English for Nursing

UNIT 4. PAIN
WHAT DO YOU ALREADY KNOW ABOUT PAIN?
Introduction
Look at this quiz and let’s see what you know. Compare your answers with a
classmate’s. Finally, we will review as a group. Make sure you understand the
questions and vocabulary.

A) DESCRIBING PAIN (I): TYPES

1 2 lower 3 4 hand and feet 5

head back stomach

1. Listen to five patients talking about their pain. In the boxes above, write down the
area/part of the body where each patient feels the pain.

2. Listen again. Complete the sentences the patient uses to describe the pain with
the words in the box below.
punzante hormigueo palpitante
arde insensibilizado
burning dull shooting stabbing tingling throbbing
tiroteo
throbbing
2.1. I still have a headache. It’s like a drum, a real _________________ pain.
parecido a un tambor
leve
2.2. There’s a _________________
dull ache in my lower back. It’s quite a mild pain, but
sometimes I can feel a _________________
shooting pain, like an electric shock.
burning parecido a una descarga electrica
2.3. I get this _________________ feeling two or three hours after food and
llaga
sometimes it’s very sore.
parecido a afileres y agujas
tingling
2.4. It’s a kind of _________________ feeling, like pins and needles. I get it in my
feet as well, but it’s better than last week.
muy fuerte
2.5. Yes, it’s a _________________
stabbing pain, like a knife. It’s a severe pain. It really hurts
parecido a un cuchillo
a lot.

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3. Match the adjective phrases 1-8 with the descriptions a-h.

Se siente como si alguien estuviera tocando un tambor.

Adjective Description
Sensación de ardor
1. A burning sensation a. It feels like someone is beating a drum.
b. It feels like someone is hurting me with a
Un método de dolor 2. A dull ache
knife or something sharp. Se siente como si alguien me estuviera
lastimando con un cuchillo o algo afilado
Un dolor punzante 3. A shooting pain c. It’s strong and sudden. Es fuerte y repentino.
Un dolor punzante
4. A stabbing pain d. It feels like a bee is stinging me. picando.
. Se siente como si una abeja me estuviera

sensación de hormigueo
5. A tingling feeling e. It feels very hot. Se siente mucho calor
f. It feels like someone is pushing lots of
6. A throbbing pain
Un dolor punzante small needles in your skin. Se siente como si alguien estuviera empujando
muchas agujas pequeñas en tu piel.
g. It’s sudden pain that moves quickly from
Sensación de escozor 7. A stinging sensation Es un dolor repentino que se mueve rápidamente de un
one place to another. lugar a otro
No es un dolor, pero sí pica
8. Not a pain, but itchy h. It’s a mild pain that is continuous. . Es un dolor leve que es continuo
Un dolor agudo 9. A sharp pain i. It feels like I want to scratch.
Se siente como si quisiera rascar
1. e 2. h 3. 4. 5. 6. a 7. d 8. 9. c
g b f i

4. Read the following patient-nurse dialogues where patients try to describe their
pain. Use the pictures in each dialogue and the language from ex.3 to complete the
descriptions of the pain. Complete the nurses’ diagnoses choosing from the box below.
micosis dolor de muelas nervio pellizcado dolor muscular angina migraña

fungal infection toothache pinched nerve sore muscle angina migraine

4.1. P: Nurse, it’s horrible, my head _________________________________

feel like some is beating a drum

N: I think you may be having a/an _______________________________

migraine (throbbing pain)

4.2. P: Nurse, I have a really annoying sensation in my hands.

N: Does it feel like ____________________________________________?

someone is pushing lots of small needles in your skin

P: Yes, exactly that! What is it!?

N: You’re experiencing a _______________.

tingling feeling It may be a/an________________.
pinched nerve

4.3. P: Nurse, help! I’ve suddenly felt this really strong pain in my chest!

N: Does the pain move down to your arms, or does it stay in your chest?

P: It stays there, but it’s very intense. Help me, please!!

N: You’re experiencing a _______________.

stabbing pain It could be a symptom of ________________.
angina

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4.4. N: I see that you have some blisters on the soles of your feet. How do they feel?

P: It’s so bad! They feel like _________________________________

very hot/fire/they are very hot . They’ve
been like this since I went to the swimming pool a couple of days ago.

