Rose Mary has been an Occupational Therapist since 1987. She has treated children and adults with a wide array of conditions.
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 the 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. You will learn how to describe your symptoms in terms of history of injury, location, quality, intensity, frequency and duration.
Most people are terrible 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?
Sharp pain is commonly in the wrist, elbow, shoulder or knee/patellar tendinitis. The pain is very sharp and very quick — think gasp, jump or flinch. It is associated with movement or activity. Because it is so sharp, 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 starts gradually with low intensity and can 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 pain 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 redefined 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.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
rmcrayne (author) from San Antonio Texas on January 16, 2012:
Thanks for visiting homesteadbound. That's pretty amazing (in a bad way) to have "broken your back" at such a young age. You definitely had to reset your pain thermostat.
Cindy Murdoch from Texas on January 11, 2012:
Pain is something that I have always had to deal with, and I think I ignore pain even higher than the norm. I shattered a vertebra (L3) in my back when I was 14, and was diagnosed with arthritis in my back when I was 18. I am now 52 and in lots of pain, but I am able to ignore it most of the time. It does interrupt my sleep frequently. This is a very good article to help me understand how to explain my various pains to a doctor should I decide to need to go.
Joe Bricky from Northern Nevada on June 23, 2011:
Very good article. Thanks for the info.
MyLovely1 on June 12, 2011:
enjoyed this one- now to find your 179 others LOL!
rmcrayne (author) from San Antonio Texas on September 01, 2010:
Thanks for your visit and comment healthhubs.
healthhubs from USA on August 29, 2010:
Thanks for sharing the useful information. helps a lot to communicate to the physician.
rmcrayne (author) from San Antonio Texas on June 23, 2010:
Thanks westdrug. I do actually have more "on similar topics", but they may be a little hard to find now that I have over 180 hubs.
rmcrayne (author) from San Antonio Texas on May 09, 2010:
Thank you U Neek. You might also enjoy my hub, Healthcare in America.
U Neek from Georgia, USA on May 09, 2010:
This is a wonderful Hub. I have been in constant pain for several years and was finally diagnosed with fibromyalgia. This on top of the arthritis pain I had been dealing with for years has made my life miserable and I am very hesitant to complain about it to my doctor as I don't want to be viewed as a drug seeker. Thanks for letting me know that all medical professionals do not think their patients are lying or exagerrating.
rmcrayne (author) from San Antonio Texas on April 19, 2010:
Thanks for the visit Springboard. Pain is a heck of a thing to be expert in, eh?
Springboard from Wisconsin on April 07, 2010:
Just had a hernia surgery a few weeks ago, so pain language has become somewhat more understandable. This hub helped clean up any loose ends. :)
rmcrayne (author) from San Antonio Texas on February 07, 2010:
Thanks for visiting dinkan. Unfortunately the situation is often the opposite. Patients don't know which are the most important pieces to share, and doctors don't have time to listen to all of it.
dinkan53 from India on February 06, 2010:
don't hide anything from doctors and lawyers.
rmcrayne (author) from San Antonio Texas on February 06, 2010:
I may very well borrow your "electric toothache". Within "achy pain' there is achy bones/joins, achy muscles, and nerve pain. Most everyone has experienced the first two and can relate. The hardest is when a client has never previously experienced nerve pain, or never recognized it.
Holle Abee from Georgia on February 05, 2010:
My doc loved it when I described my nerve pain as "an electric toothache"! Great advice here, RM!
rmcrayne (author) from San Antonio Texas on November 16, 2009:
Tickled that you dropped by sunforged. I've learned a lot about patients' perceptions of and interactions with doctors. And the news unfortunately is not always good so to speak.
sunforged from Sunforged.com on November 16, 2009:
Very well written and important, its surprising how many people are cowed by their service providers and fail to communicate effectively, having a guide like this is quite useful.
rate it UP!
rmcrayne (author) from San Antonio Texas on October 01, 2009:
Thanks for reading and commenting Robert. You reminded me of something I meant to include. With long-standing pain, people often "reset their pain thermostat". If 3-4 of 10 is as good as it gets, sometimes this becomes the new 0 for them.
