Symptom Awareness

The Symptom Awareness article in the Fall 2004 issue of The Motivator, focused on both pharmaceutical and non-pharmaceutical medical treatments for the types of pain that individuals with multiple sclerosis commonly experience. Please note that the treatments mentioned in Symptom Awareness articles do not affect one's level of disease activity and myelin damage, but rather address the specific symptom to help provide temporary relief.

Readers who did not see the previous article may call MSAA at (800) 532-7667 to request a copy of the Fall 2004 issue, or they may also log onto msaa.com and go to "publications" to view or download and print the article or full magazine. As a follow-up, this Symptom Awareness column explains how to prepare a pain diary. In the next issue, complementary and alternative medicine (CAM) therapies that may help reduce pain will be discussed.

Monitoring Your Pain

The first step is to acknowledge your pain; only you know how severe and persistent it is. The key is to work with your doctor to develop a pain-management plan. Chronic pain can become a quality-of-life issue, affecting not only how you feel, but also how you live your life.

Pain was the topic of the cover story in the Winter 2002 issue of The Motivator. (Please call MSAA at (800) 532-7667 if you would like a copy.) The article featured Dr. Ann Berger, RN, MSN, MD and chief of pain and palliative care services at the Clinical Center at the National Institutes of Health (NIH). In this article, Dr. Berger expresses the importance of acknowledging your pain and managing it with the help of your doctors. Dr. Berger also gives suggestions on how to identify your pain and how to express to your doctor what you are feeling.

Dr. Berger notes some things to consider when monitoring your pain. She states, "Pain is individual. It's different for each person. That means modalities will be different for all people, and on an individual basis, we need to address the spiritual, psychological, and psychosocial aspects, in addition to the physical side of pain."

Dr. Berger continues, "People should be careful to note the site of the pain, its severity, the date of its onset, its duration, any aggravating or relieving factors, and its effect on physical and social function. To judge the quality of pain, one should determine if it's sharp, stabbing, dull, cramp-like, aching, throbbing, shooting, burning, numbing, pulling, radiating, tight, or responsive to pressure. One should also pay attention to factors that exacerbate or calm the pain. These could be movement, bending, sitting, lying flat, standing, walking, eating, or swallowing, as well as changes in the weather, a specific time of day, or distractions."

One way to track this information is to keep a "pain diary," which will help your doctor in managing your pain, as recommended by The American Pain Foundation. In a pain diary, a person chronicles the following: where a pain is, how it feels, if it was present upon waking, if it changed during the day, if anything (including medication) makes it feel better or worse, if any medications were stopped because of their side effects, if anything aside from medicine helps the pain subside, if sleep is disturbed or made impossible by the pain, if the pain precludes spending time with family and friends, if it makes one skip meals, and if has changed the person's life. By keeping a consistent and accurate diary, you will be providing your doctor with valuable information, which can help with your diagnosis and treatment.

The American Pain Foundation provides a Pain Action Guide on their website (www.painfoundation.org). They may also be contacted at (888) 615-7246. With a pain diary, you will be able to share with your doctor specific details about your pain that you might not otherwise recall or realize. Here are some of their guidelines:

1. Speak up; tell your doctor, nurse or social worker that you are in pain. Talking about pain is not a sign of weakness.
2. Tell your doctor, nurse or social worker exactly where it hurts. Ask yourself if you have pain in one place or several places, and if the pain seems to move around.
3. Describe how much your pain hurts. Use a scale from zero to 10, where zero means no pain and 10 means the worst pain you can imagine. Explain where the pain is the highest, lowest, and how it is at that moment.
4. Describe what makes your pain better or worse. Is the pain always present? Does it get worse when you move in certain ways?
5. Describe what your pain feels like. Use specific words like sharp, dull, aching, burning, tingling, throbbing, etc.
6. Explain how pain affects your daily life. Do you sleep well? Are you able to work, concentrate, exercise, and participate in social activities? How does it affect your mood?
7. Tell your doctor, nurse or social worker about past treatments for pain. Have you: taken prescription medicine or had surgery; tried massage, applied heat or cold, or exercised; have you taken over-the-counter medications or vitamin supplements?

You can help to take charge by understanding your pain and learning about treatment options. The first step toward feeling better is to recognize that the pain is real. The next steps are to monitor the pain through a pain diary and to visit your physician.

—Amanda Bednar