N: That makes sense. The _____________________

burning sensation that you are experiencing
could be caused by a ___________________________
fungal infecction .

4.5. N: Now, Noriko, calm down, I’m here to help you. Tell me, how does your
mouth hurt? Is it like when you play with a slingshot? Like how your hand
feels when the bands accidentally snap on them?

P: [crying desperately] Yeeeeeeeeees!! It hurts a lot!!!

N: [To father] That pain is a ______________________,

shooting pain then. It’s probably just a
regular _______________________
toothache from teething, it’s intense but it will pass
with some paracetamol.

4.6. P: I have this constant pain here in my lower back. It’s not too bad, but it
just doesn’t go away no matter what I do.

N: Does the pain move at all? Do you feel it going to other parts of your body,
like down your legs or up your back?

P: No, just in my lower back, on the left side.

N: I suppose that feels more like ____________________,

a dull ache then. Do you spend
long periods of time in the same position?

P: Yes, standing up at work. I work at an assembly line.

N: Then it’s probably just a/an _________________________.

sore muscle

5. Read the completed dialogues from exercise 4 and answer in pairs:

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5.1. How do patients normally explain their pain?

5.2. How does the nurse help patients to explain their pain?

5.3. What other information does the nurse request to understand the patients’ pain?

5.4. How does the nurse adapt to different patients when helping them explain their pain?

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6. Medical professionals often interact with patients with different types of disabilities
or impairments, or who have other special needs. In pairs, think about the following:

6.1. Which needs do you think that a blind or partially-sighted patient can
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have during a medical appointment?

7. Read the testimony of a blind patient talking about the difficulties he finds during
medical appointments and check with your answers to 6.1.

“I’ve h a d a fe w issu e s w h e n a c c e ssin g h e a lt h c a re , a n d it is re a lly

fru st ra t in g . Fo r e xa m p le , I d o n ’t h a ve a c c e ss t o m y h e a lt h re c o rd s
b e c a u se t h e y a re o n ly a va ila b le o n p a p e r in st e a d o f e le c t ro n ic a lly,
so I n e e d o t h e r p e o p le t o re a d t h e m fo r m e . Th a t c a n fe e l ve ry
in t ru sive , lik e I h a ve n o rig h t t o p riva c y. Ve ry o ft e n , I o n ly g e t
p re sc rip t io n s o r re fe rra l d o c u m e n t s o n p a p e r o n ly, a n d t h a t fe e ls
lik e m y in d e p e n d e n c e is t a k e n a w a y fro m m e , b e c a u se I n e e d
so m e o n e e lse t o a rra n g e re fe rra l a p p o in t m e n t s o r t o g o t o t h e
Ch a rle s Bu rn e t t , p h a rm a c y t o g e t m e d ic in e s fo r m e . An o t h e r c o m m o n p ro b le m
t h a t I e n c o u n t e r is t h a t , d u rin g a p p o in t m e n t s, d o c t o rs o r n u rse s
6 2, Sa lfo rd
o ft e n fo rg e t t h a t I c a n n o t se e w h a t t h e y d o o r w h e re t h e y a re , so
(La n c a s h ire ) w h e n t h e y su d d e n ly t o u c h m e o r st a rt m a n ip u la t in g t h in g s a n d I
c a n h e a r t h e so u n d s, I fe e l ve ry u n p ro t e c t e d . O t h e r t im e s, m e d ic a l
p ro fe ssio n a ls h a ve g o o d in t e n t io n s, b u t t h e y h a ve n o d isa b ilit y
t ra in in g . Fo r e xa m p le , in st e a d o f a skin g w h a t h e lp I n e e d , t h e y
ju st g ra b m e b y t h e a rm a n d st a rt p u sh in g m e in o n e d ire c t io n ,
b u t t h a t fe e ls ve ry sc a ry b e c a u se I d o n ’t k n o w w h o t h e y a re o r
w h e re t h e y a re t a kin g m e . Th is is a ll ve ry d ist re ssin g , a n d m e d ic a l
a p p o in t m e n t s a re a lre a d y st re ssin g e n o u g h !”
Ch a rle s Bu rn e t t CH

Mediation

7.1. Based on Mr. Burnett’s testimony: What adaptations PDU >> Mediation (Support
could medical professionals (doctors or nurses) make to satisfy Guides & Materials) >> “Good
the needs of blind patients during medical appointments? Practice Guidance” & more

7.2. What other patients could have special needs during medical appointments?
Try to list two or three needs for each type of patient that you can think of.

