MODULE 2 Describing Pain
Asking about Symptoms
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Module Description and Content Goals:
Given topics on pain history taking as well as signs and symptoms reporting; texts that are varied and of a specialized and medical nature, which include information presented from dialogues and other sources (e.g. photographs, drawings, reference text /research information), the participant will use English with 70 % accuracy to:
1. Use such words describing the concept of pain as: PAIN (noun), PAINFUL (adjective), ACHE (verb), ACHE (noun), HURT (verb), SORE (adjective) and SORE (noun). (Words and Expressions)
2. Identify and use adjectives describing the intensity, character and duration of pain. (Words and Expressions)
3. Listen for main ideas and details. (Listening)
4. Ask appropriate questions about signs and symptoms. (Listening, Speaking, Writing)
5. Identify three primary types of headaches and obtain information from tables. (Reading)
6. Form indirect questions. (Grammar and Speaking)
7. Conduct an interview between a patient and a doctor while taking a history of pain. (Speaking)
8. Record patients’ symptoms and write a history of pain (Writing)
9. Identify the Doorknob Syndrome and the techniques on how to get a patient to open up earlier in the exam. (Communication Tip, Reading).
Module 2 STUDENT HANDOUT H2:1
A. WORDS & EXPRESSIONS TO KNOW.
There are many words that Americans use to describe the concept of pain. Some of them are:
PAIN (noun), PAINFUL (adjective), ACHE (noun), ACHE (verb), HURT (verb), SORE (noun), SORE (adjective)
In addition to understanding the meaning of these words, it is necessary to know how to use them correctly in a phrase or sentence. Not all words go together. For example, do you we have an earache or ear pain, a chest ache or chest pain? Do we hurt all over or do we ache all over? Do people have a sore throat or a painful throat? Below are the common collocations that are used with each word. Study them and then do the exercise that follows.
PAIN (noun) - the feeling you have when part of your body hurts
to cause pain/ to give pain
to be in pain/to have pain/to suffer from pain/ to feel pain
The following expressions are antonyms (opposites):
to increase pain/to make it worse ≠ to alleviate/to ease/to kill/to relieve/to stop pain
pain intensifies/ increases/ grows stronger ≠ pain wears off / stops/ disappears
PAINFUL (adjective) - that causes pain (can be both physical and emotional)
The patient was complaining of painful, swollen knee joints.
It is still painful for him to talk about the divorce.
ACHE (noun) – pain that lasts for a long time; usually used in compound nouns
I have a headache/ stomachache/ toothache/ earache/backache/heartache (often emotional; a strong feeling of sadness)
He suffered from all kinds of pains and aches – many small pains which he felt at the same time, but no real health problems
ACHE (verb) - to feel a continuous pain
I ached all over. /My back ached badly. /My feet really ached.
HURT (verb) - to feel pain/to cause pain in a part of your body
She fell and hurt her leg slightly/quite badly.
My ankle still hurts me slightly/quite badly.
It hurts my knees to run.
I have to sit down because my legs are hurting me.
HURT can mean not only physical pain but also emotional
His remarks hurt me deeply. /I didn’t mean to hurt you.
SORE (noun) - a painful, often red place on your body caused by a wound or infection
The patient developed a bedsore. / Cold sores are also called fever blisters.
SORE (adjective) – painful as a result of a wound, infection or too much exercise
I have a sore throat. / My foot is sore.
B. PAIN, PAINFUL, ACHE, HURT or SORE? Fill in the blanks choosing the best word:
1. He is suffering from chronic ______.
2. He completed the marathon and his body ______ all over.
3. I made an appointment with the dentist because I couldn’t put up with my ______ any longer.
4. A wasp sting can be very______.
5. He was badly ______ in the accident.
6. Gardening and biking aggravates my ______.
7. That spot is very ______, doctor. Don’t press it.
8. After I took the analgesic, the ______ wore off.
9. I can’t walk. My ankle ______.
10. Old people usually suffer from a lot of ______and ______.
11. He is ______ because of all that exercise.
12. Despite all the chiropractic adjustments, my back still ______ me.
C. Your patients may use the following adjectives to describe their pain:
acute burning sudden chronic blunt sharp deep intermittent manageable
nagging shooting persistent stabbing throbbing constant colicky excruciating subsiding
gnawing gripping receding slight agonizing intense aching unbearable stinging
cutting piercing searing radiating subtle sporadic tender uncomfortable dull cramping splitting recurring heavy pounding debilitating pulsating incapacitating jabbing
It is important to understand these terms as they may indicate the type and the source of the pain. Use patient’s own words to record the subjective data; restating in other words what client says may change its original meaning.
