You will have an appointment with a pain doctor, a specialist like me!
You waited a long time for this appointment and now you are getting anxious as you have
so many things to say about your pain. Where do you start telling your story? How do you
explain your pain and how it affects you? You want to make the best of this appointment,
get your questions answered, get a proper diagnosis and an individualized treatment plan.
But you wonder, which questions the doctor will ask me? How do I give an accurate response
so I can help the doctor to help me? In this video, I will tell you exactly
what questions I ask all of my patients with chronic pain,
and how you can get prepared for this appointment. So, let’s talk about Talking About Pain today
I use the SOCRATES method to get the information I need about pain.
S is the site, where does it hurt? O is the onset, what were you doing
when the pain started? C is for characteristics,
how does the pain feel like? R is for radiation, does it go anywhere else?
A is for associated symptoms T is for time, when did it start?
E is for exacerbating, what makes it worse or better?
S is for severity or pain intensity. The SOCRATES method is one of the methods that I
use to teach medical students how to ask questions about a patient’s pain. The order of the questions
does not really matter, but it is important that we cover all of these aspects when we are taking
a pain history. An appointment with a pain doctor may take between one to one and a half hours, but
we want to use this time wisely. We need to get a lot of information, not just about the pain, but
also about medications, other medical conditions, family history, psychological status, habits,
work and relationships. We also need to do a thorough physical examination and we need
to save some time in the end for me to explain things to you and what we are going to do. what the next steps will be.
So, although 90 minutes may seem a long time, we have a packed agenda.
Before I continue, let me remind you that this video is not intended to replace medical advice.
It is for educational purposes only. If you need medical advice, contact your doctor.
In case of emergency, go to the nearest emergency department or call 911.
The pain site I am a pain doctor
and I treat chronic pain. Chronic pain is pain that persists for more than 6 months.
I need to know the localization of your chronic pain. I will give you a pain diagram like this
and I will ask you to mark all areas that you have pain on a regular basis.
I want to know which is the number 1 painful spot, the one that bothers you most. Put #1
on that pain. If you have other sites of pain, mark all of them. You may use different shades,
different symbols or colours. You may create a legend for the symbols and colours. That will
be very helpful. Do not write text on the body diagram. I need to see clearly the borders of the
body diagram to get a sense of the pain area. Onset of pain
I need to know what were you doing when this pain started. Was it associated with an injury,
an accident, another disease, or treatment for another condition?
Did it start abruptly or slowly? Characteristics
The quality of the pain is very important to me. I will ask you “How does the pain feel like?”
or “Can you describe how you feel this pain?” The answer to this question may give us hints
if this pain is inflammatory, neuropathic, or myofascial. Here are some examples or words that you can use to describe your pain: hot,
burning, electrical shocks, ice-cold, tiring, heavy, diffuse, throbbing, numbing, etc.
Radiation Does the pain radiate somewhere? For example,
neck pain that radiates to the arm, or buttock pain that radiates to the back of the thigh.
Sometimes headaches are caused by neck pain, and you may notice that the pain starts in the neck.
Associated symptoms. It is important to know
if when there is pain there are also other symptoms like nausea, fever, dizziness,
muscle paralysis, joint stiffness, muscle cramps, incontinence of bladder or bowels?
These are all important symptoms that suggest a specific cause or more urgent problems.
Time How long have you had this pain? Here
we are also interested in knowing the pattern, is it constant or intermittent? Is there a time of
the day that the pain is worse? Pain that is worse when you wake up suggests inflammatory
arthritis. Pain that is worse after a full day of work suggests muscle strain and myofascial
trigger points. Pain that is worse at night and better during the day suggests bone diseases, like bone metastases.
Exacerbating factors What makes it worse and better?
Does movement make it worse or better? How about anxiety, frustration and sadness?
Do you take painkillers, do they help? How much is the pain improved with painkillers?
Does it get better with heat? How about an ice pack? Does ice make it better or worse?
If the pain gets better with ice it is likely inflammation, but if it gets worse with ice,
then it is likely neuropathic. If the pain gets better with NSAIDs,
then it suggests inflammation, if it gets better with antidepressants medications,
it suggests neuropathic pain. All pains get better when the person is distracted,
but if the pain goes away completely when you are distracted, it suggests nociplastic pain.
I explain what nociplastic pain is in my other video about “chronic pain”. It is basically
when the body’s alarm system is malfunctioning. For example: the pain is a false alarm,
or the alarm volume is turned up, or there is a short-circuit in the alarm system.
Severity I’ll ask you to give me a number from 0 to 10,
where zero is no pain and 10 is the most horrible pain you can imagine. I’ll ask you to give me a
number for the pain: 1) right now, 2) the highest in the past 7 days, 3) the lowest in the past 7
days and 4) the average in the past 7 days. Patients tell me that it is hard to assign
a number because pain is more complex than just a number, but this is really important.
First, we need to know if there is ever a time that your pain is zero. That will be very helpful
because if there is a chance that your pain can get to zero, then it is easier to come up
with a treatment plan. Then, we need to know how are your pain severity scores before you start
taking any treatment, as I want to compare your pain severity scores after you try the treatments
that I will suggest to you, and the only way for us to know if they worked is to compare you
with yourself, before and after these treatments.
So, remember these topics next time you are talking to your pain doctor. They will likely
ask these questions and it is better when you are prepared to answer them. You may take notes
before your appointment and start paying attention to those topics that I mentioned.
If you want, you may download a document containing these questions to work at
home. Check the description of this video below to download the document.
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Thank you for watching. Goodbye!