7.3. How could you, as a nurse, help blind patients or the patients you listed in 7.2.
particularly during pain assessments?

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B) DESCRIBING PAIN (II): INTENSITY

IW Pain rating scales, also called pain scales, are used by physicians and other health
care providers to evaluate pain and measure pain levels. Sometimes doctors ask
patients to indicate one of the faces below to say how bad their pain is.

1. look at the faces used in the Wong-Baker pain rating scale. In pairs, think of a
situation in which a patient could point at each of the faces.
a) What kind of pain do they have?
b) What symptoms?
c) What are they suffering from?

duele peor
sin daño
duele un poco duele aun mas duele mucho
duele un poco
mas

2) slight 4) 6) quite bad 8) 10) unbearable

mild
severe excruciating
moderate agonizing
no bad

2.1. Each of the levels of pain can be described using an ADJECTIVE. Look at the
adjectives below and write each one under the faces (table above) according to
severity of pain. Some words are synonyms.

Ex.: 0 = no pain inaguantable

bastante malo moderado sin dolor
leve mild quite bad moderate no pain unbearable
agonizante agonizing excruciating slight not bad severe
agudisimo leve nada malo severo

2.2. When doctors and nurses explain the pain scale to patients, they normally
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describe how much the pain is normally perceived, and how it can affect the
patient’s daily activities.

In pairs, imagine that you have to explain each level of pain to a patient. Do it in the
form of “can” or “can’t” statements like in the example below:

Level Description Level Description

1 The pain is very mild, you can barely 6
notice it. Most of the time you don’t
think about it. There isn’t any normal
activity that you can’t do.

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2 7

3 8

4 9

5 10

Now, compare with the descriptions on the PDU. Pay attenttion

PDU >> Mediation (Support Guides
to any new language.
& Materials) >> “Explaining the
Did you use similar descriptions? Pain Rating Scale” & more

C) TALKING ABOUT PAIN

1. Look at this patient, Mr. Daniels. In pairs, discuss:

a) What do you think are the patient’s symptoms?

b) What do you think he is suffering from?

c) Based on your answer to (b), how do you think his pain is?

d) What do you think he was doing when his pain started?

2. (Track 31) Listen to the nurse interviewing Mr. Daniels and compare with your
answers to exercise 1.

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3. Read the patient record and see if you can complete any gaps from what you
remember from the listening. Then, listen again and fill in the gaps.

shortness
chest
center
face three
arm

was crying

4. Read the completed patient record and list on the table below all the aspects that
you need to record when carrying out a pain assessment.

1) Symptoms 5) Feelings/emotional impact

2) Location 6) start of pain7 ONSET

3) Duration/Frequency 7) relief/worsening factors
4) Characteristics/Movement 8) Timing/timeline
5. Match the beginnings and the endings of the nurse’s questions. To which of the 8
pain assessment aspects does each question relate?

Characteristics
Location
Characteristics
Movement
Duration
Onset
Factors
Emotional impact

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6. Read the cartoons on the following page and decide whether HURT, PAIN, and
ACHE are used as verbs, nouns, or both.

VERB NOUN EXAMPLES

doler HURT X
This won,t hurt

ACHE X

dolor PAIN X

1 2

3
5

[!!] LANGUAGE POINT

I) NOUNS: ‘ache’ vs ‘pain’
a) We use the noun ache for toothache, stomachache, backache, earache, and
headache.
b) For other parts of the body we use pain. With both nouns, we often use the verb
get.
I’ve got a terrible headache. (=a bad headache)
I woke up with a terrible pain in my chest.
I often get backache.

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I get a pain in my leg when I run.

c)The expression BE IN PAIN is common.
Are you in pain?
He has been in pain for some time.