D. Classify the words in Part C according to pain intensity, duration and character. Record them in the correct column. Some adjectives belong to more than one column. Use your English-English dictionary if you need it. Follow the example.
INTENSITY OF PAIN / CHARACTER OF PAIN / DURATION OF PAINSEVERE / MILD
acute
sharp / nagging
E. Rate the pain on a scale from 1 to 10. 1 signifies the least pain; 10 means the worst pain possible. The first one is done for you. Answers may slightly vary as this rating is highly subjective.
debilitating aching agonizing dull tender
gripping mild manageable gnawing throbbing
1 mild
2 ______
3 ______
4 ______
5 ______
6 ______
7 ______
8 ______
9 ______
10 ______
Module 2 STUDENT HANDOUT H2:2
LISTENING:
A. Listening for Main Ideas.
Pain is one of the most common symptoms patients complain about. The best judge of the severity and character of pain is the patient, so Dr. Howell is trying to get as much information from Ms. Sandler as possible. Listen to the second part of their interview. Then answer the following questions:
1. Ms. Sandler describes her pain as
A. stabbing and excruciating B. severe and throbbing C. dull and nagging
2. Ms. Sandler’s headache usually lasts 2 days.
True False
3. When Ms. Sandler has an episode of pain, it usually occurs
A. on one side of the head B. on the left and on the right C. at the front and at the back of
the head
4. It hurts the least
A. in the morning B. in the evening C. when she goes to bed
5. Ms. Sandler has a well-balanced diet.
True False
6. Which wasn’t one of the pain triggers Ms. Sandler mentioned:
A. Chocolate B. Her son C. Skipping meals D. Depression E. Her business
7. Ms. Sandler is embarrassed to talk about her headaches.
True False
B. In order to be able to assess pain and help the patient, it is necessary to collect as much information about it as possible. Listen to this interview again. This time, pay close attention to the questions the physician uses to gather information about the pain. Write them down in the spaces provided.
Dr. Howell: So, Ms. Sandler, we have several things going on here, but let’s talk about your headaches first.
______
Ms. Sandler: Usually it’s a severe, throbbing pain. Last week it was so bad that I had to take a couple days off, and I can’t do it right now, being the only owner of the restaurant.
Dr. Howell: You said it’s severe and throbbing. ______
______
______
Ms. Sandler: It can be anywhere from 4 to 10, although last week I experienced the worst pain ever. If I had to use the same scale, I would rate it 11! It was excruciating.
Dr. Howell: ______
Ms. Sandler: Well, it seems to vary. It usually lasts a day and it wears off in the second half of the day. But last week I was down with it for 2 days.
Dr. Howell: OK. ______
Ms. Sandler: Well, the pain is usually on the left or on the right. It never occurs on both sides.
Dr. Howell: ______
Ms. Sandler: I don’t think so… Let’s see... What do you mean by”radiate”?
Dr. Howell: ______
Ms. Sandler: No, I don’t think so, although it’s often in my cheeks and around my eyes.
Dr. Howell: So, let’s see if I got it right. Only one side of your head is affected, left or right, and it is around your eye and your cheek on that side. Can you show me exactly where it hurts?
Ms. Sandler: Right here, doctor… and right over here … on the side.
Dr. Howell: Got it. So, the pain is mainly at the front of your head and it involves a forehead, temple, eye and cheek. Does it ever hurt at the back of your head?
Ms. Sandler: No, only at the front.
Dr. Howell: OK. ______
Ms. Sandler: It’s especially bad in the mornings. It’s so unbearable that I can’t get up. It completely immobilizes me.
