Talking With Your Doctor About Pain


Jim Sliney Jr, RMA 2/28/2016
original artwork jjsjr

Talking about your pain is one of the most challenging conversations you will ever. You are bound to have it with your doctor, or with friends and loved ones, and each time you do it’s going to be unpleasant. Why? Because to everyone but you your pain is invisible and as a result, people just don’t get it.

Explaining your pain to your Doctor is more than just unpleasant, it’s difficult and it’s a very high stakes conversation. If you don’t convey your experience correctly the road to cure, management or treatment can be longer than it needs to be. I don’t want to diminish the value of having the pain talk with loved ones but because of the impact it can have on your entire approach to medical care I’m going to focus on how to talk to your Doctor.

Doctors rely heavily on signs. Signs are things they can test and measure objectively, like blood tests, electrocardiograms, MRIs and blood pressure measurements. In contrast, pain is a symptom. Symptoms are subjective effects that only the patient experiences. Because they are subjective, it is not always easy for a Doctor to understand or interpret symptoms. Fortunately there is language you can use to make your subjective symptoms more objective. Let’s call this pain language “FLIC” (Frequency, Location, Intensity, Characteristics).

FREQUENCY:How Long Has This Been Going On?
Headaches that happen intermittently every day, versus ones that occur persistently all night long are approached differently by your Doctor. Being able to tell your Doctor how long or how frequently your pain presents itself goes a long way to solving the mystery of cause and a subsequent treatment plan. The simplest way to look at the frequency of pain is to measure how long it lasts, or its duration.
You can have acute pain which is short in duration, or chronic pain which is long in duration. Hitting your thumb with a hammer produces acute pain. The pain from fibromyalgia is chronic pain. Once the duration is determined there are other accepted terms you can use to fine tune the frequency and duration of pain:
  • Intermittent – not continuous / occasional (e.g. back pain can be a chronic condition that  comes and goes intermittently)
  • Sporadic – occurring irregularly or randomly (e.g. cluster headaches can be sporadic,  happening at unpredictable intervals)
  • Predictable – foretold on the basis of experience or scientific reason (e.g. every time it rains  the pain in my neck increases in intensity)
  • Flair-up – a sudden occurrence or worsening (when your intermittent or sporadic or  predictable pain is suddenly present or suddenly worse than usual)
  • Constant – happening all the time (e.g. the pain in my shoulder joints is always present)
  • Acute recurrent – this happens in short duration but happens again and again, like migraine  headaches
  • Chronic progressive – pain of long duration that continues to change and evolve, like    degenerative nerve pain

LOCATION:Where Is Your Pain? / The Mcgill Pain Questionnaire

Where does it hurt? Pain conversations may start just like that. There is a common graphic of a unisex human figure with a back view and a front view. Doctors may instruct you to mark on such a drawing where your pain is being experienced. Doctors may even request you to note a difference between pain that is on the surface and pain that is under the surface. This tool comes from the McGill Pain Questionnaire which includes other measurements, but the front and back of the unisex human figure is the most recognizable. If you don’t happen to have a figure to draw on remember terms like, front, back, on the surface, under the surface, deepand shallow, however it should be easy enough to find the McGill Pain Diagram online and print it out.

INTENSITY:The Wong-Baker Faces / Scale of 1-10

original artwork jjsjr

The Wong-Baker Faces scale was originally devised to help children express the kind of pain they were experiencing. Most of us have seen this scale before (six faces ranging from a happy face to an upset, crying face) and it is very easy to use but its limitation is that it only addresses pain intensity.The Wong-Baker Faces scale works the same way that the “1-10 Pain Scale” works, with ZERO being no pain and TEN being the worst possible pain. Take some time to think about where your pain falls on this scale. It is perfectly fine to say that your pain falls within a range of scores.

CHARACTERISTICS: The Neuropathic Pain Scale
Knowing the Frequency, Location and Intensity of pain is very important, but to anyone living with chronic pain, there are still more ways to talk about it. The Neuropathic Pain Scale uses the same ONE through TEN model (when ONE is none and TEN is the most possible) to measure other aspects like:
  • Sharpness – a stabbing pain like an exposed nerve
  • Hotness
  • Coldness
  • Dullness  – a deep pain, maybe throbbing, like swelling from an infection
  • Sensitivity to contact – does it hurt when clothes brush against it, when you poke it?
  • Itchiness

Being able to provide characteristics like this will help your Doctor understand the cause of your pain.

In addition, a discussion of the characteristics of your pain should include what treatments make it feel better or feel worse. Does your pain respond well to warm compress or aspirin? Have you found that hot showers make you feel worse? This can help your Doctor rule out certain treatments thus saving you time and frustration.
If you don’t have this information prepared when you go to see your Doctor you will probably spend a good portion of your visit trying to figure all this out. That cuts into the time you could spend asking important questions, and getting better quality information and instructions. Also, under such circumstances it is possible that your pain will be misrepresented.  So when you are preparing for a visit with your Doctor prepare your FLIC ahead of time. You will be able to give your Doctor the kind of highly specific information they need to help diagnose or treat your pain which could get you the help you need faster.


Bibliography & Resources for basic definitions excellent source for information, tools and the pain assessment scales mentioned in this article


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