Thursday, November 04, 2010
How the pain scale can help you

By Dr. Anthony Policastro

One of the current requirements of hospital certifying agencies is to ask patients whether they have any pain at the time of each visit. There is a lot more to pain than just asking if it is present. The more detailed a description you can give of your pain, the more likely it will be that it will suggest a specific diagnosis. For that reason, whenever you go to the doctor with a complaint of pain, you should be prepared to give as much in the way of particulars as you can. There are seven major things that you can use to describe the pain. I use a mnemonic to remember them. I took Latin for six years so I use a Latin name to remember them. I think of a Roman gentleman that I have named Quintus Quintus Scala or Q.Q.SCALA for short. The first question to be asked about pain is the Quantity of the pain which refers to how severe it is. The severity is usually based on a scale of 1 to 10. A score of 1 represents just noticeable pain. A score of 10 represents the worst pain you have ever had in your life. Since this is a question that you know will be asked, it is a good idea to have an answer when you arrive to be seen. The second question refers to the Quality of the pain which refers to the kind of pain. It might be burning, stabbing, a pressure, sharp or heavy. Each of these things represents a different kind of cause of the pain. The third question is about the Setting of the pain which involves the circumstances under which it occurs. It might occur between meals or at night. Pain that wakes people up from a dead sleep is frequently due to a serious illness. That is especially true if it happens for a period of weeks to months. The fourth question is Chronology which refers to how long the pain lasts. It also refers to whether it comes and goes or is steady in nature. The fifth question is Associated Symptoms which refers to whether or not the individual is experiencing anything else besides the pain. For example, migraine headaches are often associated with nausea or vomiting. The sixth question is Location which refers not only to where the pain is but whether it moves. It also refers to whether it seems to shoot to another location briefly. The seventh question is Aggravating/Alleviating circumstances. This asks two questions. The first has to do with what makes the pain worse. The second has to do with what makes the pain better. It is a good idea to consider all these questions and write down the answers to them before you go to the doctor. This will allow you to give him/her as accurate description as possible. It will also ensure that important facts are not left out. A good description might not always suggest the exact cause of the pain. However, it will help the physician rule out some things that do not fit with the story. You can help yourself by providing an accurate description of exactly what is going on.

How will changes brought about by health care legislation affect seniors? For American seniors, their retirement years are supposed to be about relaxing, getting out and enjoying the freedom they've earned. In reality, though, even retirement has its challenges, especially when it comes to health insurance. Linda Nemes, senior insurance research analyst for the Delaware Department of Insurance, will be the featured guest speaker at the November meeting of the Sussex County Advisory Committee for the Aging & Adults with Physical Disabilities. Nemes' appearance has been rescheduled from a previous meeting. Nemes will discuss recent changes to Medicare supplemental insurance, also known as Medigap, sold by private insurers to Medicare recipients. The plans provide gap coverage between the amount paid by Medicare and the total amount billed. Nemes will also discuss this year's national health care legislation, and the anticipated effects the new reforms will have on senior citizens. The public is invited to attend the committee's next meeting at 10 a.m. Monday, Nov. 15, at the Roxana CHEER Center, 34314 Pyle Center Rd., Roxana. An open discussion will follow the featured presentation. The Sussex County Advisory Committee for the Aging & Adults with Physical Disabilities is an 11-member panel established by the Sussex County Council to be an advocate for programs and policies that benefit older and disabled residents. The committee meets every other month, in January, March, May, July, September and November. All meetings are open to the public.

'Coping with the Holidays' A special workshop on "Coping with the Holidays," offered by Delaware Hospice will be held on Tuesday, Nov. 16, from 5 to 6:30 p.m., at Nanticoke Memorial Hospital, Cancer Care Building, Seaford. The grief journey can be difficult to navigate, especially during the holiday season. Participants will find help in coping through the discussion and ideas presented at this workshop, and each will receive a free copy of James Miller's book, "How will I get through the Holidays." There is no fee for this workshop which is offered as a community service by Delaware Hospice. However, registration is required. Register by calling Paul Ganster, LCSW, at 357-7147 or email

CPR training opportunities Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford.Participants will learn how to perform the basic skills of CPR on adults, children and infants and how to help an adult, child or infant who is choking. Classes are open to participants 12 years old and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor.The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $30. Late registrations (if seating is available) will be an additional $5. To register, or for details, contact the Nanticoke Hospital's Training Center at 629-6611, ext. 8919. Pre-registration is required.

Mammography Van back on the road The Women's Mobile Health Screening van, newly retrofitted with state-of-the-art digital mammography equipment, was re-dedicated on Oct. 4 at Legislative Hall in Dover.State Senator Nancy Cook and the Delaware General Assembly sponsored the upgrade.