Dr. Howell: ______
Ms. Sandler: I feel nauseated, sometimes even after the headache is gone.
Dr. Howell: ______
Ms. Sandler: I wish I knew it, doctor. I think it’s stress that’s causing it. It’s not easy to run the restaurant by myself. I get so busy at times that I don’t have a minute to relax or eat. Then in the evening I will have a big meal and the headache will come on. Or when things go wrong at work, I can be so nervous that I would eat the whole bar of chocolate. Chocolate always aggravates it. And then, of course, I have another aggravating factor in my life. It’s my son. He is my biggest headache. I don’t know when he will grow up.
Dr. Howell: You mentioned chocolate. ______
Ms. Sandler: Precipitate pain? Sorry, I am not sure I understand what you’re asking about?
Dr. Howell: Well, I would like to know if there are any other foods that you think may bring on or cause the headaches.
Ms. Sandler: Oh, foods that cause it… Well, I don’t know… It’s lack of food, if anything. I eat only one sit-down meal a day, and it’s usually late at night. I sometimes wonder if that’s what causes my malaise and morning sickness.
Dr. Howell: ______
Ms. Sandler: I haven’t found any cures yet. Even the pain killers don’t always work. I was hoping that you would help me find the magic bullet. I really need my energy back. I can’t live like this any longer.
Dr. Howell: ______
Ms. Sandler: I used to get some headaches, but I don’t remember them being so unbearable.
Dr. Howell: ______
Ms. Sandler: No, not that I know of... Do you have any idea of what’s going on with me?
Dr. Howell: Well, Ms. Sandler. I have some thoughts, but first I would like to run some tests and see if your blood work is OK. My notes indicate that you haven’t had a routine physical checkup for 3 years.
Ms. Sandler: There’s just one more thing I wanted to share with you, Dr. Howell… I am embarrassed to tell you, but, you know, I’ve been feeling a bit depressed lately.
Dr. Howell: OK, Ms. Sandler. Tell me more about it… When did you start to feel down?
C. Compare your notes with a partner. Listen to the conversation again. During each pause, repeat the sentence or phrase you just heard. Then read it with your partner using proper pronunciation and intonation.
Module 2 STUDENT HANDOUT H2:3
A. In the interview you have just heard, the physician tried to establish the following features about pain:
character, intensity, onset, location, duration, timing, precipitating and alleviating factors, associated features, previous occurrences and family history. What is the typical question asked about every feature? Read the dialogue again and find those questions. Then record them in the right column of the table. Follow the example.
Intensity:
Onset :
Location:
Duration:
Timing
Precipitating factors:
Alleviating factors:
Associated features:
Previous occurrences:
Family history:
B. There are three primary types of headache: tension headaches, cluster headaches, and migraines.These three primary types account for about 90% of all headaches.
Migraine / Tension / ClusterSeverity of pain / at least moderate in severity / mild to moderate in severity / very severe
Characteristics of pain / deep, throbbing and pulsating / dull, aching and pressure-like / intense and stabbing
Precipitating factors / bright lights; loud noises; strong odors; physical or emotional stress; changes in sleep patterns; exposure to smoke; skipping meals; hormones; certain foods (cheese, chocolate, peanuts, etc). / emotional stress, anxiety, hidden depression / may be provoked by alcohol, tobacco, napping, or selected drugs like histamine or nitroglycerin
Onset / long onset; may have prodromal stage (visual disturbances, vertigo, tinnitus, numbness or tingling of fingers or toes) / Pain develops gradually, fluctuates in severity and then can remain for several days / sudden onset
Location of pain / One or both sides of the head; located around eyes, temples, cheeks, or forehead / More generalized pain on both sides of the head; with areas of more intense pain in the scalp, forehead, temples or the back of the neck. / deep, stabbing pain around the temple or the eye; on one side of the head
Runny nose and red, watery eye / absent / absent / present
Sensitivity to light or sound / typical / rare / rare
Nausea or vomiting / common / rare / not common
Sex predominance / more in females / more common in females / more in young males
Study the characteristics of each type of headache in the chart above. Based on the symptoms Ms. Sandler reported, which type of headache does she have? ______