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Understanding Pain, Enhancing Doctor-Patient Communication

by WidaaMD on 08/01/2015
Education
Doctor's Pick
Doctor's Pick

When it comes to your possible presentation at the emergency department or doctor’s office, perhaps one of the most alarming symptoms to the patient, as well as to the physician in many cases, is pain. Pain is often an immediate cause of distress to the patient, and depending on the severity, warrant some intervention, whether it be taking a simple analgesic for mild pain, or rushing to the emergency department for more significant pain. If you have or are suffering from pain, there are a few important points which would be useful for you to know regarding the characteristics of this pain which your physician will be looking to identify, and understanding such characteristics may aid in bettering your understanding of the possible cause, as well as the physician’s ability to rapidly collect the information from an informed patient to localize and hopefully accurately diagnose the cause of this pain. So what particular characteristics of pain are important. So what things do I need to know about my pain?

The Site or Location of the Pain

This is probably the easiest to recognize and is usually volunteered readily bu the patient. It goes without saying that eye pain probably is caused by something completely different from lower abdominal pain, although it is useful ti bear in mind that many diseases may cause systemic symptoms and signs, and hence an inflammatory condition in your bowel (Inflammatory Bowel Disease) may present with eye symptoms. By volunteering this information, the physician can further localize in on the exact cause of the problem. Abdominal pain is a common presentation, and although many patients initially report simply generalized abdominal pain or point to a vague area of the abdomen, it is useful to understand that your abdomen, or belly, is divided into nine quadrants as illustrated below. Some diseases or conditions which typically cause pain in these areas is also illustrated.

Sites and Causes of Abdominal Pain

Image Credit harvard-wm.org

RUQ and LUQ refer to the right upper quadrant and left upper quadrant respectively, where RIF and LIF refer to right iliac fossa and left iliac fossa respectively.

From this illustration you can see how localizing the site of your pain is important in aiding the diagnosis of your condition. Do not feel compelled to localize pain that is generalized, however, as many conditions may simply present with generalized abdominal pain, and that in itself is an important piece of information.

The Onset of the Pain

Not all pain comes about in exactly the same way. Your pain may come on suddenly, precipitated by a specific activity, such as coughing or lifting heavy weights in the case of the neurogenic pain of a lumbar disc herniation (lower back pain) or may arise more gradually such as in the case of degenerative diseases involving the weight bearing joints and changes occur over time to the structure of the cartilage and bones (Osteoarthritis.) Whatever the cause, it is important to inform your health provider of the speed of onset as well as any precipitating factors which brought the pain about.

The Character (Quality) of Pain

Not all pain feels the same, and although most patients are simply inclined to point out, “I have pain right here!” it does not always provide the most useful information in the clinical setting. I am not suggesting in any way that the urgency of any sort of pain be diminished in any way, but if tolerable, it may be useful to describe just how your pain feels. Certain common characteristics are sharp, dull, pressure-like, tearing, burning,throbbing, amongst many others. Again, do not feel pressured to describe a quality which is vague to you. It is alright to have ill defined pain!

The Radiation of Pain

We all know that pain starts somewhere, but does it say there? In many cases, that is not so. For example, the pain of appendicitis typically starts as a vague peri-umbilical (around the umbilicus) pain that later localizes to the right iliac fossa or right lower quadrant (See the sites and causes of abdominal pain in the image there. The pain of cholecystitis (inflammation of the gall bladder) may start as right upper quadrant (RUQ) pain, but then radiate around the side to the back. Pancreatitis (inflammation of the pancreas) starts as an epigastric (between the RUQ and LUQ) pain and then radiates straight through to the back. The radiation of your pain may paint a very characteristic picture which will aid in timely diagnosis and management of your condition.

Associated Symptoms

While you may indeed be suffering from pain alone, pain is often accompanied by other symptoms which help direct the physician, and yourself to the possible cause, or at least the involved system. For example, abdominal pain may be accompanied by a fever in appendicitis, or by vomiting and constipation in cases of intestinal obstruction. An associated symptom is basically any other symptom which occurs with the pain. If you are suffering from a pressure like pain in your chest accompanied by sweating and nausea, this may point to a serious underlying condition such as a myocardial infarction (heart attach,) hence associated symptoms should never be taken lightly and should be pointed out to your physician whenever possible.

Aggravating and Relieving Factors

What makes your pain worse? What makes it better? Do you have abdominal pain in the right upper quadrant which is worse after eating fatty meals? In that case you may be suffering from gall stones (cholelithiasis.) Is your epigastric (mid upper) abdominal pain aggravated by food intake, or is it relieved by food intake? These aggravating factors may indicate a gastric and duodenal ulcer respectively. Is your joint pain worse with exercise and through use of the joint throughout the day? Does it involve a large joint such as the knee? You may be suffering from osteoarthritis, a degenerative disease of joints which usually affects weight bearing joints. Are your joints stiffest in the morning and improve throughout the day? Such a description is classic for rheumatoid arthritis or Ankylosing Spondylitis. Is your headache relieved with over the counter Tylenol, or may your physician need to consider more potent analgesia for relief. Needless to say, aggravating and relieving factors are also quite important in describing your pain to the physician and in reaching a diagnosis.

Frequency, Duration, & Intensity

How often does your pain occur? Is it disturbing your level of functioning? Can you no longer go about your daily activities? The disturbance in quality of life is often a strong indication for intervention or at least more extensive workup on the part of your physician. Duration is important for diagnostic purposes. Chest pain which occurs behind the sternum, is heavy in character, and associated with sweating and aggravated by exertion may be stable angina if it lasts only a few minutes, but once the pain lasts longer than 20-30 minutes you may be having a myocardial infarction (heart attack) and need emergency management. The intensity of pain is usually graded on a 1-10 scale, with one being the mildest score and 10 being the most severe. This will usually help the physician assess the need and potency of analgesics which may be required.

Conclusion

In conclusion, simply presenting with pain may not paint the most colorful picture of your condition. Attempting to understand the various characteristics such as site, onset, character, radiation, aggravating and alleviating factors, frequency, duration, and intensity will help you communicate your presenting symptoms more effectively, allowing more efficient communication between you and your physician and improving the chances that the diagnosis of your pain is made in a timely manner. Attempt to characterize your pain whenever possible, but do not delay heading to the emergency department in the event of any severe or debilitating pain in your attempts to further understand it!

The content published on this website is not intended to be an alternative to medical advice, recommendations, or management by your attending physician. Correct medical management requires thorough history, examination, and investigations, all of which can not be substituted by online resources.

 

WidaaMD
WidaaMD is founder and chief editor at Dr.Discuss. As a physician and part-time web developer, he enjoys building new online projects and startups which are both fun, entertaining, and offer educational value to the public. Dr.Discuss is one of those projects.
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