TidBit Tuesday: Describing Pain 101
The definition of pain is physical suffering or discomfort caused by illness or injury. Other similar words are suffering, agony, affliction, torture, torment, and discomfort. Pain is subjective and can be different for each person. Different types of injuries (bone, soft tissue, nerve) can be described differently as well. Pain can also be chronic (reoccurring, old) or acute (recent). For a physical therapist, the way you describe your pain may help them in figuring out the root cause of the pain. For example, one may say it is tingling and burning, this may indicate a nerve injury. My goal with this article is to help you learn how to describe pain as well as rate the pain. This is to help you and your medical professional get on the same page of how this pain is affecting you. It is no way to discredit one’s pain, but to help better explain.
Pain can be described in a variety of ways. As mentioned before, it is very personal to each person. Most people do not know how to describe it due to lack of experiences or experiencing it often. A questionnaire used by physical therapists is called the McGill Pain Questionnaire. It allows the patient to self-describe the quality and intensity of the pain to the medical professional. There are different sections which signify different components of pain like sensory, affective, evaluative, and miscellaneous. Examples of sensory words are throbbing, shooting, sharp, stabbing, crushing, pulling, burning, tingling, dull, sore, achy, and tender. Examples of affective words are exhausting, suffocating, terrifying, punishing, grueling, and blinding. Examples of evaluative words are annoying, miserable, unbearable, and intense. Examples of miscellaneous words are radiating, tight, numb, cold, nagging, and penetrating. All of these words can be very helpful when the physical therapist is trying to determine what is causing the pain and how it is affecting your life.
The next step in determining pain is the rating of it. I am sure you have all seen the pain scale depicted in faces at a healthcare facility. Medical professionals must figure out where you fall on the pain scale and how you would best describe what it is you are experiencing. There are people who have more sensitivity and will be tapped on their leg and it will hurt. Then others can be hit by a dump truck and will say they are fine. Pain rating is where I see the most discrepancy between patients and medical providers. The pain scale is a strict 0 to 10 scale. People like to always tell their medical professional that it is a 20 out of 10. By telling the doctor your pain is this high, does not make it more of an immediate issue or an emergency. When people tell me their pain is 20/10, I ask them if they would like me to call 911 or go to the emergency room. Medical professionals are concerned if someone is saying their pain is 7 or greater, you do not need to exaggerate. If the pain is causing limited activity or ability to perform simple normal tasks, one perceives it a lot higher. We are not discrediting your pain, just trying to get a better idea of how it is affecting you personally. Don't be surprised if we reference "you are being mauled by bears", “attacked by ninjas”, "stung by bees", or "unconscious". Pain scales that use phrases like this are over the top, but honestly when I say these phrases it makes the patient think about how it is truly feeling and takes some of the emotional component away. When people have pain, there are other things that a therapist is looking at like change in vitals. These factors are something we look at to see how it is affecting your overall body as well.
Pain is physical and emotional which is why it is important to look at all aspects of it. Medical professionals are trying to get the big picture of your pain, how intense it is, what type of pain is it, how it is affecting your daily life, and what the cause could be. Please use this as a guide next time you describe pain to someone. The more descriptive you can be about how it affects you the better it will be understood.
Debra Myhr PT, DPT, ATC