Taking a Pain History — Medical English Ep. 22

0:00 A patient's knee has hurt for three weeks. It's hard to put into words, she says. What do you ask next? By the end of this episode, you'll have the English to take a pain history, the words and phrases for how it started, what it feels like, and what makes it worse. Listen to how Dr. Okafor turns a vague answer into something precise.

0:27 Can you describe the pain for me? What does it actually feel like?

0:32 It's hard to put into words, Doctor. Some days it's just a dull ache, and other days it's quite sharp.

0:39 That it's hard to put into words moment. That's exactly what we're solving today. I'm Tom.

0:47 And I'm Nadia. This is Medical Voices. We teach the language of medicine, not medical advice. First, ten terms you'll need. Then the full consultation.

1:00 Before we step into the consulting room, let's run through the 10 terms you'll hear in today's conversation. Nadia will start us off. Term 1.

1:10 Pain history. A structured set of questions a clinician uses to understand a patient's pain, covering when it started, what it feels like, how bad it is, where exactly it is, and what makes it worse or better. Example. I'd like to take a pain history if that's alright.

1:30 Term 2. ONSE. When the pain first started and how it began, whether suddenly or gradually. You'll remember onset from episode 3, and it came back in episodes 11 and 18. Today, same question, very different pace. No emergency, just a GP building the picture. Example. Can you tell me about the onset of the pain?

2:02 Term 3. Character of pain. What the pain actually feels like. Dull ache. Sharp. Stabbing. Throbbing. The clinician asks, what does it feel like? And listens for these descriptors. Example. How would you describe the character of the pain?

2:25 Term 4. Severity. How bad the pain is, typically measured on a numerical scale. You heard severity in episode 11's triage episode. Same word, new context, applied to pain specifically. Example. On a scale of 1 to 10, how would you rate the severity?

2:51 Term 5. Pain scale. A simple numerical tool, 1 to 10, that a clinician uses to quantify a patient's pain. You've seen this in episodes 3 and 9. Example. Can you rate the pain on a scale of 1 to 10?

3:09 Term 6. Radiation. Or the verb radiate, whether the pain spreads from its original site to another part of the body. In episode 18, this was chest pain spreading to the arm. Today, a karma context. Does the knee pain travel? Example. Does the pain radiate down the leg at all?

3:38 Term 7. Tenderness. Pain felt when a specific area is touched or pressed during examination. The key distinction. Tenderness is what the examiner finds, not what the patient reports unprompted. Example. There's some tenderness around the kneecap.

4:00 Term 8. Intermittent. Pain that comes and goes rather than being constant. The opposite of continuous. A key timing descriptor in any pain history. Example. Is the pain constant or would you say it's intermittent?

4:21 Term 9. Exacerbating and relieving factors. What makes the pain worse? That's exacerbating. And what makes it better? That's relieving. Always taught as a pair. Example. What are the main exacerbating and relieving factors? Term 10.

4:41 Localized pain and referred pain. Localized pain stays in one place. Referred pain is felt somewhere different from its actual source. A foundational clinical concept that's going to come back in future episodes. Example. The pain appears to be localized rather than referred. Ten terms.

5:09 You'll hear every one of them in the consultation. This exact structure comes up constantly in OET speaking and NMCOSCI history taking stations, so it's worth knowing cold.

5:22 And if OET's on your radar, our channel partner E2 Language has courses built around exactly this kind of consultation. Link in the description. Right, I'll be Dr. Ravi Okafor, a GP at Elmwood Surgery. And Nadia will be Mrs. Sarah Whitfield, a patient in her late 30s who's come in about her knee. Mrs.

5:47 Whitfield, hello. Come in, please, take a seat. I'm Dr. Okafor. What's brought you in today?

5:55 Thank you, Doctor. It's my right knee. It's been hurting for about three weeks now, and it just doesn't seem to be getting any better on its own.

6:04 Three weeks, alright. I'd like to take a proper pain history, if that's okay, just to build a full picture. Can you tell me how it started? Was it sudden or did it come on gradually?

6:16 It was after a run, actually. I usually run two or three times a week, but I did a longer one that weekend, about 10 kilometers, instead of my usual five. The knee was fine during the run, but the next morning it was really stiff, and the pain started from there.

