Take a moment to increase your pain vocabulary
It’s been said that the Inuit have over a hundred words to describe snow. Linguists use the number to explain something significant about how we see the world. The Inuit and Eskimo encounter snow much more frequently than the average Spanish or English speaker, therefore they would describe it with more words. But it also gives insight into our life experiences. When an Inuit sees snow, he sees more than you or I do. Same snow, more meaning.
And so it is with medicine and pain. We see a bunch more pain than the average everyday Joe. We learn to evaluate pain more deeply and we understand more about it. It stands to reason that we would have more words to describe pain.
Most of us are pretty efficient at evaluating pain. We push, we prod, we ask our OPQRST questions and we get an idea about what’s going on. But sometimes we come up short when it comes to describing what we’ve found. When it’s time to hand off to another medical provider we can have those moments when our palette of pain words run dry.
I had a similar moment recently while teaching. A student asked me to help with a national registry review question. The question was regarding the nature of “parietal pain”. I drew a blank. I picked through some likely possibilities for the definition but each time I came up empty for a clear answer. I had to punt. I told them that I recalled learning the term but couldn’t remember the exact meaning of parietal pain.
The moment inspired me to do a review of some of the words we use in medicine to describe pain. You will certainly encounter and evaluate plenty of pain in your EMS career. You’ll get to know pain the way an Inuit knows snow. Here are some words to help you through the blizzard.
The word colicky is often used to describe fussy babies, especially when we suspect that they are experiencing some sort of GI discomfort. But the term can be used to describe any abdominal pain that is generalized, achy and comes and goes in waves. Colicky pain comes from blockage of any of the hollow organs of the abdomen and anyone who has had an obstructed or upset bowel is familiar with the achy waves of pain known as colic.
When a nerve in the body is pinched or damaged it tends to send off random, disrupted electrical impulses. These do not stay in the localized area of the damage, instead, they tend to travel the length of the nerve fiber. This can be very uncomfortable for the sufferer of nerve pain. Neuralgia and sciatica are examples of nerve pain.
Don’t get stumped by the national registry! Parietal pain is associated with infections involving the abdominal peritoneal lining or the pleural lining of the chest wall. It is a sharp, well localized pain that increases on inspiration, palpation and movement. The pain from pleurisy, or “pleuritic chest pain” is the type of pain most commonly associated with the term “parietal pain”. Infection of the peritoneal lining in the abdomen (peritonitis) also produces parietal type pain.
This one is also associated with the abdominal pleura and peritoneum. When the lining of the abdomen is irritated from infection it adopts a unique characteristic. The examiner can gently apply pressure to the abdomen without producing significant pain, but when the pressure is quickly removed, the pain increases dramatically. This is known as rebound tenderness.
Referred pain is an ache felt close to the surface of the skin. What singles out referred pain is that it occurs in an area of the body that is remote from the actually area of injury or inflammation. Referred pain is not the same as pain that radiates. Radiating pain travels from one area to another, like the way a heart attack victim may feel pain travel from his chest down his arm.
Referred pain is isolated and separate from the actual area of irritation and is often considered a separate complaint. It’s useful to learn common patterns of referred pain to avoid dismissing it as a secondary injury. For example, both an inflamed gallbladder, or bleeding in the abdominal cavity can produce referred pain in the scapula.
Tissue, skin, muscles, joints, ligaments and solid organs tend to produce somatic pain. It is sometimes called skeletal pain. This pain is sharp, well localized and can easily be reproduced through movement of the area involved.
Visceral pain is a vague, deep, achy pain that is poorly localized. It can be colicky and doesn’t tend to increase on palpation or movement. This pain is experienced during blockage of hollow organs. Bowel obstruction, cholecystitis and early appendicitis all cause visceral pain.
So there you have it. When you wade forward into the snow storm of human pain hopefully you’ll have a few more words to help you explain and document what you find. what other words have you found useful in describing your pain assesments? How do you describe the snow? Leave a comment and let us know.
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