We’ve broken pain down into characteristics and common examples in order to help build as much clarity as possible. For any manual therapists reading this, it can be helpful to prompt using these characteristics as you ask your patient to describe their pain.
This one is seemingly an easier category to discuss. However, all pain/sensation intensity scales are entirely subjective, making it difficult to create a universal scale. Typically we use a self-reporting VAS (visual analog scale) of 1 – 10 to identify the degree of intensity. This scale is about as good as it gets, really. You can layer more information on top of this with additional questions about intensity, including:
“Has it ever woken you up at night?”
“When it hurts, how do you respond – are you sweating, breathing fast, or holding your breath, do you reach to hold the painful area?”
Sometimes the pain can be specifically located – when it hurts, if you know exactly where it hurts, it’s good for us to know.
With less distinct pain, you can usually identify a general area where it hurts.
If you’re really unsure where it is, it might be a result of there being multiple areas of pain – even being able to identify this is important. Throughout the treatment it might get more specific when we apply pressure to certain points, and as you get more information, communicate that to your healthcare practitioner.
There’s often an association between sharp pain and intensity. However it’s important that you try to separate the two characteristics (dull pain can be just as intense as sharp pain). Often when it’s sharp we can clearly locate the pain. It might also feel like a “stabbing” or “needle point” sensation. Sharp pain is also more commonly sudden, instead of present all the time. An common example of this is the prick of a needle when getting an injection.
Not necessarily less intense. In contrast to sharp pain, dull pain tends to be more consistently present. It also doesn’t necessarily have to be a broader area (it can be just as small of an area as sharp pain). An example might be the sensation you feel days after getting an injection.
It can be a little difficult to describe this one. The example of “pins and needles” often comes along with numbness, so it’s multiple sensations layered. I personally like to think of Tingly pain as the black and white speckled screen of a tv when it’s not tuned.
Think less about “fire-burning” and more about biological heat. An example you might have encountered is the after-effects of hitting your “funny bone” – not the initial sensation, but the heat that runs down the forearm and hand afterwards.
Numbness can be one of the most confusing pain sensations to experience, because it’s really a lack of sensation, yet it can be excruciatingly painful at the same time. Think of the heaviness of a limb/or portion of your body as an indicator for numbness. Commonly we might experience this (in a big way) when we end up sleeping on our arm and waking up to a “dead-arm”.
If the pain follows a pattern of your pulse, you’d describe it as throbbing. An important note to make with your therapist is whether or not that was how the pain felt initially, or if it has developed into this. The aftermath of a sprained ankle is an example that many of us might be able to recall.
How close to the skin is the sensation? For a superficial pain simply think about a scratch of the skin.
Sometimes it can be difficult to identify just how deep a pain is when it’s not superficial! This is because our skin has a significantly larger nocireceptor (pain receptor) population than organs and deeper structures. Examples of deep pain include organ pain (like a really bad stomach ache), or joint pain (like the sensation you experience when you sit in a really uncomfortable position for too long and then have to move again).
Whatever the type of pain, it’s really useful for us to also know of any patterns in that sensation. In other words, does the pain spread or does it stay local? And if it spreads, where and how does it spread to? A local pattern of pain would be when you bump your shin on something, and even though it’s intense, it doesn’t really go anywhere from there. A referred pattern of pain is very commonly experienced in things like “sciatica”, a heart attack (left arm pain) or tension headaches. If your pain pattern changes during the treatment it’s important that you keep your therapist in the loop on that – does pressure on one spot initiate pain somewhere else?
“It happened when…” or “I’m not really sure when it happened, I kind of woke up like this“. This information is remarkably important for us to know, and helps us understand your pain more than you might think. [Note: if a medical professional tells you that it doesn’t matter how or when your pain started, leave and find someone who realizes the importance of such information].
What does movement or stillness do to the pain? Does all movement hurt, is all movement alleviating? (What about stillness or a particular position?) If specific actions or positions trigger or alleviate the pain, demonstrating those actions for us (slowly) really helps us get a clearer picture. If a particular movement triggers more pain, show us slowly and stop right before it starts to hurt.
This is most likely going to show up in the treatment. Always feel free to let you know how their pressure makes you feel – but especially when it comes to pain, get vocal! Sometimes pressure on a spot could be alleviating/triggering and it can actually also highlight other spots of pain that you didn’t necessarily know about. All of this is good for us to know.
It’s all in the detail.
With all of these characteristics to discuss, you can see how complex and detailed pain can be. More information for us means we can start to understand if it’s acute or chronic, inflammatory, neural, muscular, soft tissue/hard tissue, referred, local, multifaceted or “simple”. And when we understand this, we can tell when it’s inside or outside our scope of practice. When it’s outside of our scope, that’s when we recommend you to a fellow healthcare provider that can investigate your pain further.
As much as we want to avoid pain, it’s an inevitable part of living, so the next time you’re in pain, go through these terms and examples and see what “fits-the-bill” the best.