Depending on the severity, dealing with pain can be like carrying an unwanted weight. We might grow accustomed to it but we can’t wait to get rid of it.
With September being Pain Awareness Month, we asked local doctors what to consider when describing pain to a care provider.
“What it boils down to is that pain is a personal and subjective experience,” said Dr. Lukasz Chebes, Pain Medicine of Evangelical and medical director of Pain Medicine at Evangelical Community Hospital. “So when we evaluate a patient with pain and we take their history, we rely on the patient’s own self-report. That is the gold standard.”
Both Chebes and Dr. Ryan Ness, director of Pain Management at Geisinger Medical Center, referred to the commonly used pain scale, with zero being no pain and 10 being the worst pain imaginable.
At Geisinger, Ness said, care providers have tried to help patients communicate their pain story by attaching descriptors and emojis, or facial expressions, to the scale numbers. Geisinger describes a 10 pain level as immobilizing, followed by 9, severe; 8, intense; 7, unmanageable and 6, distressing; to 5, distracting; 4, moderate; 3, uncomfortable; 2, mild; 1, minimal; and zero, meaning no pain.
“As we go down through the scale, you can imagine that getting a good number to describe your pain is only part of the storytelling,” Ness said.
Chebes pointed out at least six other considerations in describing pain, starting with location. For example, he said care providers would need to know if a patient is experiencing, say, low back pain or leg pain. Or both. If it’s leg pain, is it in one or both legs?
Quality and duration of pain also help doctors with a diagnosis. Is the pain dull or achy, sharp or stabbing? How long has it lasted? Is it more recent, acute pain or pain the patient has had for years? Or is it intermittent?
“Sharp, shooting, lancing pain can sometimes describe a nerve pain,” Ness said. “So if that’s going down a leg or arm or shooting up the back of your head, that can help us understand what’s happening. Soreness or aching similar to a toothache can sometimes be arthritic or mechanical pain, a pain in the joint.”
Context guides doctors in a diagnosis, Chebes said. Has the patient suffered a fall, been involved in an accident or undergone a recent surgery?
“If you’re at rest or in bed and you’re awakened by this pain, it’s a whole lot different than if you’re a weekend warrior and you’re playing in a local softball tournament and you slide into second base and twist your ankle and it’s tough to put weight on it,” Ness said.
Modifying factors and associated symptoms are also considered.
“What alleviates the pain?” Chebes asked. “Maybe it’s better when you’re sitting down. Maybe it’s worse and is aggravated with ambulation, when you walk or when you’re upright. and then things like associated symptoms: if you have radiating neck pain, is it associated with things like numbness or tingling or weakness?”
“These are all categories of pain and descriptive words that help us give some insight into what’s happening to a patient when they present to the emergency room or to the pain clinic,” Ness said.
Along with the patient’s story, care providers use objective findings like X-ray, MRI and CT scans.
“We want to talk to the patient and gather all this pertinent information as part of the history and revealed systems and put that together with objective findings to formulate a diagnosis and come up with an appropriate treatment management plan,” Chebes said.
Continuum of options
Many treatment options are available to patients suffering from chronic pain, including: rehabilitative measures like physical therapy or occupational therapy, medications, interventional treatments like injections, dorsal column or spinal column stimulation and, ultimately, surgeries like decompression or fusion.
“We want to use the appropriate treatment option for the right presentation,” Chebes said.
Other options can include acupuncture, therapeutic massage, biofeedback and cognitive behavioral therapy.
“There’s really a lot of treatments out there that can help people with chronic pain,” Chebes said.
With the opioid epidemic and the stigma associated with pain management, Geisinger started a multi-disciplinary pain program. Individual strategies could include something as simple as sleep hygiene, stretching and relaxation techniques, mindfulness and yoga therapy.
“Our pain educators and nurse practitioners will review your medication management and some of your medical history to see if you’re a candidate for any additional pain management therapies,” Ness said.
Pain is a part of life. Acute pain, from an injury or surgery, comes and goes, but chronic pain, lasting months or years, is another issue.
“In those cases, pain becomes sort of the problem — or the disease itself,” Chebes said. “To some degree, that’s no different than chronic, progressive illnesses and diseases like heart disease or diabetes, for which there isn’t necessarily a cure. So chronic pain has to be managed no different than other chronic conditions.”
Self-management is critical for pain management, Ness said. It helps to stay as active as possible, maintain a healthy weight, follow a healthy diet and become educated on pain strategies. A 25-year-old who is considerably overweight is setting themselves up for future bone and joint problems. At the same time, an 85-year-old who thinks they can clean the whole house in one day, or climb a ladder to do outside work, is being unrealistic and setting themselves up for potential trouble.
“I think the biggest message I would convey is, be kind to yourself and keep realistic moving forward,” Ness said. “If you do have a painful condition, ask others to help you out. Doing too much too quickly and unrealistically is not good for anybody.”
“The encouraging news is that there really is an entire continuum of pretty effective treatment options available to help manage chronic pain,” Chebes said. “And there are therapies emerging all time.”
Cindy O. Herman lives in Snyder County. Email comments to her at CindyOHerman@gmail.com