someone who normally doesn't have high BP. I have a very normal BP 120/70, but it's gotten to 220/170 when I was in my worse crisis. You can't fake a blood pressure. There are so many ways that a good doctor can weed out the drug seekers from the legitimate chronic pain patients. And just like Ron said-the eyes say it all.

    My PM explained to me at the very begining that a 10 on his pain scale would be a gunshot with my blood and guts scattered on his wall. Pretty graphic, but I always get that visual when I'm given that paperwork to fill out. For me personally, I've only reported a 9 once and that was at the same time as the BP spike. Later, when looking back and going over my MRI report, it was the exact time that a fragment of my disc broke off and was sitting on the S1 nerve root.

    I hope to never see a 9 again! My pain generally hovers around 6/7 and at the very best has never been below a 5-but that's according to my scale and experiences. All of our's are different according to our individual injuries and experiences, it's just up to the doctor's to figure out what to do with us :)
  • My worst time is usually in the morning. I wake up with about a 5-6 level pain and wait until I'm fully awake (about 45 min) before I take my meds. It takes an additional 45 minutes for them to kick in and than I'm at about a 2-3 and take Wally for a walk.

    I think many times taking meds, when you've taken them for so long, is a preventative measure. I've found this to be true one time last week when I forgot to take my meds in the early afternoon. By 5 pm I'm all hunched over and realized I'd forgotten to take my meds. By then it was hard to get it back down to a manageable level.

    Also, if I stand at the sink or kitchen counter too long my pain escalates. Or if I bend over shaving my legs in the shower, stand back up straight takes my pain level up a few notches until it settles back down.

    Then there are the days where I feel pretty decent and, like I said on a previous thread, pulled weeds for two hours. The next day I'm confined to my recliner not only taking my regular meds, but throwing in a percoset because the pain had gotten so bad.

    Then we can talk about us older folks who get the joint pain thrown in, cramps, headaches, whatever. Just adds to the whole mix.

    It's so subjective and arbitrary that it's very difficult to put a find point on pain. But I think it's important to know what triggers it, when you know you'll have the hardest time, etc. At least we can get to know our pain and learn what we need to do to deal with it, with the help of tens units, heating pads, ice, other therapies and our doctors.

    Cath
  • When I see these pain scale discussions, one thing that comes to mind is ... at least there has been something created in an effort to better assess an individuals pain level.

    Doctor How bad do you hurt ma'am?

    Patient Really really really bad doctor.

    Doctor Is that to mean that it's worse that really stinkin bad? Or is really stinkin bad still the worst pain you can experience.
  • The thing I don't understand about the rating scale is why nobody explains it or discusses it. I mean, if anybody had discussed the level of disability I was experiencing due to pain (or read the forms they had me fill out) they might have realized that there was a disconnect between that and the numbers I was telling them, and asked me why.

    I found the process really frustrating at first because I couldn't explain my pain. It was everywhere, and some places it was like a 2 and some places it was like an 8. How was I supposed to explain that? And some days were good and some horrible. If I show up on a good day, but had a bunch of bad days, how does that work?

    Why is this all a big secret?
  • My doctors don't seem to use the standard "pain scale" in so far as asking, "On a scale of one to ten, where are you?" After letting them know 'what' causes pain and such, they watch and ask questions during the exam.

    In '02' I had an abdominal tumor in place of an ovary. It descended and twisted and bled. The pain was so bad I dropped to the floor in the fetal position. Rushed to the hospital, immediately admitted. The nurse asked me "On a scale of 1-10 what are you feeling?" I remember screaming 50, and then passed out. I guess that's a 10? (G) I know it was way worse than when I passed a stone!! Woke up 9 hours later 3.75lbs lighter! lol!!

    The scale descriptions that HappyHBmom put out was spot one! I suspect without their telling me, they are using that sort of 'level' for judging? Based on her scale, I sit between 5/6 and if I don't take my Lyrica and push it...7 or slightly more. As it describes, can't "adapt to it", it caused me to retire because I couldn't function for my job etc. I like that scale better too as it leaves less to interpret, or be as subjective to me. Thanks for posting that HB!!

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I think that's why my doctors 'ask' me what I am feeling, and when I am feeling it, then examine me at times to induce 'said' pain. "No pain to traumatic disaster" is a pretty wide margin to gage in my book! I agree with your sentiments though....

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I still think the best thing is to keep a pain log. Even if you are the only one to review it before an appt it will make you remember how you've been feeling.

