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Harvard Commentaries
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Harvard Commentaries
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Creating a History


October 25, 2013

Chronic Pain
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Creating a History
Creating a History
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Reviewed by the Faculty of Harvard Medical School

Creating a History

As with any symptom, a detailed description of the problem is the place to start. To do this, your health-care provider will take your history, meaning that he or she will gather information about your pain. Your health-care provider may ask you the following questions:

    • When and how did your pain begin? Did it start suddenly or gradually? Was there an injury that started the problem?
    • Does the pain come and go, does it get better and worse or is it constant?
    • Is the pain sharp or dull, crampy or throbbing, burning or tingling?
    • Where is your pain located? Has it moved slowly over time, or is it a shooting pain or fleeting pain that arrives and disappears in a few seconds?
    • What makes the pain better or worse? Is it affected by a change in position, any treatment you've tried, your menstrual cycle or your stress level?
    • Are there other symptoms associated with the pain, such as fever, weakness, numbness or nausea?
    • Do you have any other medical problems?
    • Are you taking any prescription or over-the-counter drugs?

Answers to these questions will be helpful in figuring out the cause of your pain. But even if no cause is ever found, your answers may help your health-care provider find the best treatment. For example, a burning pain with numbness suggests that you have neuropathy (nerve disease); your health-care provider might prescribe drugs that can reduce this type of pain, even if the exact cause of the nerve problem is unknown.

The importance of being thorough. You may well have given your pain history before, perhaps several times to several health-care providers. For some patients, this can be a frustrating exercise, and the impulse may be to resist retreading this old territory. But it's important to volunteer as much detail as possible during the history — even if you think you're repeating yourself — because chronic pain can change over time. If it does, new tests may be needed to confirm or even change the diagnosis and help guide treatment. In addition, because the expertise of your health care providers differs, the information you provide may have different meanings and different importance to each of your doctors.

For instance, back pain that has lasted for three months and then spreads into one hip could be caused by hip arthritis. But if your health-care provider learns from your history that the pain has gradually changed, increasing in your back and extending into both hips and legs, he or she might suspect spinal stenosis — a condition that compresses nerves in your back. Your health-care provider's choice of diagnostic tests (and the resulting treatments) may be influenced by the details that you provide. So be as thorough and precise as you are able.

 

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