Communicating Pain

Dr. Jeff Metheny

    Let’s talk about what pain is, and how to communicate it in an effective way. Pain is a noxious stimulus resulting from an irritation or damage to tissue that is sensed by local nerve receptors and transmitted rapidly by afferent nerves to pain centers in the brain which register the “ouch.” How and why we feel pain can be a complex and often perplexing experience that’s difficult to describe. Some areas of the body have large numbers and more sensitive receptors, like fingers and the tongue, which feel more intense, pinpoint pain as compared to areas less endowed with nerve receptors like the buttocks, or many internal organs (nobody wants to feel the digestive process). To add to the confusion when our body is sorting out pain, we each have different pain thresholds and tolerance levels. To some people, an IV stick is unbearable, whereas to others it can become unnoticed.

    Acute pain appears quickly, is registered, and then usually goes away in a couple days. If it recurs or persists, we may get fearful, angry and frustrated that we can’t figure out what’s causing it and end up saying,” It just hurts!”

    Let’s slow it down a bit. Whether you are self- assessment of your pain, getting a friend’s opinion, or you have decided to seek the advice of a licensed healthcare provider, it may be best to take a minute and honestly evaluate your symptoms.

    Symptoms are those puzzle pieces that you can see, feel, and often quantify and clearly monitor. And like a puzzle, arranging and putting these pieces together ultimately helps paint a clearer picture. Using a team approach to solve the puzzle makes the process easier if everyone is on the same page and speaking the same language. How can we best accomplish this?

    Keep a mental or written list of parameters that will help you and your healthcare provider communicate, collaborate, evaluate and formulate a treatment plan. After all, no one enjoys pain. It doesn’t feel good for a reason. Keep it simple and think about:

  1. Location –   Is there a specific spot that hurts and can you use one finger to touch it? Or is the pain diffuse and over a broader area, say “a circular handful”? Does your entire body ache? Can you be specific about the body part, such as: joints, muscles, abdomen, finger, etc.?
  2. Quality – Try to describe your perception of what the pain feels like: sharp stinging, stabbing, cramping, deep aching, constant or intermittent?
  3. Intensity – Using a numeric scale of 0 – 10 where 0 is no pain and 10 is excruciating. It may be easier to give a range: for example, right now it’s a 3, but last night it was more like a 7. Write the number down periodically through the day to provide a pattern to the pain. It’s easier to get the bigger picture that way.
  4. Triggers – Can you make your pain worse? If so, how? Through movements, weight bearing, deep breathing/coughing, after taking medication? What relieves the pain? Lying flat, stretching/warming up, swimming or walking, sleeping?
  5. Reflections – To jog your recent memory, have you in the past week, changed your medications, activity level, or diet, traveled, participated in any atypical activities? Is the pain a familiar one, or something new?

    At appointments with your healthcare provider, a checklist adds efficiency when history taking, decision making, and I promise it will be appreciated (take a doctor’s word for it.)

    Describing what we are feeling can be challenging – especially when it’s negative and undesirable, like pain.  Walking it through our checklist provides a framework where we find some clarification, control, and calm about what hurts. Consult your doctor when necessary – they are the professionals, after all.

Dr. Jeff Metheny is a widely respected retired physician and surgeon, and a member of the Cancer Champions Advisory Board.