6:32 So the onset was gradual, the day after the run, not during it. That's useful to know. And has anything like this happened before with the knee?

6:42 No, never. I've been running for years, and I've never had any trouble with it.

6:48 Alright, now can you describe the pain for me? What does it actually feel like?

6:54 It's hard to put into words, Doctor. Some days it's just a dull ache, and other days it's quite sharp.

7:01 That's very common actually. Let me give you a few words and you tell me which ones fit. Would you say it's more of a dull ache, a sharp pain, a stabbing feeling, or a throbbing sensation?

7:17 Mostly a dull ache. But it goes sharp when I bend it, like going downstairs, or if I've been sitting for a long time and I stand up.

7:26 So a dull ache at rest and sharper with certain movements. That helps. Now I'd like to get a sense of the severity. On a scale of one to ten, with ten being the worst pain you can imagine, where would you put it?

7:42 On a bad day, I'd say five, maybe six. When I'm just sitting, it's more like a three.

7:47 So it varies. Five or six on a bad day, three at rest. That's the pain scale we use, and the range is really what matters. Mednomads, quick question for you. When a patient says five or six out of ten, what follow-up question do you ask to make that number more useful? Drop yours in the comments. Does the pain stay in the knee or does it radiate anywhere else?

8:16 Up into the thigh or down into the shin?

8:20 No, it stays right in the knee. I don't feel it anywhere else.

8:25 Good. That tells me the pain is localized to the knee itself, rather than being referred from somewhere else. Referred pain is when you feel it in one place, but the cause is actually somewhere different. In your case, it sounds like the knee is the source and the site.

8:46 Oh, I see. So that's a good thing?

8:49 It's helpful information. It narrows things down. Now, is the pain there all the time or does it come and go? It comes and goes. So intermittent, worse with activity, and worse as the day goes on. What about the other direction? Is there anything that seems to help? Rest helps.

9:20 If I stay off it for a while, it settles down, and I'd been putting ice on it at home, which takes the edge off for a bit.

9:27 So the exacerbating factors, the things that make it worse, are activity, particularly impact, like running or stairs, and the relieving factors, what helps, are rest, keeping the weight off it, and ice. Does that match how you'd describe it? Yes, exactly. A couple more questions before I examine you.

9:48 Have you noticed any swelling or the knee locking or giving way?

9:54 No swelling that I've noticed, and it hasn't locked or given way, no.

9:59 Good, that's helpful. Would you mind if I have a look at the knee? I'll just ask you to roll up your trouser leg for me. Of course. I'm just going to press around the knee gently. Tell me if anything is particularly sore. There's some tenderness here, around the front of the knee, just below the kneecap.

10:22 Does that match where you normally feel the pain? Yes, that's the spot. It's right there. Okay. So, Mrs. Whitfield, let me summarize what we've covered. You've had pain in the right knee for about three weeks, starting the day after a longer run. The character of the pain is a dull ache at rest, sharper with movement.

10:46 You'd rate it around five or six on a bad day, and it's intermittent, worse with activity. It stays in the knee, it doesn't travel, and rest and ice help. No swelling, locking, or giving way. On examination, there's some tenderness around the front of the knee.

11:06 Yes, that's it exactly.

11:08 That's a helpful picture. I don't want to jump to conclusions on one visit, but nothing here is ringing alarm bells. What I'd like to do is have you back in a couple of weeks so we can see how it's tracking. And in the meantime, just listen to the knee. Don't push through pain.

11:27 So I don't need to stop running completely.

11:30 Not at all. That's not where we are. Just listen to what it's telling you day to day. And if it gets worse, or you notice swelling, locking, or the knee giving way, don't wait for that appointment. Come back sooner.

11:45 That sounds good, Doctor. Thank you.

11:48 You're welcome. Any other questions for now?

11:52 No, I think that covers it. Thank you, Dr.

11:54 Ockerfall. You're welcome, Mrs. Whitfield. Take care. Now let's replay three key exchanges from that consultation. A little more slowly this time, so you can hear the phrasing clearly. Can you describe the pain for me? What does it actually feel like?

