If you are living with chronic pain, it is important that you meet with your doctor regularly. All people tolerate pain to different degrees, so you’ll need to work with your doctor to monitor your symptoms and your response to therapy.
Your doctor will begin assessing your pain by taking your history, which may help establish if your pain is caused by a physical illness, such as cancer, or if your pain is affected by psychological factors, such as depression or anxiety. In addition, your doctor may ask you to rate your pain by using a pain scale. A pain scale can help your doctor gauge if your pain is changing over time.
It is also important to determine the degree to which your pain is affecting your ability to enjoy life. Your doctor may vary the approach to treatment based on whether you find your pain to be only annoying vs. debilitating.
Finally, your doctor will perform a thorough physical examination and may order one or more diagnostic tests. A multitude of diseases and conditions can lead to chronic pain, and the results of your physical exam and diagnostic tests may help your doctor focus on one cause.
Until your doctor assesses your health status and understands the way you experience chronic pain, he or she must consider many possible causes.
Creating a History
As with any symptom, a detailed description of the problem is the place to start. To do this, your health-care provider will take your history, meaning that he or she will gather information about your pain. Your health-care provider may ask you the following questions:
- When and how did your pain begin? Did it start suddenly or gradually? Was there an injury that started the problem?
- Does the pain come and go, does it get better and worse or is it constant?
- Is the pain sharp or dull, crampy or throbbing, burning or tingling?
- Where is your pain located? Has it moved slowly over time, or is it a shooting pain or fleeting pain that arrives and disappears in a few seconds?
- What makes the pain better or worse? Is it affected by a change in position, any treatment you’ve tried, your menstrual cycle or your stress level?
- Are there other symptoms associated with the pain, such as fever, weakness, numbness or nausea?
- Do you have any other medical problems?
- Are you taking any prescription or over-the-counter drugs?
Answers to these questions will be helpful in figuring out the cause of your pain. But even if no cause is ever found, your answers may help your health-care provider find the best treatment. For example, a burning pain with numbness suggests that you have neuropathy (nerve disease); your health-care provider might prescribe drugs that can reduce this type of pain, even if the exact cause of the nerve problem is unknown.
The importance of being thorough.
You may well have given your pain history before, perhaps several times to several health-care providers. For some patients, this can be a frustrating exercise, and the impulse may be to resist retreading this old territory. But it’s important to volunteer as much detail as possible during the history — even if you think you’re repeating yourself — because chronic pain can change over time. If it does, new tests may be needed to confirm or even change the diagnosis and help guide treatment. In addition, because the expertise of your health care providers differs, the information you provide may have different meanings and different importance to each of your doctors.
For instance, back pain that has lasted for three months and then spreads into one hip could be caused by hip arthritis. But if your health-care provider learns from your history that the pain has gradually changed, increasing in your back and extending into both hips and legs, he or she might suspect spinal stenosis — a condition that compresses nerves in your back. Your health-care provider’s choice of diagnostic tests (and the resulting treatments) may be influenced by the details that you provide. So be as thorough and precise as you are able.
Rating Your Pain
Although some of the questions you’ll be asked during the history are straightforward, such as those about your use of prescription or over-the-counter drugs, others defy simple answers. In particular, it can be very hard to describe what your pain feels like. But, clearly, you know more about your pain than anyone else does.
How a person feels pain is very individualized; a tetanus shot that feels like a harmless pinprick to one person may be an excruciating ordeal to another. Because no one else can actually experience the pain you’re feeling, doctors use a variety of tests to rate and compare pain. Although these are imprecise tools, they are the best way health-care providers have to understand what you’re feeling. And, of course, the better your health-care provider understands what you’re experiencing, the better he or she can help manage your pain.
Using a pain scale.
Among the most common scales health-care providers and patients use to described pain are the 0 to 10 scale and the visual analog scale.
- With a 0 to 10 scale, you rank how your pain feels from 0 (no pain at all) to 10 (the worst pain imaginable).