II) VERBS: ‘to ache’ vs ‘to hurt’

a) Ache is also a verb, describing a pain which is constant but not sudden or very
strong.
By the end of the day, my feet were aching.
I have been cleaning windows all morning. My arms ache.

b) Hurt is commonly used as a verb, to describe a pain which is stronger/sharper or

more sudden.
My throat hurts when I speak.
Where does it hurt? (=Where is the pain?)
Ouch!! That hurts!

c) Hurt (somebody/something/yourself): to cause physical pain to

somebody/yourself; to injure somebody/yourself.
He hurt his back playing squash.
Did you hurt yourself?
Stop it. You're hurting me.
d) HURT is an irregular verb: HURT, HURT, HURT

III) DIFFERENTIATING VERBS, NOUNS, AND ADJECTIVES

In the following box you can see various ways to communicate the same idea.

Verb Noun Adjective

My head hurts.
My head aches. I’ve got a headache.
I’ve got a pain in my head. It’s painful

IV) PRACTICE
7. Complete the sentences with PAIN, HURT(S) or ACHE(S)

1) The child fell down and ____________

hurt himself.
2) I’m really tired and my legs ____________
ache after that 15km run we did
yesterday.
3) Are you____________?
hurt

4) Are you in ____________?

pain

5) I get back ____________

ache if I sit in that chair.
6) I felt a sharp ____________
pain in my side.
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7) When you've got the flu, you ____________

ache all over.
8) Luckily, nobody was badly ____________.
hurt

9) Shut up, will you?! You're giving me a head ____________.

ache
10) Where's the ____________?
pain

11) I think he is in ____________.

pain

12) Does your leg___________

hurt when you move it like this?
13) Women have a higher ____________
pain threshold than men.
14) I was in a lot of ____________
pain after my fall.
15) Her ankle_____________
hurts so much that she can’t stand on it.
16) He was_____________
hurt in a traffic accident.
17) Where does it__________?
hurt

18) With your back condition any movement may cause _____________.
pain

19) Where does your leg ____________?

hurt

V) OTHER FIXED PHRASES WITH PAIN, HURT AND ACHE

IW
8. Can you complete the following five idiomatic expressions with the correct word?
a. pain
That customer is a real ____________ in the neck.
hurt
b. Don't mention her weight or you'll ____________ her feelings.
c. No ____________,
pain no gain.
d. A little hard work never ____________
hurt anyone.
e. I have a lot of __________
aches and ___________;
pains it's part of growing older!

VI) MORE ON NOUN vs VERB: RELIEF OR RELIEVE?

9. Read the text 1 on p.8. Find examples of ‘relief’
NOUN VERB
and ‘relieve’ and complete the table: which one is a
noun? Which a verb?
a) Can you find one example where it is not used
as a noun nor as a verb? What is it used as?
b) Can you find another word derived from ‘relieve’? What type of word is it?
What does it mean?

1 Adapted from: https://www.aurorahealthcare.org/services/aurora-spine-services/neck-pain/relief

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SUFFERING FROM NECK PAIN?

With nearly 1 in 3 people suffering from neck pain, it’s nice to know there are
strategies to relieve the discomfort at home. For many people, a few simple
remedies can bring lasting relief.

Using ice packs or heating pads can help relieve neck pain fast. Ice reduces
inflammation, while heat relaxes stiff muscles. Minor neck strains may get better
after a day or so of over-the-counter pain-relieving medication. Regular stretching
can also provide tension relief in your neck muscles. Especially if you spend long
hours at a desk, take breaks every one to two hours for a few minutes of stretches.

But always remember that there’s no shortcut for curing a stiff neck. Stretching,
gentle heat and pain relievers are usually the best ways to decrease neck stiffness
quickly. For long-term neck pain relief and prevention, improve your lifestyle by
exercising regularly, watching your posture, and incorporating healthy habits such
as stretching, relaxing techniques or a healthy diet.

10. Complete the sentences with ‘relief’ or ‘relieve’ (in the correct tense):
a) Exercise can help _____________ symptoms of depression.
b) An allergist can help you find _____________ from conditions such as asthma,
hay fever, skin infections and eye and skin allergies.
c) Epidurals _____________ pain, but increased the numbers of births needing
forceps and the risk of low blood pressure.
d) Neuropathic pain is difficult to treat and drugs often don’t provide much
___________.
e) Researchers find why nicotine in cigarettes may ___________ anxiety in smokers.
f) Almost all studies show people and animals return to normal eating and drinking
habits sooner when given _____________ from pain.

