**3. Pain scales modification proposal**

Medical professionals must be aware that a suffering patient's experiences are impossible to imagine for non-sufferers. A correctly conducted medical interview must use methods which will ensure a correct assessment of the patient's state. Quantitative pain scales should be avoided; rather, the interviewing physician should create a space for patients to freely report on their comfort levels and also to share their own observations and insights into their symptoms. The procedure should consider the following actions:

	- burning pain
	- tingling pain
	- stabbing pain
	- painful reaction to touch (e.g. by clothing)
	- hot/cold to the touch
	- pulsation
	- numbness
	- increased or diminished pain under pressure

A longer list of adjectives, appropriate to the assessed condition, ought to be available for use during the medical interview. The list should be expanded and reviewed as the dataset of performed interviews grows.

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*Suffering as a Diagnostic Indicator*

*DOI: http://dx.doi.org/10.5772/intechopen.94146*

inadequate after surgery [22].

**3.1 Changes in patient communication**

dissonance and incompetence.

3.Ask the patient to describe any changes to their experience prior to treatment and during the course of treatment (e.g., has a new type of pain appeared? Has pain changed type or intensity?) Any change reported should be a prompt to consider whether a new condition or another disease entity has developed.

ineffective or otherwise inadequate. For example, if dosage or strength become

4.Pay attention to the patient's suggestions that the painkillers used are

5.If, after surgery, pain persists in the limbs for more than 2–3 months, or otherwise more than the time expected for full tissue repair from acute

Correctly conducted medical interviews are key in accurate diagnoses of pain conditions. Nevertheless, medical professionals often ignore information given by patients. Feedback from c. 50 patients diagnosed with CRPS in Poland, Germany, UK and USA reveals counterproductive language used by medical professionals in response to reports of painful conditions. It is imperative that doctors be aware of such unhelpful phrases and avoid them. Their use demonstrates that patient reports

1. "**You do not look ill**". Suffering, understood as unwanted, intense pain, need not be visible. Very often the professional forms a visual first impression of the patient's condition before hearing the patient's oral report. Nobody would admit disbelieving a patient, but doctors nevertheless make a "first-impressions assessment" which influences their subsequent approach and diagnosis. If the visual impression is that of a healthy individual (or healthier than the individual's own words suggest), there is a tendency to accept the more positive observation. Opposing one's own first impression may result in feelings of cognitive

2. "**Perhaps you should be more active**" or "**Healing must hurt**". Both of these are symptomatic of the persistent belief in the human body's ability to selfrepair. Our bodies indeed have amazing capacity for regeneration, and the patient's mental attitude - belief that they can be healed - is a factor in this capacity. However, this capacity and self-belief have their limitations and ought not to be relied on in conducting treatment. If a patient experiences increased pain as a result of following the doctors' advice, they will stop cooperating.

Any further reliance on self-repair will become counter-productive.

3. "**You can learn to cope**". It is impossible for a non-sufferer to confidently assert that the chronic sufferer - such as a CRPS sufferer - can ever learn to cope, and important to realize that treatment may be far from straightforward. Many conditions are untreatable and only subject to palliative care - and not everyone, and not under all circumstances, can learn to cope with that.

4. "**It is all in your head/you are making it up**". Patients often report that

doctors, when confronted with reports of increasing pain or requests for more painkillers, begin suspecting mental disorders. Before doctors jump to such conclusions, they ought to consider pain-causing conditions such as CRPS.

trauma, sprain, fracture, or surgery, consider CRPS [23].

are ignored and indicates a high likelihood of an incorrect diagnosis.

*Pain Management - Practices, Novel Therapies and Bioactives*

**3. Pain scales modification proposal**

should consider the following actions:

offered as core descriptors:

• burning pain

• tingling pain

• stabbing pain

• pulsation

• numbness

• hot/cold to the touch

flagged as potential chronic suffering.

• painful reaction to touch (e.g. by clothing)

• increased or diminished pain under pressure

reviewed as the dataset of performed interviews grows.

A longer list of adjectives, appropriate to the assessed condition, ought to be available for use during the medical interview. The list should be expanded and

new disease entities. It seems reasonable to suggest refinements to existing medical procedures. There should be a procedure for when there are no more procedures. Let us use another example, of a girl aged 15 diagnosed with antero-inferior subluxation of the glenohumeral (shoulder) joint with muscle weakness of the shoulder girdle. The various treatments prescribed, such as Kirschner wire fixation, all followed existing procedures but, irrespective of the method used, the shoulder always slipped. In effect, the patient was discharged from several hospitals without positive prognosis. Doctors failed to act on the patient's reports of pain, treating it as normal under the circumstances, because procedures which they followed did not anticipate the particular symptoms which occurred. They failed to reach beyond standard procedures to investigate the patient's condition and offer solutions; a state

of affairs unfortunately common in an underfunded national health service.

Medical professionals must be aware that a suffering patient's experiences are impossible to imagine for non-sufferers. A correctly conducted medical interview must use methods which will ensure a correct assessment of the patient's state. Quantitative pain scales should be avoided; rather, the interviewing physician should create a space for patients to freely report on their comfort levels and also to share their own observations and insights into their symptoms. The procedure

1.Establish the time period during which the patient has experienced constant or near-constant decline in comfort. A period of four weeks or more should be

2.Elicit description of pain in the patient's own words. Patients are usually able to identify differences in their experience. The medical professional may help by suggesting adjectives describing various experiences. The following should be

**120**

