9 Things to Know Before Describing Pain to Your Doctor

Before describing your MS pain to your doctor, ask yourself these questions

A doctor and patient in an exam room.
A doctor and patient in an exam room. Thomas Barwick/Getty Images

When you have a condition that causes you pain such as multiple sclerosis (MS), all you want is your doctor to bring you relief when you say it hurts. But you play a vital role in helping your doctor correctly and swiftly treat your pain. Even though describing pain in detail can feel overwhelming in the midst of an acute episode, the information (or lack thereof) that you provide can mean the difference between feeling better and living with uncontrolled, disabling pain.

Being specific is important not only for diagnostic purposes, but also because most physicians can become somewhat desensitized to pain. After all, they hear about it from their patients every day. And since most of us are apt to get a little nervous or intimidated when visiting the doctor, we may forget something important or not think to share how much pain is affecting our lives. Doing everything in your power to explain your pain clearly and accurately gives you the best chances of being heard and treated appropriately.

Pain and Multiple Sclerosis

Pain in MS can be caused by the disease process itself or as a result of other MS symptoms, such as spasticity, neuralgia, or immobility. There are medications that can help almost any type of pain, but your doctor must be able to determine the most likely cause of your pain, and how much it is affecting your life, before knowing what course to try and how aggressive to be in a pain management approach.

Questions to Ask Yourself (and Be Prepared to Answer)

Here are the questions about your MS-related pain that you should be prepared to discuss with your doctor. Thinking about them ahead of time, and ideally writing down your answers, can make your appointment go more smoothly. While these are specific to pain, you can tweak them to apply to almost any symptom or medication side effect that you might have from your disease.

Where Does It Hurt?

This is probably the easiest question of all to answer. However, remember – you need to be as specific as possible. Don’t say, “back” when the truth is “low back and sometimes down my legs.” If possible, point to the pain. If your pain moves around, tell your doctor all areas that can be painful and the areas that hurt most often.

How Long Does It Last?

Your doc will be trying to determine if the pain is paroxysmal (meaning it comes on suddenly and sporadically, then leaves just as suddenly) or chronic (meaning it comes on more slowly and sticks around for a long time before slowly fading away or lessening). These two types of pain are usually caused by different things. So saying you're always in pain, or sometimes in pain, is not specific enough. Try something like: "I'm always in some degree of aching pain in this spot, but it's severe in the early mornings and that lasts about an hour."

How Often Are You In Pain?

Try to be precise in your answer to this and include information from the question above about duration.

For instance, has the pain occurred every day in the afternoon for the past week and lasted for 1.5 hours (until you took a nap)? Or does the pain seem to come every 2 months for the past year and stay for 3 days straight each time until slowly resolving? Or, did you notice a sharp pain when getting dressed this morning that went away after 10 minutes, so you thought you should get it checked out?

When Is It Worse?

Do you feel worse when you first wake up and are stiff, or does the pain seem to worsen as the day wears on? Think about the pain in relation to the timing of medications: Does the pain get worse or better right after you take certain medications, or does it seem to not be related to meds at all?

How Would You Describe the Pain?

Here, the doctor is looking for words like throbbing, sharp, burning or stabbing. You can also get descriptive and give answers like “it feels like someone has stuck a knife in my leg and is twisting it around” or “it feels like a belt is being tightened around my ribs.” Answer with as much detail as you can, avoiding answers like “painful” and “it hurts.”

How Intense Is the Pain?

See if you can rate your pain on a scale of 1 to 10 – with “1” being a very slight discomfort and “10” being the very worst pain you have ever experienced (or worse). If you are able to sit and talk normally, your pain is definitely not a 10. Just as you want to make sure your doctor understands that you're in pain, you also want to be careful about overstating your pain level, as your doctor may then think you are prone to exaggeration and assume your pain isn't that bad.

Does The Pain Affect Your Daily Activities?

In other words, has the pain kept you home from work? Have you not kept up with your usual chores around the house because of the pain? Have there been any times that you were supposed to spend time with friends and family that you canceled or not engaged in your favorite hobbies because of the pain? Has your pain affected your sex life? Think hard about any times that your pain has interfered with your life.

Have You Noticed Anything that Worsens or Improves the Pain?

Think hard about this one. Does the pain get more intense after you have been in the sun? Is the pain brought on by an external stimulus (for instance, when clothes touch your body or when someone hugs you) or does it just appear out of nowhere? Is the pain worsened by stress? Stress and pain can make each other worse in a vicious cycle, where a little pain causes worry that it will get worse, and in turn, this stress actually does have a negative effect on the pain. In relation to stress and pain, think about people in your life. Do you see a connection with being around different people and the pain feeling worse or better?

How Effective Are Your Pain Medications?

Think about all medications and remedies that you have tried for your pain, including over-the-counter drugs and any illegal drugs you may have tried (it is important to tell all of these things to the doctor, even if you don’t think he will think it was a good idea to use these things). Rate their effects on a scale of 1 to 10 – “1” being that you detected no effect at all and “10” meaning that your pain quickly and completely disappeared. Don’t forget to mention alcohol use, if you have been drinking to try and lessen the pain. Also mention any other things you may have tried, including acupuncture, massage, biofeedback or other complementary and alternative methods.

Source:

Brenda Stoelb and Dawn M Ehde. Prevalence, classification and measurement of pain. MS in focus. Multiple Sclerosis International Federation; Issue 10, 2007.

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