by Robin Hamilton, DPT, OCS
When you’re in pain and you’ve tried all you could to remedy it or wait for it to go away but it’s still lingering, it’s time to seek help. You’ve set up the appointment with your doctor or physical therapist and you’re thinking about how to tell them about what’s going on in order to receive the right kind of treatment. The way you describe your symptoms and behavior can differentiate between being given a muscle relaxant, receiving an injection, going to get imaging, or being referred to a physical therapist or another specialist.
As a physical therapist, when I’m at family holidays, I get a lot of “Hey Robin, I have this pain right here,” and they point to some spot on their body, “what is it?” And I answer honestly, “I don’t know.” The location of the symptoms isn’t enough information to get an idea about what’s going on. So I’ll usually add, “Why don’t we talk about it and I’ll see how I can help you.” And let the games begin.
I have my techniques and questions I like to ask to try to get the most useful information from the other person. At the same time, they’re trying to express everything they think is most useful for me in order to help them. Sometimes we’re on the same page, sometimes we’re speaking the same language, but other times, we’re not even in the same universe.
Communication is hard, especially about pain. There are an infinite number of ways to describe it. You’re the only one that can feel it. You’re the only one who knows how it behaves and how it affects you and your life, even if that may be, “My pain just does what it wants, whenever it wants.”
So, let’s dive into the Where, What and When. But first, if you have multiple areas of pain, just pick one for now and you can repeat this process after for the others.
1. Where does it hurt? Use just one finger to point to the spot that bothers you. No matter the size or even if the location varies, use just one finger. Depending on where you point, as a physical therapist, I’m thinking about the anatomy of the body in that location and tissues that could possibly refer to that area.
2. What does it feel like? Some common examples are: sharp, pinch, dull, ache, shooting, burning, tightness, stiffness, numbness or tingling. The way you describe what you feel can help to point me in the right direction. However, there are overlaps, which is why it’s important to understand the context and behavior of your symptoms as well.
3. When does it hurt? More specifically, what makes your symptoms worse or better? I’m interested in the behavior of your symptoms. What type of movement, posture, position or activity aggravates your symptoms? For example, does sitting, standing, walking, reaching, running or throwing increase pain? The more detailed you can get, the better! The bonus details that are great to know include:
a. Intensity: what’s the intensity of pain during this activity on a 0-10 scale
(0 = you don’t notice it, 10 = it’s so intense, you’re going to the hospital)
b. Onset: how long does it take after beginning this activity for your symptoms to come on?
c. Duration: how long do your symptoms last once they begin to intensify?
d. Frequency: how often do you get your symptoms?
e. Special conditions: are there any other special conditions that would affect your symptoms?
(For example, if I go uphill or downhill, in the AM or PM, sitting on a soft couch or hard chair, cooking for one or cooking Thanksgiving for 20, etc.)
Now, let’s put it all together with an example of of a problem that I have. I have pain that is
1. On the outside of my right knee, about the size of a quarter
2. It can feel achy and sometimes sharp.
3. It bothers me when I go hiking more than 4-5 miles and worse when I go downhill.
a. The intensity can vary from 0/10 at rest and up to 7/10.
If you’re able to describe the symptoms you have in this way – great job! The vast majority of people have a hard time conveying this and never really think of their symptoms in this kind of detail. Some may find this overwhelming and feel that they have pain in different parts of their body, each with a variety of descriptions that get worse at random times, or the pain is there all of the time. To those people, I would suggest that becoming more mindful of your symptoms in this way is exactly what’s necessary in order to get the most effective treatment plan. And you have all of the skills you need right now to be able to practice this. How?
To begin your pain/symptom journal, grab something to write on or use your phone and carry it with you for one full day. Begin the moment you wake up and go through your checklist:
1. Where is your symptom?
2. What does it feel like?
3. What are you doing right this moment?
4. What is the intensity 0-10? (Mild/medium/strong is fine if the 0-10 rating scale is too difficult)
5. Any additional details are a bonus.
Continue the sequence for the next body region if you have more than one. Repeat this process throughout the day as you do a different activity and/or if the pain intensity changes. If your symptoms vary from day to day, it would be helpful to continue journaling for a week to get the full picture. If you’re unable to see some patterns in the behavior of your symptoms, that’s okay! That’s where your healthcare providers come in. If you gather the information, we’re here to help interpret it and make sense of it for you – that’s our job.
All of this data will be well worth the effort, as it will have a massive impact on the decision-making process of your healthcare providers and, ultimately, on the success of your treatment. Becoming more mindful about your pain will help you speak the same language at your next appointment and get you set on the right track to reach your health and wellness goals.