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Pain : finding the ' why ' for your pain

Or, " ...why the heck are you asking me so many questions about my pain ? "

Pain is THE number one problem that brings patients to our door. Yes, people also present with other problems like weakness and poor sleep but about 80% of those that walk through our door to see any of our therapists are there because something hurts and usually they don't know what's causing that pain and they want it sorted. Quickly ! So it can be frustrating when the therapist spends so much of your first session asking questions and apparantly just chatting before you've even taken your shirt off ! Is it really necessary ?

Why do you need to know so much about my pain ?

Years ago my grandfather took my then nine-year old big brother to the GP with tummy ache only to find when he lifted his shirt that Stephen had written on his stomach " Pain here " with a big helpful arrow drawn pointing down to the sore tummy. Grandpa was mortified but the GP laughed, thrilled, and said Stephen was the most helpful patient he'd had all week. Your pain is of course obvious to you but we can't see it or feel it so the more you can tell us the better it is. Your therapist is a bit like a detective, searching for the clues that helps them solve the mystery of what is causing your problem and pain is a big clue towards helping solve that mystery. So what kind of questions do we need to ask and how does it help us find the ' why' to your pain ?

1. How did your pain start ?

Always best to start at the beginning of any story. How did your pain start? Was it an injury, a result of a fall or sporting injury ? For some conditions like knee injuries the way the knee twisted or slipped is a really useful indicator of the kind of structure that may be damaged. Or did the pain start for no apparant reason and gradually sneaked up on you ? Did you wake up with it one morning and if so what had you been doing the day before ? was there any bruising or swelling ? How an injury responds in the first few hours or days can be very helpful in determining the cause. For example sudden swelling or bruising after a knee twisting injury is suggesive of an ACL injury or tear whereas swelling developing over time is more suggestive of cartilege or soft tissue damage.

2. What is your pain ?

Is your pain dull, achy, sharp, shooting, burny, tingly, throbbing etc.... different structures in the body give different types of pain or sensation. For example joint pain is often vague, deep achy pain and can be difficult to describe whereas nerve pain is usually sharp, fast, shooting pain or may include numbess or pins and needly type sensations. Describing pain can be tricky, some people, and indeed some languages, don't have the words to express these subtle differences but just do the best you can with your symptoms. We may ask you to quantify how intense or powerful your pain is such as on a simple 1-10 scale There's no right or wrong answer and it is completely individual - we're not judging you for being wimpy, it merely helps us track how your pain or symptoms are changing over the course of your treatment.

3. When do you have your pain ?

By this I don't mean 3:45pm on Wednesdays but does your pain follow a pattern ? Is it better ( or worse ) at sometimes than others or is it associated with any particular activities, movements or postures etc ? Mechanical pains where structures are being pinched or nipped are often aggrevated by the same movements or postures. Does it make getting to sleep problematic or does it wake you in the night ? Night pain is of particular interest to a therapist as it can be an indicator or what kind of systems may be at fault e.g nerve pain is often worse at night. How does it feel in the morning when you first wake up ? Can you get moving easily or does your body feel stiff or sore ? Inflammatory conditions like Rheumatoid or Polymyalgia tend to follow a fairly regular pattern over a 24 hour period whilst mechnical or non-inflammatory problems tend to be far more erratic.

4. Where do you have your pain ?

You'd think this would be obvious but Mother Nature has wired us up in an odd fashion and we don't always feel the pain where the actual problem is. For example, someone having a heart attack may complain of left arm pain even though there is no injury or problem in the arm itself, the heart has the same ' wiring ' as the left arm so the pain is referred to this region. Gynaecological problems can present at back pain or even on rare occasions as shoulder pain.

5. How has your pain changed ?

Has it improved initially but now is 'stuck' and not getting any better ? Are there things you can do to make it feel better like popping on a hot water bottle or an ice pack ?

How has it improved ? Is there less pain intensity generally or has the kind of pain changed ? Is it still in as wide an area as previously or has it pinpointed down to a more specific region ?

Or has your pain got worse ? Is there more pain now than when it started ? Or has the pain spread ? Have you developed any new pains since it originally started ?

How does your pain respond to any painkillers ?

So you've told us the when, what, where and how and it's our job to tell you the why ! I do understand it can be frustrating going over the same information apparantly again and again but your therapist will ask the questions that are pertinent to their own particular therapy. The answers to all of these questions help to give vital information so your therapist can play Miss Marple and determine the why of your pain or problem and devise the best plan of action to help to get you better as quickly as possible. So whilst you don't need to draw any helpful arrows, please be a patient patient with us and forgive us if your first session seems like Mastermind. There is method in our apparant madness.... honest.


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