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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.



  • 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.

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  • 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?

  • 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: 11,347
    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
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  • 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: 11,347
    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
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