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D) COMMUNICATION: MEDIATION IN PAIN ASSESSMENTS

*A NOTE ON MEDIATION
‘Mediating’ means facilitating communication in one way or another. For example:
• mediating a text can be reading it aloud for a blind person. You are mediating, because
you are giving that person access to a text that they could not access otherwise.
• mediating knowledge can be explaining concepts to someone who is not familiar with
them. You are mediating because you help that person access that knowledge (for
example, numbers in the pain scale), and you build knowledge together.
• mediating communication can be helping to solve conflicts or to reconcile different
points of view, by helping people understand each other’s position. It can also be
eliminating a communication barrier, such as interpreting between languages orally,
or using sign language with deaf people.
In other words: when you mediate, you are more concerned about the other person’s needs
(what they know, the language they are used to, etc.).

Can you think of situations in healthcare contexts where mediation could be necessary?
What could you do in those situations to facilitate communication with patients?

REMEMBER HOW…?
Question structures: remember that you can ask DIRECT and INDIRECT questions – try to use both during
the interview. Some structures you can use are:
 “Could you tell me…?”
 “May I ask you to rate your pain…?”
 “What can you tell me about how your pain affects you in your…?”
 “Does your pain interfere with…? How much would you say that it interferes?”
 “On a scale of 1 to 10, how much does your pain affect / interfere with…?”
 “How do you feel about…?” / “How much relief do feel when…?” “Do you feel any relief if you…?”
“Is there anything that makes the pain worse / better?”

NURSES: PATIENTS:
 Always explain  use adjectives to describe the intensity  Be descriptive: use as many words as possible, use
(numbers, e.g. “Is your pain tolerable?”)) or metaphors (e.g. “It’s as if it was on fire”) or
characteristics (type) of the pain (e.g. “Does your pain comparisons.
move?”); ask them to compare it to other pain.  Compare this pain to other pains you have experience:
 Explain how much that level of pain is normally perceived how is it compared to the worst pain you ever had?
and how it normally interferes with daily life: what CAN How is it compared to other pains you often get?
the patient do? What CAN’T the patient do?  Link pain to actions: give examples of things you CAN
 Adapt language to ensure the patient understands: use or CAN’Tdo because of the pain: describe how it
synonyms, comparisons, metaphors, etc. interferes with your routine, activities, work, etc.

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11. SPEAKING: ORAL EXAM PRACTICE.

Mediation
In pairs, read the context below and exchange roles as nurse and patient to
conduct a pain assessment.
Pay attention to the different patient profiles: what adaptations will the
communication require?
Use the PAIN RATING SCALE on p. 13 to guide the pain assessment. Ask and answer
the questions considering the aspects explained on p.12.

PAIN ASSESSMENT SCENARIOS

BACKGROUND: Student A is a nurse at a medical center (pain clinic, GP surgery, or

hospital). Student B is a patient with specific communication needs (choose from
“PATIENT PROFILES” below). The patient is experiencing pain after suffering a domestic
accident (invent the details).

OBJECTIVE: Conduct a pain assessment role play. NURSE: obtain information from the
patient about the characteristics of the pain (intensity, type, evolution, location,
factors, etc.) to complete the PAIN RATING SCALE; help the patient describe the pain.
PATIENT: describe the accident and the pain in all detail, explain how it affects you,
ask the nurse questions about it.

LANGUAGE FOCUS: Use comparisons and other adequate strategies to explain the pain and
its evolution, factors, etc. Use present and past tenses as needed. Use interrogative
structures to ask questions. Use varied vocabulary to explain pain or symptoms. Ask for
clarification as needed.

PATIENT PROFILES:
a) 10-year-old child
b) Adult foreign patient with only general English knowledge
c) Elderly patient

E) For further practice: WRITING

1. After completing both parts of the interview, write the full patient report with
your partner(s). Your report must include the following sections:
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Patient’s details
Background: cause of pain, timeline, medication history, etc.
Pain assessment (based on Pain Rating Scale)

Your report should be written in full, well-connected sentences. Pay attention to

the use of past tenses and linguistic correctness in general. Be as comprehensive and
detailed as possible to ensure that the patient’s case is recorded properly.

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