I've heard so many clients say what you have here about fear of narcotics and becoming addicted or dependent. It's certainly more of a concern with long-standing or chronic pain.
robertsloan2 from San Francisco, CA on October 01, 2009:
Thank you. I wish I'd known this when I first started trying to get my disabilities diagnosed. Part of the problem when they'd ask how long I had my pain I'd have to answer "all my life" and connect it with certain activities, many of which I stopped doing as soon as I was legal age. You're right about underreporting pain.
As you said, most people seek narcotics -- I got so afraid of becoming addicted to narcotics that I wouldn't even take an aspirin or acetaminophen when it started getting up into the 8-10 range, because I knew if I did that I would start taking it all the time.
rmcrayne (author) from San Antonio Texas on September 23, 2009:
Lady E thanks for dropping by and commenting. Unfortunately, we've practically turned our doctors into assembly line workers- get 'em (patients) in, get 'em out.
Elena from London, UK on September 23, 2009:
Very Useful Hub. It can be hard sometimes. I just point to where the pain is. Doctors should ask more questions though, which I'm glad you do. Will Bookmark this. Thanks for sharing. :)
Ps. Thanks for your support. lol (saw your comment)
rmcrayne (author) from San Antonio Texas on September 22, 2009:
Wow, thanks lrohner. High praise indeed. My patients used to say to me "Where were you 5 years ago?!" My standard reply, "I wasn't this smart then, but we're both here now."
lrohner from USA on September 22, 2009:
Really, really great job, RM. I've had my share of pain as well as the frustration of trying to describe it to my physician. I wish I had read this a loooong time ago!
rmcrayne (author) from San Antonio Texas on September 22, 2009:
Lily, You should write a hub! Healthcare is the HubMob topic this week. Great visibility and another opportunity to share your lessons learned.
rmcrayne (author) from San Antonio Texas on September 22, 2009:
Fastfreda, Helen Cater, Princessa, Jaspal thank you all for reading my hub. Here’s to a pain free week.
Freta you had read and commented within 5 minutes of my release of the piece. Talk about hot off the press!
Princessa, the 0-10 scale is really big right now in the US as well. At my facility all the primary care, specialty and therapy clinics use it and the patients hate it! What I hate is being pressed about pain when I did not go in to be seen for pain. These things are usually driven by inspections. The last few years The Joint Commission has scrutinized whether patients’ pain is adequately addressed.
Lily Rose from A Coast on September 22, 2009:
As usual, very well written and informative. I have certainly seen my share of doctors over the past year since my cancer diagnosis and I have learned the importance not only of effective communication, but of being your own advocate.
So many doctors these days are scheduling patients every 15 minutes - some even schedule multiple patients for the same appointment time! - and when they finally come in the exam room to see you, you can feel how rushed they are to move on to the next patient - so annoying!
Realizing I had to be my own advocate, I have gotten good at remembering to write down questions I have or comments before the appointment and when there I do not let the Dr's rush, rush, deter me from getting what I need from him/her.
Jaspal from New Delhi, India on September 22, 2009:
Very helpful and informative hub - though I hope one doesn't have to make use of it! :)
Wendy Iturrizaga from France on September 22, 2009:
This is really good. Here in France the doctors actually ask you to score your pain from 1 to 10, so your scale is really useful for me. Thanks!
Helen Cater from UK on September 21, 2009:
This has some great information. I will be in need of this I am sure.
Alfreta Sailor from Southern California on September 21, 2009:
rmcrayne, this is one of those hubs that, after reading, you save it for a later date, and I will. At this point, today, this minute I don't need it, however I know I will one day, maybe sooner than later. Bookmark time! Very good hub.