12:17 Mostly a dull ache. But it goes sharp when I bend it, like going downstairs, or if I've been sitting for a long time and I stand up.

12:28 So the exacerbating factors, the things that make it worse, are activity, particularly impact, like running or stairs, and the relieving factors, what helps, are rest, keeping the weight off it, and ice. Does that match how you'd describe it?

12:46 Yes, exactly.

12:49 That tells me the pain is localized to the knee itself, rather than being referred from somewhere else. Referred pain is when you feel it in one place, but the cause is actually somewhere different. In your case, it sounds like the knee is the source and the site. Before we unpack what Dr. Okerford did in that consultation, a quick word about our channel partner, E2 Language.

14:10 If OET or IELTS is on your radar, E2 has courses built around the kind of clinical conversation you just heard. Medical Voices viewers get 26% off with the code MDV26. The link is in the description. And just so you know, that's an affiliate link, so we earn a small commission at no extra cost to you.

14:36 So the consultation is done. Let's break down what made that conversation work and what you can take into the next history you take in English. Point 1. Starting broad, then narrowing down. Notice how the GP opened with an open question, what's brought you in today? And then moved to closed questions to pin down specifics.

15:00 Is it sharp or dull? Does it travel anywhere? That open-to-closed sequence is the foundational communication skill of history taking. It lets the patient tell their story first, and then the clinician fills in the detail.

15:17 Point 2. The words patients reach for. Mrs. Whitfield's first response was, it's hard to put into words. That's the real clinical moment. The clinician's job at that point is to offer the vocabulary without leading the patient. The GP didn't say, so it's sharp, is it? He offered a menu. Dull ache, sharp, stabbing, throbbing?

15:46 That lets the patient choose without being steered toward a particular answer. Point 3.

15:53 What 1 to 10 actually gives you? The numerical scale is useful, but it's not a diagnostic instrument. It's a communication tool. When Mrs. Whitfield says, 5 or 6 on a bad day, 3 at rest, the GP isn't treating those numbers as absolute, he's listening for the range, the pattern, and how the pain affects the patient's life.

16:17 That context around the number is where the clinical value sits.

16:43 The clinician translates that into clinical language. Exacerbating factor, impact activity. That register move from everyday English to clinical English is exactly what you need to practice for any exam or any real-world handover.

17:04 Point 5. Summarizing and safety netting. Two moves happen at the close. First, the GP restates everything he's heard in clinical terms and checks the patient agrees. That summary and check is providing structure, showing the examiner you can close a history-taking sequence cleanly, and it's exactly what OET speaking raters look for.

17:28 Then he safety nets. If the pain gets worse, or you notice swelling, locking, or the knee giving way, come back sooner. That come back if language is what protects the patient.

17:42 Time for the quiz. Three questions all from today's vocabulary. See if you can answer before Nadia does. Question 1. What is a pain history and what are the main areas it covers?

18:01 A pain history is a structured set of questions a clinician uses to understand a patient's pain. It covers onset, character of pain, severity, radiation, timing, and exacerbating and relieving factors.

18:16 Question 2. What is the difference between localized pain and referred pain?

18:28 Localized pain stays in one place, right where the problem is. Referred pain is felt somewhere different from its actual source. The patient's knee pain was localized, staying in the knee itself, rather than traveling elsewhere.

18:42 Question 3. A patient says, it hurts more when I walk. What is the clinical term for something that makes pain worse?

18:57 That's an exacerbating factor. Walking is the exacerbating factor. And whatever helps, like rest, is a relieving factor.

19:06 Three out of three. The full vocabulary list and the complete dialogue are in the PDF transcript. You'll find the download link in the description. And remember, if OET or IELTS is on your horizon, check out E2 Language. The link and the discount code are in the description. If you'd like to support medical voices directly, you can join us as a Med Nomad member with the Join button under the video.

19:37 That's episode 22. Mrs. Whitfield's pain history is done, and Dr. Okafor has a clear picture. Next time, the same framework but applied to abdominal pain, where the questions have to be sharper and the differential is wider. See you next week, Med Nomads. See you next week.