I’m hugely interested in how we describe our pains. Lower back pain and sciatica seem to come with an endless list of adjectives… achy, stiff, stinging, tingly, constant, throbbing, pulsing, shooting, jabbing, agony, flowing (sounds nice), irritating, disabling, excruciating, incapacitating… and yesterday – a new one on me – mangling. Clinicians make a judgment on what’s wrong with you partly based on your description of your pain, so what if our descriptions are misleading?
I’ve had lower back pain myself this last week – no tears please, because it’s been a great opportunity to explore a number of things. ;-) My own back and leg pain has at times been achy, stiff, disabling, boring, and stinging (outside of thigh). What is it about us that causes such variety in our pain?
Different peripheral mechanisms
Out where the pain seems to originate, a variety of things can go on that can affect the messages your peripheral nervous system takes back to the spinal cord. Muscle tightness causes a build up of the “waste products of metabolism”; lactic acid and carbon dioxide. It’s believed that these substances sensitise our nerves, which could be the cause of the constant, relatively low grade ache. Acute inflammation can cause a hot throbbing pain, and if that inflammation is around one of your big spinal nerves (some of which join to form the sciatica nerve), it’s going to be pretty unpleasant – probably throbbing, pulsing and shooting pains and a bit of excruciating thrown in there too. Muscle spasm – a bit like cramp – seems to cause a massive firing of “nociceptors” (the peripheral nerves that are part of the pain-pathway) – this pain is often “agony” and “disabling”.
Different central mechanisms
As I’ve commented before, our central nervous systems (spinal cord and brain) have a nasty (but sometimes useful) habit of learning things – including pain. The longer your pain goes on, the more the nerve pathways can become sensitised and the more potential there is for different manifestations of pain. Pain is not a sensation that exists wholly “out there” in your body; without a brain you cannot experience pain. The other activity in your brain and spinal cord can affect the way your sensations are processed, and therefore their quality – and your description.
Certain hormones like adrenalin and cortisol can have a big impact peripherally and centrally on your pain pathways. They and others also have a big impact on your mood; some hormones “lifting you up” and others “bringing you down”. This will affect how you feel and describe your pain too.
Some of us make use of a lot of words and others make do with very few. Pain is a subjective thing, so you’ll describe it in whatever way makes sense to you, and with whatever words you have at your disposal. I’ve seen people completely stumped when trying to describe their pain – they just don’t seem to have the words for it; and I’ve also seen people describe their pain with a whole host of adjectives, and still not content, they go on to make up words to describe their pain.
Ultimately our descriptions of our pains are just that – our descriptions. They don’t define what’s wrong with us, but as I commented before, clinicians are heavily influenced by the description. In fact medical texts often state that the more words a sufferer uses to describe their pain the more likely the person is to have “psychological issues”. Often people describe their pain as “nervy” or “muscular”, which is known to influence the clinician’s judgment when reaching a diagnosis. “Nervy” suggests a big nerve is involved, “muscular” suggests the pain is coming from muscle – but do you really know that, or is that just your subjective opinion? I rest my case.
So, what to do when faced with the question “How does it feel”?
- If you’re at the doctor’s, don’t over-elaborate – unless you want to be labelled as hysterical.
- Try to separate out different sensations and describe them individually e.g. at rest I have a constant ache, and when I bend forwards or arch backwards I get a stabbing pain.
- Use a pain scale like 1-10
- Describe the impact it has on your life e.g. “I can’t swing a golf club”, “sitting at work is really too sore after 10 minutes”.
If you haven’t tried our backscore, have a go here – it helps to define your back pain or sciatica and the impact it has on you, giving you a numerical score. This is a slightly more objective way of tracking your progress. Have a go at the backscore and if you fancy, post your result on our Facebook page.