The pain diagram and questionnaire are invaluable tools for defining the disease process and tracking patient outcomes. They also elicit information that may greatly influence management, such as the patient’s psychosocial factors, including occupation, worker’s compensation, and legal situations.
The pain diagram allows patients to map out and put into their own words all of their sensory and pain symptoms that are often difficult to characterize and describe. They do this even before the examiner comes into the room.
It provides a clear clue to the diagnosis that can quickly be confirmed by brief review of the history and a pointed physical exam, saving valuable time.
It also provides information that can be awkward or difficult to elucidate through direct questioning, such as:
• The physician can avoid direct questions that may be perceived as judging or confrontational, such as those regarding worker’s compensation and legal matters, but still retrieve this vital information.
• The physician can concentrate on questions that delve into solving the injury/disability at hand with a target towards improving functional status, which should be the goal of the medical treatment plan.
• It focuses the interaction on the symptoms and loss of function and not on proving fault, permanent degree of impairment, and other medicolegal issues that may be important but should not overshadow the issues of function and quality of life.
The first page of the pain questionnaire is given to patients on subsequent follow up as well:
• This allows tracking of improvement.
• Although, not all pain may be resolved, having information that the patient had 9/10 pain preoperatively with 100% effect on their quality of life and now, postoperatively, has 3/10 pain and 20% effect on quality of life is reassuring for both the patient and treating physician.
• Indeed, in many of these complex injuries a return to 100% ‘normal’ is not possible. Up front acknowledgement of this goes a long way towards creating realistic expectations for patients, and it allows physicians to understand both the opportunities and limitations inherent to the care of patients with peripheral nerve disease.