- With a visual analog scale, you mark where your pain falls on a line that runs from 0 (no pain) to 100 (the worst pain).
Pain specialists may also use more sophisticated methods, such as the McGill Pain Questionnaire, to get a clearer picture of the pain you’re experiencing. These tests take longer to answer, and some have to be given by another person. Because of their complexity, these tests are not as easy to do as the 0 to 10 or visual scale ways of rating pain.
Keeping a pain diary.
You can also use these scales to rate your pain yourself and record your experience from day to day, week to week and month to month. This record keeping is called a pain diary. A pain diary can be useful in gauging how well treatments are working and whether lifestyle changes or other pain management strategies are helping. Keeping a pain diary is important because it will help you remember details about your pain that you may want to discuss with your health-care provider, and it may demonstrate patterns in your pain that are not obvious day to day. For example, pain may be worse at certain times during your menstrual cycle or when you are at work — a pain diary may make these associations much easier to see.
Using a Pain Diary
You know you hurt, but finding a way to help your doctor diagnose the reason for your pain can be difficult. Sometimes, you can’t find the right words, or you’ve forgotten exactly how long you’ve been experiencing the discomfort.
In many cases, by the time you schedule a doctor’s visit, you’ve forgotten other important details about your pain. For instance, if the pain comes and goes, you may have forgotten the degree of the pain, whether or not the pain moves, or if it occurs in response to some action you perform. Keeping a written record of your pain — sometimes referred to as a pain diary — can help lead to a more prompt diagnosis.
Write down when you experience pain, describe how it feels and record any drugs you take. If writing is too painful, keep a small tape recorder on hand. You can have a relative or friend transcribe your comments if necessary. This type of documentation may help your doctor determine the cause of your pain and the best initial treatment.
Describing your pain.
Here are some terms the American Pain Foundation recommends that you use to help describe the uncomfortable feelings and sensations commonly called pain.
- Aching, dull, sore, pressing, deep, gnawing
- On the surface, tender, pinching, sharp
- Burning, pins and needles, prickling, shooting, electric
- Stabbing, pounding, throbbing, pulsing, crushing
- Crampy, knotlike, stretching, tight
You may find these terms useful when filling out a pain diary, such as the one below. You can print the diary and use it as a record. It may be especially helpful to show the pain diary to your doctor and discuss your experiences with pain.
|When did the pain begin?||When did the pain end?||Where did you hurt? (In one place, or did the pain move?)||What did the pain feel like?||What drugs, if any, did you take for the pain?||Did the drugs help?|
Working With Your Health Care Provider
As anyone coping with chronic pain knows, the physical sensation of pain is only half the story. Just as important is how the pain affects you, its impact on your life. During your visits to your health care provider, he or she will try to establish how your pain is affecting your life at home and at work by asking several questions.
- Does your pain affect your relationships with family and friends?
- Does your pain affect how you exercise?
- Does your pain impede your ability to have fun?
- Does your pain affect your mood?
- How are you coping with your pain?
Communicating these feelings to your health care provider is crucial, as there are treatments that can help with these problems. Depression and anxiety can make chronic pain harder to endure and harder to treat. Often, these problems can be taken care of with prescription drugs and counseling. Then, both patient and health care provider can focus their energies on treating the principal challenge, the pain itself.
Deciding on Treatment
Once you and your health-care provider have finished assessing your pain — from its location and intensity, to what remedies you’ve tried, to its effect on your life — then a new or modified treatment plan can begin.
Fortunately, there are many ways to treat chronic pain. Some approaches don’t require either drugs or surgery, although there are several drug and surgical options available.
For many pain treatments, there’s only limited scientific evidence that they work. Sometimes a treatment that seems to be effective in one study doesn’t work well in another. So health-care providers who treat chronic pain may suggest a series of different treatments or a combination of treatments to find what works for you. For example, people with chronic pain caused by cancer often need a combination of drugs, surgery and radiation to treat their cancer and control their pain.