As patients, we often have difficulty explaining where, when and how we hurt. All imperative in helping providers to define the potential cause and treatment options.
Pain is felt when the nerves, spinal cord and brain send signals alerting the body to an issue. But we all feel it differently. That’s why getting a thorough understanding of a particular patients pain is so critical. My knee may throb and burn, whereas yours may have a sharp, intense pain. Each depiction helps to hone in on the origin. Being able to present them as accurately as possible is key.
Acute pain
This has a sudden and specific cause:
- An abscessed or cracked tooth exposing a nerve
- A bone fracture
- Lacerations
- Burns
- Recent surgery
- Delivering a baby
Chronic pain
Chronic pain lasts over six months, even after the inciting event has passed. As discussed in multiple posts, many suffer from an obvious point of origin:
- Failed back surgery
- Bone that heals poorly
- Persistent underlying causes such as arthritis
- Reactions from treatments such as cancer
- Migraines
But too often, after the event has resolved or in some cases with no obvious source, chronic pain persists.
It affects every aspect of our lives. From the physical to the emotional manifestations.
Nociceptive pain
This is the most common type of pain. Nociceptive receptors lie in every tissue, especially our skin and organs. They send signals to the brain warning us of an injury or inflammatory response. It can be acute, when we’re initially harmed by a cut, burn, or fracture, or chronic. It can then be further distinguished as visceral or somatic.
Visceral pain
This is caused by damage to our internal organs in the chest, abdomen and pelvis, as a result the exact source can be difficult to pinpoint. Symptoms often present as a heaviness, tightness, squeezing, pressure type of pain. Temperature, heart rate, blood pressure, nausea and vomiting are often associated with visceral pain such as an acute appendicitis, heart attack, gall bladder pain, or diverticulitis.
Somatic pain
This is when pain signals are stimulated in tissues outside our internal organs e.g. skin, muscles, joints, connective tissue, tendons, ligaments, bones. In most cases it’s easier to pinpoint, but not all. Sometimes pain is referred away from the true source making knee pain a possible hip or foot issue instead. It’s usually described as an ache, throb, dull, gnawing sensation. It can be deep in the leg as with a tendon tear or superficial as with a fever blister on the lip.
Neuropathic pain
This is due to damage or nerves that keep firing pain signals long after the inciting event has resolved. Since it’s not due to a specific injury it can often seem random and exacerbated by usually benign events e.g. cold weather or a blanket on your skin. It’s been described as numbing, tingling, burning, shooting, electrical shocks, sharp, stabbing. . .type pains. It can be from diabetes, chronic nerve damage or impingement, alcohol use, chemotherapy, radiation, shingles, among other causes.
This is why it’s so important to give the provider all the data possible. Pain is incredibly personal. How I feel something won’t be the same for you. The more information you provide the easier it will be to define the source. Don’t be put off by a long list of questions that follow. We aren’t “interrogating” as some have misunderstood, but rather trying to delineate through all the possible nuances that pain can cause, which are suited to your pain concerns. Knowing the answers can make all the difference in how well it’s treated.
Here are key items we need to know:
- When did the pain start?
- Was there an inciting event e.g. trauma or injury?
- Is it constant or intermittent?
- What makes it better? Worse?
- How long does it last?
- Where does it start? Does it radiate?
- Does the site get red, hit or swollen?
- Is there loss of strength, mobility, function?
- On a scale from “1 to 10” what is the severity?
- How would you characterize the pain? Burning, sharp, achey, throbbing?
But don’t forget the emotional toll.
I recently had a sweet 78 year-old lady establish care in my office. She is being well cared for by a specialist regarding her rheumatoid arthritis. But just a few minutes into the exam it became clear her feelings of isolation, depression and fears were not. To the point she kept saying “what’s the point of doing anything when I’d rather let nature take its course.” She wasn’t suicidal, just so exhausted with her disease process she believed nothing more could be done. Just expressing this to a heathcare provider was cathartic, learning there might be viable ways to intervene was more than she could imagine.
- Talk about your emotional status as well.
- Any feelings of depression, isolation, anxiety.
- How limitations affect your daily life and interactions.
- Sleep deprivation.
- How it may impact food intake.
The more you prepare before seeing your healthcare provider the more they’ll be able to do. Pain is not just physical. It’s an emotional, exhausting and overwhelming aspect to everyone’s life. Being able to explain how it feels can make a huge difference in all our interactions. It won’t happen in the first visit. But over time a well-rounded picture will emerge, giving those involved a better perspective on what treatments may be best for you. As with any healthy relationship, communication is the key.