The Delaware Breast Cancer Coalition (DBCC) manages and operates the van, which provides free or reduced cost mammograms to eligible uninsured or underinsured women. Digital technology (Hologic Lorad Selenia) replaced x-ray film equipment on the 2002 Airstream Commercial medical vehicle. Digital technology provides greater image resolution, while allowing health providers to access mammograms from any workstation. Digital records are also easier to store. The Delaware Cancer Consortium recommends annual clinical breast exams for all women, with mammograms by age 40, and annual mammograms and clinical breast exams afterwards. Women at greater risk for breast cancer may need earlier and more frequent screenings, and should discuss those options with their doctors. For more information about arranging a screening mammogram, call DBCC at 1-888-672-9647 weekdays between 8:30 a.m. and 5 p.m. Van staff works some Saturdays and early evenings. Women should have a mammography prescription from their doctor and if possible, a copy of their previous mammogram films for comparison. Van staff will help those without a prescription or a primary care provider.

Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. The program is facilitated by Nanticoke Memorial Hospital Cancer Center professional staff - Terri A. Clifton, MS, NCC, Cancer Care coordinator; Mary Brown, RN, DSN, manager Cancer Care Center; and Wendy Polk, nutritionist - with assistance from Lois Wilkinson, DBCC special projects manager, who helps facilitate the program at Bayhealth. Of particular value to newly-diagnosed women is DBCC's Peer Mentor Program through which they are paired with a long-term survivor for one-on-one support. To learn more about Beginning Your Pink Ribbon Journey at Nanticoke Memorial Hospital Cancer Center, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.

Cancer Support Group The Wellness Community-Delaware offers a general cancer support group for people affected by cancer and their loved ones held at Nanticoke Memorial Hospital. The monthly support group meets in the second floor conference room of the Cancer Care center on the third Monday of each month from 4:30 to 6 p.m. The next meeting takes place on Nov. 15 at 4:30 p.m. The Wellness Community, an affiliate of the Cancer Support community, is dedicated to helping people affected by cancer enhance their health and well-being through participation in a professional program of emotional support and hope. Facilitators are trained mental health professionals with a master's degree or more. Call 645-9150 for information or to register. All support groups offered at the Wellness Community are free of charge. This program is made possible by the support of Nanticoke Memorial Hospital.

Competition to improve school meals Agriculture Secretary Tom Vilsack has announced the Recipes for Healthy Kids Challenge to improve school meals and the health of children across the nation through the creation of exciting new recipes for inclusion on school lunch menus. The competition will draw on the talents of chefs, students, food service professionals, and parents or other community members working together to develop tasty, nutritious, kid-approved foods.There will be a grand prize chosen by the judging panel as well as a Popular Choice winner based on public voting. The judges will also choose award winners for the top two recipes in each category. Winning teams will be invited to prepare their nutrition-packed meals alongside White House chefs. The top ten recipes in each category will be published in a Recipes for Healthy Kids Cookbook to share with students and families. To learn more about the First Lady's Let's Move! campaign, visit The deadline for recipe submissions is Dec. 30. For more information, visit

Bereavement luncheons Delaware Hospice's "New Beginnings" bereavement luncheons are an informal way to meet and talk with others, who have had similar loss experiences. Lunch begins at noon and is followed by a brief program.The location rotates each week of the month according to the following schedule:
  • 1st Thursday: Grottos Pizza, Rte. 26, Bethany Beach;
  • 2nd Thursday: Georgia House, 300 Delaware Ave., Laurel;
  • 3rd Thursday: Millsboro Pizza Palace, Rt. 113-southbound lane, Millsboro;
  • 4th Thursday: Blue Ocean Grill (formerly Milton House), 200 Broadkill Rd., Milton;
  • 5th Thursday (when applicable): Texas Grill (formerly Ocean Point Grill), 26089 Long Neck Rd., Millsboro.
"New Beginnings" luncheons are open to the public. Registration is not required.There is no fee except the cost of your lunch. For more information, call Carol Dobson or Paul Ganster at 856-7717.

Survivors of Suicide Day program Delaware Hospice and Exceptional Care for Children will host the 12th Annual Survivors of Suicide Day Program on Saturday, Nov. 20, with a program at the Delaware Hospice Center, 100 Patriots Way, Milford, from 10 a.m. to noon. A panel of local survivors of suicide loss will begin the program, which will be followed by the 12th National Survivors of Suicide Day Video Conference, sponsored by the American Foundation for Suicide Prevention. There is no fee for this program, but registration is required by Nov. 10. Register online at:, or contact Vicki Costa, LCSW: 302-478-5707 or 302-856-7717, or Sponsored by the Delaware End-of-Life Coalition and the Mental Health Association.