Friday, May 31, 2013

Tracking Your Pain: How to Effectively Communicate Your Pain Symptoms

After 8 years of chronic pain, I consider myself something of a pain-connoisseur. I've tasted the nectar of throbbing joints, whiffed the bouquet of stabbing stomach pains, and drank in all manner of aching awfulness. During those years, I've learned that while our pain may be subjective, a good description can help explain your situation to medical professionals and avoid miscommunications. Maintaining a consistent way of describing your pain can be a great way to assess how well a new treatment may be working, or showing any trends in your illness.

So how do you explain your pain symptoms to your doctor? One of the best ways is through the use of a pain journal where you enter information about your pain at some general times every day (ie morning-afternoon-evening) Here are some basic things to keep track of in your pain journal to help explain your pain to a medical professional.

1. When noting pain's intensity, start on the same playing field, and start on a good one. Pain is one of the most subjective experiences in the world. To try and quantify pain in a more objective way, medical professionals usually use a standard "pain chart." My doctor's office has the standard Wong-Baker smiley-face 10-point chart for pain.  
A quick look shows you that it makes absolutely no sense. If it hurts a little, why is he smiling? Does #4 look pained, or puzzled? And certainly, my face doesn't always read like a little smushed up ball even when the pain is "hurts a whole lot" intense. If my doctor and I are even playing on the same playing-field with this chart... the playing field stinks. I find the more objective Mankoski Pain Scale has a more accurate description of what my "pain level" actually feels like. I keep a copy on the back of my pain-journal, and make sure I print one off for each doctor to keep as well.
0 - Pain Free
1 - Very minor annoyance - occasional minor twinges.
2 - Minor Annoyance - occasional strong twinges.
3 - Annoying enough to be distracting
4 - Can be ignored if you are really involved in your work, but still distracting
5 - Can't be ignored for more than 30 minutes.
6 - Can't be ignored for any length of time, but you can still go to work and participate in social activities.
7 - Makes it difficult to concentrate, interferes with sleep. You can still function with effort.
8 - Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain.
9 - Unable to speak. Crying out or moaning uncontrollably - near delirium.
10 - Unconscious. Pain makes you pass out. 
© Andrea Mankoski 
 2. Notice the qualities of your pain, and describe them consistently. Pains have unique characteristics which make them distinct from each-other. For example, the stabbing pain of a headache is different from the shooting burn of nerve pain. Knowing words that help describe the quality of your pain can help doctors decide what might be causing it. Here's a good "glossary" to memorize. When you're experiencing pain, go to your glossary and try to describe what you're feeling: aching, cramping, pounding, sharp, throbbing, stabbing, shooting, creeping, dull, electric, burning, freezing, spasming, radiating, penetrating, crawling, sore, tight.

3. Record the location of your pain (and use tech to help!) Knowing where the pain is is tantamount to diagnosis on your doctor's part. One way to really show doctors what's hurting is to take a photo of yourself (or find a photo of a basic anatomical illustration) and shade in the parts that are causing pain. Shade in areas of intense pain more darkly. If the pain is radiating, use arrows to show which way it travels. Note whether the pain is superficial (near the skin) or deep inside.

4. Be cognizant of what makes your pain change. Pains respond differently to the daily wear we put our bodies through. Noticing how the changes in your day effect your pain can help pinpoint it's cause.  Does your pain get better or worse with activity? Does your stress level correlate with your pain? Do certain activities like climbing stairs or reaching overhead aggravate your pain? Do things like showers, stretching, or a full night's sleep makes your pain level decrease? More broadly, notice if there certain weather patterns that correlate with better or worse pain.If your pain lets up at certain points, note the duration of time when you're in pain, and the duration of time you're pain free.

5. Make your pain human by relating it to your life. Pain is such an abstract concept that it's often easier for doctors to think in terms of what's concrete, and the way your pain interferes with your life is a concrete measure. If you're having trouble with tasks of daily living like doing laundry, climbing stairs, or personal grooming, make note of that. If it's interfering with your family life or your work responsibilities, mention how.


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