Rating Pain- How to Talk to Your Doctor About Pain
I think most people have had the experience of walking out of a doctor’s appointment and thinking “We were totally not speaking the same language.” I hope to help you learn a language to talk about your pain and symptoms with your doctor or other medical provider. I will introduce you to a system of rating pain. I hope to help you learn to describe your symptoms in terms of history of injury, location, quality, intensity, frequency and duration.
Most people suck at describing pain, so don’t think you are alone. As an Occupational Therapist, I have heard thousands of patients try to describe their pain and other symptoms. I’ve frequently heard “It’s really hard to describe.” To which I’ve replied, “I’ve heard a lot of stories. Maybe I can help you out.” I felt it was my obligation to dig the information out of patients. My new evaluation appointments were 45 to 60 minutes. Your doctor has 5 to 10 minutes. He or she is not likely going to do the same digging. It will help if you go to your appointment ready to describe your pain with your new understanding of rating pain.
History and Location of Symptoms
Did you injure yourself? Did the pain gradually start and finally get to the point you knew it was not going to go away on its own? Do you think your pain was caused by a particular activity but you’re not sure? Do you think the pain may be related to an old injury?
I fell off my bike and hurt my shoulder 3 days ago. Now my entire arm hurts and I can’t raise my arm.
I power washed my house 2 weeks ago and my elbow started hurting 3 days later and has been hurting ever since. Sometimes it radiates all the way down to my hand. Occasionally it radiates to my neck.
About 6 month ago, my wrist started hurting after 4 to 6 hours of typing. Now it just hurts all the time. My hand had been getting numb and tingly off and on for a year or more, but that was just annoying. I put up with it until the pain became constant.
My elbow started hurting about 3 months ago. Sometimes it hurts all the way up to my neck. My neck and upper back have given me trouble for years, which I think is related to stress and desk work. I’m not sure if my elbow pain is related to my neck or not.
My wrist hurts a lot lately. The only thing I can figure is I’ve been doing a lot of needle work recently.
Quality of Pain
Do you have tingling, numbness, sharp pain, or dull achy pain?
A good example of sharp pain is wrist, elbow, shoulder or knee/patellar tendinitis. The pain is very sharp, but very quick. It is associated with movement or activity. Because it is so sharp [think gasp, jump or flinch], invariably you stop the movement immediately. Pain does not tend to linger. This kind of pain would tend to make you avoid certain movements. Another example of sharp pain would be with hitting a nerve, like hitting the funny bone on the inside of the elbow.
Achy pain may start gradually and with low intensity and be easy to ignore. The pain may increase in intensity to get your attention, but not prevent you from continuing your regular activities. Pain may continue to progress to throbbing pain.
Some pain may have a burning quality. Some patients report their skin feels sore to the touch. Some patients may describe “a nerve pain”.
Tingling is like pins and needles sensation, ants crawling or tiny shocks. Numbness is no feeling or dead, like Novocain from the dentist. Dull sensation is like a decrease in normal sensation, and usually patients are not aware of this. I use my fingernail to each small finger, ring finger, forearm etc. One side sometimes feels dull compared to the other. Sometimes thumbs and index fingers of both hands may feel dull compared to ring and small fingers, or vice versa.
Intensity of Pain
Intensity of pain or other symptoms is the dreaded 0 to 10 scale. Contrary to what many physicians have told me, patients do not like to complain, and they do not exaggerate their symptoms. I learned early on, patients tend to under-report their pain and symptoms. When a patient tells me that their pain is a 3 of 10 or less, it’s time to start my digging. No one goes to the trouble or the wait to see a doctor for 1, 2 or 3 of 10 pain. Past the age of 40, we all ignore 1, 2 or 3 of 10 pain every day. SO I re-defined pain for my patients, the Crayne scale if you will.
It is relatively easy to tune out 1, 2 or 3 of 10 pain. In fact, you may really have to stop and think to identify it. It may be the slightest awareness, but easy to do your normal daily activities. It rarely becomes a problem at this level. Constant pain at this level is bothersome. If you have a 2 to 3 of 10 pain headache for 2 or 3 days, that becomes wearing to you.
You would be aware of 4 or 5 of 10 pain. You may still be able to do your normal activities.
At 6 or 7 of 10 pain, you could probably do quiet work, such as desk work, but without your usual smile and wit. You may or may not be able to do physical work.
At 8 to 10 of 10 pain, most people would be seeking narcotics.
How often do you have pain? Are you ever pain free? Do you only have pain on work days? Does your pain seem to come for no reason, about once a month? Twice a year? Does your pain interrupt your sleep or keep you from sleeping soundly?
How long does the pain last? If at best, your pain is a tolerable 1, 2 or 3 of 10 pain, that is still pain. Therefore you are never pain free. If you have pain all of the time, you have constant pain.
Do you only have pain after certain activities? Do you hurt for 4 hours or 4 days after using the weed eater? Do you start hurting about mid-workday and continue to have pain for several hours after you get off work?
Maybe you don’t know what causes your pain, but you know that when the pain comes, it takes 3 to 4 days to run its course. Maybe you know that the pain starts a day before stormy weather and subsides about one day after the storm passes.
Your Follow-Up Visits
Many times a patient has told me on follow-up that they are no better. I don’t think the patient is lying, I just think I’m that good, and that it is rare that my treatment plan had absolutely no impact on their symptoms. Sometimes it turns out that because they are not back to normal and could not resume all of their activities, this somehow becomes “I’m not any better.” I don’t expect patients to be cured by the first follow-up visit. After all, most of the time, you didn’t develop your problem overnight. It usually takes time to get better.
To not be any better means that your symptoms occur just as frequently, last just as long and is the same on the 0 to 10 scale. If your pain is still constant, but now at least part of the day it is a 3 or 4 instead of 6 of 10, that’s better.
I hope my tips for rating pain will help you in discussing pain and other symptoms with your doctor. Remember to think about these things before your appointment, and be ready to talk to your provider about your pain in terms of intensity, frequency and duration.