Using the Words that Describe Your Back Pain to Your Doctor

Doctor and patient conversation
Doctor and patient conversation. Dan Dalton/Caiaimage/Getty Images

Back pain and neck pain are subjective — few, if any, definitive tests exist that can accurately measure and diagnose the experience. And pain levels fluctuate, in terms of timing, intensity and quality, which make it nearly impossible to use objective testing methods such as an MRI or CT scan to get a true picture of what you experience on a day to day basis. 

Just the same, a big responsibility you have in the quest for a diagnosis that can lead you to the right treatment is to describe your back pain to your doctor clearly. Sometimes that can be an art form in itself. 

To prepare for that all important conversation with your doctor, you might consider keeping a pain journal for the week or weeks leading up to your appointment. In fact, many people who live with persistent pain are long term committed journal keepers. For them, a pain journal is a necessary element of their pain management program.

Below are some of the bits of information doctors try to elicit from their pain patients during the medical history portion of the diagnostic process.

Note the Intensity of Your Pain

How bad does it hurt? Knowing this is one the first steps to working collaboratively with your doctor.

Intensity is a measure of the strength of felt pain signals.

As the patient, this is probably the most important part of the ordeal for you. Many practitioners will ask you to fill out a visual chart of some sort. You may be asked to rate the intensity of your pain with a number, or by picking a "face" that represents how the pain makes you feel; this is called the "oucher" or "faces" chart. The "faces" in the oucher chart go from happy and smiling to crying. 

Use Words that Describe the Pain

The quality of your pain may mean something about what's causing it. For example, if you experience burning, stabbing or electrical sensations down one leg or arm, it may indicate a compressed or irritated spinal nerve root. (which is called radiculopathy.)

If you can expand the pain vocabulary you use in your journal, you may find communicating with your doctor is easier and more fruitful for you.

The McGill Pain Questionnaire from McGill University in Canada provides a series of descriptive words that some doctors will use to try to get an insight into your pain, whether during the initial diagnostic process or at the follow up and monitoring experiences. The words are categorized according to 3 questions that may help you describe the pain. They are:

  • What does your pain feel like? Expanding yourexisting vocabulary with more descriptive words may come in handy here.
  • How does your pain change with time? Example words include constant, intermittent, at night only, etc.
  • How strong is your pain? With this category of questions, we're back to the intensity piece discuss above.

Examples of descriptive words that describe pain, taken from the McGill Pain Questionnaire, include: Flickering, nauseating, rhythmic, squeezing, blinding, boring. These are just a few, but hopefully you get the idea — the more expansive you can be with your language while keeping it accurate, the better your communication with your doctor will likely be. 

ID the Location of Your Pain

Where you feel the pain may not be where the problem is. If a nerve root is affected, for example, the pain may radiate down an arm or leg, as is the case in radiculopathy.

If you have trigger points or other myofascial pain, you might experience referred pain, or pain located in an area that is seemingly unrelated to the actual site of the problem.

And, pain may be located in more than one area of the body.

For this and other reasons, practitioners often use a body diagram to track the location of the pain as it changes (or doesn't) over time. In the initial assessment, the body diagram also helps your doctor or PT to get right down to business by providing a quick snapshot of the main thrust of your complaint.

As part of your medical interview, your doctor might use the information you provide in the body diagram to probe for more details.

Clarify the Timing of Your Pain

The "when" of back pain — if it comes on suddenly or gradually, if it is present constantly or only sometimes, or if there is a particular time of day when it always shows up — is key information to your doctor as she or he goes through the process of determining a diagnosis. Doctors evaluate changes in pain patterns to monitor your progress and to be on the lookout for new problems.

Understanding your individual patterns of pain may also help your doctor determine the best time for you to take medication.

More specifically, pain may come and go, which is called intermittent pain, or it can always be there, but with fluctuating severity. This second version is called variable pain.

People with variable pain may also experience breakthrough pain and background pain. Breakthrough pain is the temporary condition where pain is extremely severe and may benefit from medication or a specific pain management strategy for breakthrough pain. Background pain is of lower severity but is fairly constant.

There's also stable pain, where the pain, which also includes its intensity, is always constant.

Talk About Your Physical Functioning — Or Lack Of

Pain is more than a set of unpleasant sensations. It has the power to disrupt daily activities and lifelong dreams. Back pain can impair your ability to fully participate in both work and play, and even to do very basic things such as coughing and sneezing.

That said, your expectations and attitudes may play a determining role as to how much disability you experience when you have back pain. The ICSI, a group that provides guidance to doctors treating back pain, asserts that giving up on yourself or your treatment may perpetuate the pain. In this case. giving up means disengaging from self-care activities.

The ICSI says social support and spirituality very much factor in to the healing equation.

Another thing that affects your ability to function during the time you deal with back pain is your own perception or appraisal of yourself as able to perform actions and tasks; this is called self-efficacy. A study published in the European Journal of Pain found that back patients with strong self-efficacy had less disability.

During your physical exam, the doctor will likely ask questions about your functioning and how it has changed since the pain started. She may also try to determine the level of pain you experience while at rest and during activities.

Be Transparent about Any Psychological Issues

Many times your state of mind and/or emotion plays a role in your pain and disability status. Your doctor will likely ask you if you have depression, anxiety, substance abuse or other types of problems currently or in your past; these topics are great fodder for your pain journal, as well.

Depression may accompany your chronic back pain even if you don't have any history of psychiatric disorders. A 2018 study published in the Korean Journal of Pain concluded that unrecognized depression in patients with chronic pain is common.

Cognitive behavioral therapy or CBT, is a short-term therapy focusing on identifying and changing the thinking patterns that bring unwanted results into our lives. For people with back pain, it's especially useful for learning how to manage pain triggers.

In their 2017 clinical guidelines, the American College of Physicians strongly recommend cognitive behavior therapy as a non-pharmacological pain management treatment for acute, sub-acute and chronic low back pain.

 

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