    THe question I hate is when the doc walks into the room as says "How've you been" as he writes the date on the paper. This isn't the "official" how are you feeling but the standard greeting. I feel bad saying terrible but if I say OK like I would to anyone else I'm afraid he'll think I'm fine.
  • I really like that comparative pain scale, since it seems most of us have some problem articulating our pain. This scale is a bit more specific. I'm going to my surgeon in 2 weeks for my 9 month postop visit, and am ready to break down and see a PM dr, so hopefully information like this scale will help out during the "how much pain are you experiencing" discussion.

    Thanks again,

    Lisa
  • Here in NYC, they throw those pain scales at you whenever you walk into a clinic/hospital, for whatever reason. I'm not sure how often anybody looks at them. But it's a test, with all the same faults of any test. However, the test makers have done their research on the "reliability" and "validity" of their tests. I guess even when they factor in all the potential problems of the test, it's better than nothing. And it's only the FIRST screening tool. The Dr. always asks "How are you today" so you can elaborate on "10".

    What surprises me is not that people can have different responses, but how they can be very similar. What Charry and Cath wrote about their pain - THAT'S ME TOO!! What Brenda (I think) said about feeling like a 2 in some places and a 7 in others - that's me too. And it does drive me crazy that when I go to the Dr's and I'm all well rested and showered and relaxed - I'm usually a 2 - 4 - BUT YOU DON'T LIVE LIFE THAT WAY, SO THE 2-4 DOES NOT INDICATE THE PAIN YOU EXPERIENCE. I know when I hurt my back (which I do every few months now), if I lie perfectly still my pain is ONLY a 5-6, but when I try to move, I usually end up screaming in pain - like the dentist hit my tooth with the drill - but only when I hit "the sweet spot". That's my 10.

    I know the Drs look at me when I move, and unless they know me, they think - there's not much wrong with her. But I'm like Cath with her weeds. On Wednesday I sorted mail at home(sitting down) for about 4 hours, and by the night I was in agony - even after doubling the Oxy. And Thursday I just felt sick and stayed in bed most of the day.

    Who really looks at those numbers, I know, are the lawyers and the insurance companies - they throw them back in your face - You're OK; You can work.

    Pain, as we well know, is most complicated.
  • My husband is just not good at describing his pain. And, being a man of 66, he was taught that real men make light of pain. So I have seen him tell a doctor or nurse that his pain is a four, when I know it is much more than that. So I either butt in and look like a bossy wife, or bite my tongue and them MY pain is at least a five.

    I'm copying your post and we are going to use it when he sees his surgeon in two and a half weeks.
  • Beaver,

    It's funny, they discussed men vs women and pain reports to doctors on the news last night. Men have lower thresholds than most women. Contrary to the childbirth thing, they're answer was "men fix, and woman nurture, and as such, can't nurture if women hurt, so they push through." Or something to that affect. My hubby fit it like a tea! His level 10 is like the normal persons' 4! (G) I'm the opposite in that when he comes with me to the doctors office, I don't mention stuff, and the hubby chimes in, "Yeah, but she drops into a ball on the floor if she does this or that." "She didn't tell you about this..." My hubby knows I get a bit fussy about him doing this, but it is for my own good! Glad to see you do that when your hubby stays quiet!! *hug*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Pain level is now like the last thing my Dr. asks me. He can tell when I walk into the office. He asks me questions like "have you been riding" and stuff like that.

    But I had one doctor's PA give me a whole lecture on how I didn't want to get all hooked on narcotics. This was the same PA who used to tell me about how she had back problems too, so she knew JUST how I felt. I wanted to smack her. She never got it, she assumed I probably felt just like she did even though she saw my MRI report noting that I had a collapsed vertebrae.

    Oh, that's right, she was even worse off than I was because SHE had to quit riding. Differing priorities couldn't have anything to do with it.

  • The chart, not that it is really a very good chart.
    It just lets me as a typical guy say, "well looking at your chart right there I am a 4". Simple done and over with. It's not like anyone at the bleeping PM I sees office is going to do anything but check my SCS and do programming. They note all the meds that I take as it comes coughing out of their computer as all my doctors work for the same Entity and share files. which is great, leaves nothing to the imagination.
    Even seeing the list of meds I get from my shrink, not once has anyone in the PM's office offered to work with my shrink, even when I asked.
    When the PA saw I was on Lamictal he said a big guy like me should be on 150-175mg a day! At 75mg, my gums pull away from my teeth and dust comes out of my mouth when I talk...yes even using Biotene.
    Oh, yeah, we were talking about pain charts.
    Sorry bout the wramble...At least I feel a bit better :D
    must be a 3 now :?
  • Sorry for the hijack- what is biotene?

    (omg, you're a genius, you've anwered my prayers. Back to your scheduled programming)
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