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How to Talk to Your Doctor About Pain (or Anything Else)

Be Specific and Precise

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Updated April 13, 2010

It is estimated that up to 80 percent of people with multiple sclerosis (MS) will seek medical care for pain at some point. Pain in MS has many different causes and levels of intensity and can be challenging for our doctors to correctly diagnose and decide on the appropriate treatment plan quickly.

When we visit our doctor that the most helpful information he or she has is the details that we can give about the symptom and our experiences, especially in the case of pain. Pain in MS can be caused by the disease process itself or as a result of other MS symptoms, such as spasticity or immobility. There are treatments that can help almost any type of pain, but the doctor must be able to determine the most likely cause of the 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.

NOTE: The questions here can apply to almost any symptom or medication side effect that you might have. Use them as a guide to prepare your discussion of anything that you would like your doctor to help you with in your quest to feel better.

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, “feet” when you mean “in the big toe of my left foot.”

How Long Does It Last?

The 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.

How Often?

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 right after you take certain medications, right before certain medications (when they may start wearing off) 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).

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 (like in the following examples or in other cases) 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?

Talk 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.

Sources:

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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