Pain diary as a treatment tool for patients with numbness, pain and mood disturbance.

Abstract

A large number of patients visit hospitals with complaints of pain and numbness (numbness is an undifferentiated complaint including paresthesia, hypesthesia and muscle weakness), and doctors must carefully listen to their complaints every day. Mood disturbance such as anxiety or depression is often seen in patients with chronic pain.1 The complaints of the patients are diverse. Some patients primarily complain of pain, while some others complain of numbness or sensory disorder. The modes of treatment include pharmacotherapy, nerve block therapy, surgical therapy, rehabilitation etc. However, many patients complain that numbness still persists after treatment. During the visit the patients often say ‘I have experienced pain from time to time since infancy, but I have had very few experience of numbness and that is the source of my deep complaint’. In the results of the present investigation, evaluation was made of the difference of mood between two groups of patients: the patients complaining only of pain (group P; n = 29) and the patients with sensory disorder and pain (group N; n = 31). Patients with psychosis were excluded from this trial. The profile of mood states (POMS)2 was used for the evaluation of mood, and the visual analog scale (VAS)3 was used for the evaluation of pain and numbness. Age, duration of symptoms, and mean value of VAS were not significantly different between the two groups (Table 1). However, in the items of tension, anger, and confusion in POMS, the values were significantly higher in group N (P < 0.01; Mann–Whitney test; Table 1). This reveals that more patients in group N had severe mood disturbance. It was noteworthy that many patients in group N had mood disturbance despite the fact that there was no significant differece in VAS. In this respect, assuming that it may be better to treat the patient with regard to their mental state, the patients in group N were instructed to write about their pain and numbness in a pain diary.4 The patients were asked to write down daily events and their feeling about pain and to submit the diary on the day of the visit. By 2–3 months after the initiation of the pain diary, significant improvement was found in all of the scores of POMS (P < 0.01) and VAS (P < 0.05; paired t-test; Table 2). These results suggest that a pain diary is useful for eliminating and improving the vicious cycle of pain associated with mood disturbance. Among those who used the diary in the course of treatment, many patients confided ‘I can write down what I cannot say to the doctor during examination, so I am often relieved.’