How to Describe 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 definitive tests exist that can accurately measure and diagnose the experience. And pain levels fluctuate, in terms of timing, intensity and quality, which makes it near 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. 

Yet 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 the appointment. Many people who live with persistent pain keep a daily pain journal for years, or even decades. It's all part of the management piece.

And if you're into art or writing, you can inject a bit of fun — or at least some fulfillment — by incorporating the use of your talents into your journaling.

Below are a few guidelines, i.e., items you can express about in your journal as you prepare for your appointment.

Record Your Pain Intensity 

How bad does it hurt? Intensity is a measure of how strong the signals of felt pain are. For you, the patient, this is probably the most important part of the ordeal.

To that end, many practitioners 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.)  "Faces" in the oucher chart go from happy and smiling to crying.

 

Use Words that Describe the Way the Pain Feels

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 the follow up and monitoring experiences. The words are categorized according to 3 questions: 

  • What Does Your Pain Feel Like?
  • How Does Your Pain Change with Time?
  • How Strong is Your Pain?

Example words from the McGill Pain Questionairre 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. 

Location of Pain

The location of your pain may or may not the area from which the pain is arising. If a nerve is affected, the pain may radiate down an arm or leg, as is the case in sciatica. If you have trigger points or other myofascial pain, you might experience referred pain — pain located in an area that is seemingly unrelated to the actual site of the problem.

Plus, pain is often 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. And 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.

Pain Patterns

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 very important 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. Patterns of pain also help doctors 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 the severity can fluctuate. This 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 other pain management strategy specifically geared to the breakthrough pain; background pain is of lower severity but is fairly constant.

There's also stable pain, where you always have pain, and the intensity is always about at the same level.

These are the kinds of time and severity related things your doctor will likely be looking for in order to diagnose you properly. 

Interruption of Function

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 perform work and play activities, and even to do very basic things such as coughing and sneezing.

Your expectations and attitudes 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  disengagement from self-management activities can cause chronic pain to perpetuate.

The ICSI also wants treating physicians to know that social support and spirituality factor in when you have to adjust to living with pain.

And, your own perception or appraisal of yourself as able to perform actions and tasks has a great deal to do with your ability to function. This is called self-efficacy. A study published in the European Journal of Pain found that back paitients with strong self-efficacy had less disability.

During your exam, the doctor should ask questions about your functioning and how it has changed since you have been in pain. She or he should also try to determine the level of pain you experience while at rest and during activities.

Psychological Issues

Many times depression accompanies chronic back pain. Your doctor should 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 personal journaling, as well.

Cognitive behavioral therapy is a short-term therapy focusing on identifying and changing the thinking patterns that bring unwanted results into our lives. Basically, it's about identifying and managing your pain triggers. CBT has a good reputation for helping people with chronic back pain to avoid disability.

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.

Sources:

Woby, S.R., Roach, N.K., Urmston, M., & Watson, P.J. (2007). The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. European Journal of Pain.

Gould, H.J. III, M.D., Ph.D. (2007). Understanding Pain. Saint Paul, MN: Demos.

Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain. August 30(2).

Qaseem A., et. al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. April 2017. https://www.ncbi.nlm.nih.gov/pubmed/28192789

Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2005 Nov.

 

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