美国国家公共电台 NPR Words Matter When Talking About Pain With Your Doctor

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RACHEL MARTIN, HOST:

If you go to the doctor with a painful problem, you will likely be asked to rate that pain on a scale of zero to 10, with zero meaning no pain at all and 10, the worst pain imaginable. But many doctors and nurses say rating by numbers isn't working, and patients may not be getting the proper treatment for their pain. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE¹: Thirty-three-year-old Adam Rosette knows the numeric pain scale quite well. He suffers a painful bone disorder².

ADAM ROSETTE: It's a tricky³ question - what your pain level is.

NEIGHMOND: Just over a month ago, Rosette had brain surgery to remove benign⁴ tumors that stopped him from chewing or speaking. He was in severe pain but felt uncomfortable rating it too high and never rated it over a seven.

ROSETTE: Higher than that is, like, oh, I'm missing half of my body or a limb or something, you know? And I wasn't in that level of pain.

NEIGHMOND: But he wonders if lowballing his pain level meant he got less medication to control it.

ROSETTE: The medicine wears off and you realize you took less medicine and it's been eight hours and they're not allowed to give you any more for a while.

NEIGHMOND: Now, full disclosure, I was recently in the same boat. I was in the hospital for back surgery and I also lowballed my pain. I know patients in pain need medication, but I've done lots of stories about opioid addiction⁵ and was very wary⁶ of getting too much medication. Neurologist John Markman with the University of Rochester says the numeric pain scale may just be too simple and may lead to both over- and under-treatment.

JOHN MARKMAN: The focus on pain intensity⁷ has led to a sort of paint-by-numbers, if you will, or treat-by-numbers approach.

NEIGHMOND: Instead of focusing on the intensity of pain, Markman says it might be more useful to also look at what the pain is preventing the patient from doing. Can they walk, exercise, focus? Is the pain preventing them from sleeping?

MARKMAN: The way it interferes⁸ with particular activities are really what should be the focus of trying to treat them and take care of them because that's what's most important to them.

NEIGHMOND: Markman recently did a study analyzing⁹ data from patients who rated their pain by the numbers but also answered this simple question.

MARKMAN: Is your pain tolerable?

NEIGHMOND: It turned out three-quarters of the patients in the study who rated their pain as moderately intense - four to seven on the pain scale, a range typically resulting in higher doses of medication - also described their pain as tolerable, a description that normally means no more pain treatment is needed.

MARKMAN: If the patient tells you my pain is a six but, you know, I understand that I have osteoarthritis and I'm accustomed to it, and it's tolerable for me, it changes the discussion you're having with them to, well, what's making it tolerable for you? How are you able to work around it? Rather than thinking, well, I need to give them something or do something for them to reduce that number.

NEIGHMOND: Markman says this is why it's important not to rely only on a number.

MARKMAN: If you were just treating by the numbers, you might say, well, someone has a pain which is a six over 10, I feel obligated to do something about that to reduce that number, just like you might try and fix their blood pressure or their blood glucose¹⁰.

NEIGHMOND: Now, pain is subjective¹¹. Dr. William Maixner, president of the American Pain Society, says people respond to pain differently.

WILLIAM MAIXNER: Everyone has sort of their own internal gauge¹² with respect to how they perceive pain.

NEIGHMOND: So Maixner says patients need to be really descriptive when talking with their doctor about pain. UCLA pain management physician Dr. Chrystina Jeter agrees. She says, the more words, the better.

CHRYSTINA A. JETER: It's perfectly¹³ OK to be a little more flowery with your description of your pain. My pain is aching, it's burning. What does it feel like to you, you know? Where is it? Does it move? It's helpful for us, as health care professionals, to triage your pain and assess, how severe is this? How aggressive do I need to be?

NEIGHMOND: And Jeter says, share with your doctor anything that's helped reduce your pain in the past - massage¹⁴, acupuncture¹⁵, exercise. All these details will help your doctor come up with the most effective treatment for your pain. Patti Neighmond, NPR News.

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