“Where does it hurt?”


I burst out laughing.



Simple enough question, right? Simple enough for anyone to answer, it seems—My arm hurts. My stomach hurts. My head hurts. My toe hurts—you get the picture.


We have all been to the doctor. The routine is predictable – check in, insurance, forms to fill out, weight, then the nurses paving the way for the doctor by asking those preliminary questions such as “Why are you here today?” and finally, my favorite, “Where does it hurt?”


Even though the rheumatologist offices I have dealt with usually hand me a chart with the check in paperwork where I have to color in places of pain—doctors who do not deal with patients in chronic pain don’t have that special chart—still, someone along the way inevitably asks the question. “Where does it hurt?”


My response? I burst out laughing. Every time. No matter who does the asking. It is a knee jerk reaction to what I see as a ridiculous question that I couldn’t possibly answer in any other way.


This seemingly routine and  simple question is actually the most complex question rolled into four words that I have ever heard.


I always expect the person asking to laugh with me – but it never happens. He or she just looks at me as if I am speaking some ancient extinct language or telling an inside joke that could not possibly be understood.


After the laughter—which I just cannot help no matter how hard I try—I take a deep breath and try to scan my body for a moment so I can answer the pain question. Inevitably it is easier to say what doesn’t hurt but no one wants that answer. So, I dig right in and talk about the swelling, the joints, and the elbows that only act up when I flare really badly. There is an intense soreness that comes and goes that is my new companion that can be worse than the pain itself. It usually shows up in the aftermath of a flare. I have burning, tingling, and aching so deep it seems as though my body will implode. And I have the pain in my skin that gets drowned out by all the other constant pain that is screaming for attention. Until I bump into something. Then I suddenly realize how much pain courses through my outermost fleshly layer, and want to swear a blue streak or just break something so that I won’t be the only shattered thing in the room.


I am no longer laughing.


Before I can finish my long list of pain, I usually get cut off with some sort of comment about how it just hurts all over. Although, sometimes I get the follow up question – if the person or nurse is really truly interested: “Where does it hurt the most?”


Again, more scanning and more listing and the more I tick off the list the more I notice aches and pains I hadn’t noticed a moment ago. And, by this time I am at a loss for words. How to explain that sometimes the pain in one location is worse than pain in other locations?  Or sometimes the pain has the same horrid intensity, where I finally break down in tears and lose my ability to walk – if even for a short time.


Pain is my nemesis, ever seeking ways to startle, ratchet up its previous intensity, limit my mobility and chip away at my sanity. I know the logic behind the “Where does it hurt?” question is to gauge the effectiveness of my current medication, whether my pain treatment is helping, how fulfilled and back to normal my life is based upon my doctor’s current plan. But, sometimes I resent it. I want the doctor to just know by looking at me, and I don’t want to rehash the fact that I am never without pain somewhere in my body – it is only a matter of how much.


Try explaining that to someone who bounced out of bed, actually gets refreshed from sleeping, and doesn’t have to worry about how exhausted he or she will be at the end of the day from the pain that has been coursing through their body, wrenching every last piece of energy out of grasp. I dare you.


In the meantime, I just keep laughing.


Have you ever had difficulty communicating with your rheumatologist about your pain levels?