As spine professionals, we are always looking for a disorder that matches the symptoms. If you have reviewed the website, you will note there are many spinal disorders and these can cause a myriad of symptoms. These disorders generally have a typical history of onset and configuration of symptoms that are generated (with some exceptions). Therefore, we look for specific patterns of pain and how that pain is aggravated. This thread discusses how to describe these symptoms to your doctor.
Location and Quality of Pain
Start off with the description of the location and quality of pain. Neck pain might have different causes than shoulder and arm pain. Location is important as neck pain may be midline pain, pain off to the side or even into the top of the back of the shoulder. The pain may radiate. That is, the pain may start in the neck and then migrate into the back of the shoulder, radiate down between the shoulder blades and then down the arm. The pain may even radiate under the armpit or into the front of the chest. You may have no neck pain but your pain may start in only in the shoulder. Your pain may start in the arm and then radiate into the hand. Describing pain may be difficult might be difficult but try to be as precise as you can. This information is invaluable.
- What is the quality of the pain?
- Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?
- Does the quality of pain change with activity?
- Is the skin hypersensitive to touch?
- Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand.
Percentage of Pain by Location
- What is the percentage of pain in the neck vs. shoulder and arm?
- This is important as lateral shoulder region can be typically associated with arm pain or nerve pain while posterior shoulder pain can originate from neck or nerve sources. Don’t forget that the shoulder joint itself can cause pain.
- Is it 80% neck vs. 20% shoulder and arm pain or the reverse? Is it 70/30, 60/40 or 50/50 (equal in both areas). This percentage number is quite valuable to determine what type of pain the disorder is causing. The pain may be all posterior shoulder (100%) or even only 100% in the hand (or both hands).
Intensity of Pain
- Intensity of pain is described in a 0-10 visual analog scale (VAS). Zero is no pain and ten is intolerable “torture” type pain. The highest pain that currently occurs is noted and the least amount of current pain is also noted. Many patients will put 6-10 VAS on their pain scale but upon further questioning, that index was the maximum pain that had occurred months ago.
- The current pain might now be 0-6 VAS. It is important to know where the direction of the intensity of pain is heading. Note the current VAS pain scale now and the worst VAS pain even some months (or even years) ago and label each one so we know which one is current.
- Rate each area that you have pain. If the neck has 4-6 VAS, the shoulder has 0-2 VAS, and the arm has 8-10 VAS, make sure that is noted.
- This might be difficult for a new patient to discern, but don’t distress on this description. Just be as accurate as you can.
- Is there weakness associated with the pain?
- Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)?
- Is there now an inability to lift the arm due to pain or to weakness?
- Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle?
Incoordination and Numbness
- Are there now some noticeable problems with coordination and walking?
- Do you find yourself unbalanced when you walk?
- Do you “misstep” unintentionally much more than you use to do?
- Do you have trouble keeping your balance in a pitch black room?
- Has your handwriting changed?
- Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button?
- Do you find lightening type electrical charges down your spine if you tilt your head backwards?
- Have your bowel and bladder function substantially changed in association with any of the above symptoms?
Onset and Length of Time Symptoms Have Been Present
- How did the pain start?
- Was it a gradual onset over years or was there one specific activity or injury that caused it?
- When did that injury occur?
- Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?
- How long have the symptoms been present and have they changed in quality or intensity?
- For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe arm pain that radiates down to the hand?
- What activities increase or reduce the pain?
- Think carefully about this question as the information produced is very valuable. Is it sitting that increases the pain where standing reduces the pain or visa versa?
- Can you sit for 15 minutes or one hour before you have to get up? How far can you walk?
- Does prolonged exposure to the activity cause more pain?
- What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain?
- Does the activity cause different symptoms?
- Does the neck hurt with sitting and bending but the arm hurt with bending the head backwards?
- Does the neck pain become worse with bending forward vs. backwards?
- Does raising the arm cause pain or does it relieve pain?
- What does overhead activity do?
- Does sleeping relieve the pain or does the pain wake you at night?
- Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague?
- Does daily function go relatively smoothly unless you lift something up?
- Describe the pain intervals.
- Are you pain free for certain times of the day or with certain activities?
- An example would be that you are pain free sitting but have pain with computer work only at the end of the day. Are there flair-ups that occur?
- Are you pain free for most of the day but by the end of the day, pain onset occurs?
- Do you get pain crises?
- Are you free of pain for a week, month or even year but one event will cause severe, incapacitating pain?
- When the pain crisis occurs, how long does it last? I have some patients who are pain free for months but once every three months or so, a pain crisis would occur that would last one week or more.
Activity and Occupational Restrictions
- How has the pain changed your life?
- Have you adapted to the pain by limiting your activities? If so, what activities do you now avoid? Do you no longer participate in recreational activities that you once did? Which activities have you eliminated? What activities have you modified (bike riding for ½ an hour vs. a previous typical100 mile ride in the past)? You might have given up on running but now swim for fitness.
- What do you now do to prevent pain from occurring?
- What type of work are you involved with?
- Describe your work by its physical demands: Do you have to repeatedly lift, bend and twist? Do you have to sit without position change for long periods of time?
- Are you off of work due to the pain or did you have to change your job position secondary to pain?
- How long have you been off work or have changed your position?
- Is there liability from another party (motor vehicle accident or workman’s compensation involved)?
- Have you been injured by another’s fault?
Liability is too complex to be dealt with by a simple Internet site. Your consultant will need to obtain specific details regarding the injury to help with any decisions on settlement or causality and apportionment.
Previous Consultations or Treatment
- What previous treatment have you had?
- Have you seen a chiropractor?
- Have you seen a therapist?
- How successful or non-successful has that treatment been?
- Have you seen a surgeon and if so, what did they say?
- Did you have previous spine surgery and if so, what procedure?
- What happened to your symptoms with the prior surgery?
Disclaimer: This symptom description list may seem obtrusive, long and picky but believe it or not, this symptom list is not fully thorough. Many other factors can cause symptoms. For example, there are disorders that can mimic the pain that you describe but not be spine related at all. However, for the majority of patients, this list will be a reasonable start regarding how spine pain should be described to your provider.