CHAPTER 1 - PAIN INTRODUCTION Pain is one of the most common symptoms encountered in healthcare. Patients may describe pain in many different ways, using words such as aching, burning, stabbing, throbbing, cramping, or shooting. Understanding these descriptions is essential for effective communication between patients and healthcare professionals. In this chapter, you will learn the language of pain used in everyday patient conversations and clinical settings. You will explore the key vocabulary used to describe the location, quality, severity, onset, duration, pattern, and radiation of pain, as well as the factors that make pain better or worse. The aim is not simply to memorise medical terms. It is to develop the ability to understand what patients mean, ask appropriate questions, and express their symptoms accurately in professional medical English. By the end of this chapter, you will be able to recognise common descriptions of pain and use appropriate language to discuss and document pain clearly and confidently.CHAPTER 1 - PAINMEDICAL LANGUAGE1

Understanding Pain Pain has four dimensions: Location Where is it? Quality What does it feel like? Intensity How strong is it? Pattern When does it happen? These four elements guide every dialogue, every assessment, every OET role-play. Clinical Phrases These are your core tools. Can you describe the pain for me? Is it sharp, dull, burning, or throbbing? On a scale of 0 to 10, how severe is it? Does it spread anywhere? Is it constant or does it come and go? Does anything make it better or worse?CHAPTER 1 - PAINMEDICAL LANGUAGE2

Medical Interventions for Pain(These are the ones OET LOVES , perfect for prediction.) ★ 1. Pain relief medication Doctors often say: We can give you something for the pain. I'll prescribe some pain relief. You can take simple analgesics. Predictable gap-fill words: analgesics, pain relief, medication, tablets ★ 2. Anti-inflammatory treatment Doctors commonly recommend: You may benefit from anti- inflammatory medication. Try an anti-inflammatory gel/cream. Predictable words: anti- inflammatory, NSAIDs, ibuprofen- type medication (general) ★ 3. Rest Try to rest the area. Avoid overusing it. Predictable words: rest, avoid, reduce activity ★ 4. Ice / Heat therapy Extremely common in musculoskeletal pain: Apply ice for swelling. Use heat to relax the muscles. Predictable words: ice, heat, cold pack, warm compress Cold (for swelling) / Heat (for muscle tension) ice pack / heat pack / cold pack /warm pack /warm compress / cold compress / heat pad. ★ 5. Positioning advice Doctors often say: Try to keep your back straight. Avoid bending or twisting. Use a pillow for support." Predictable words: positioning, support, avoid bending, avoid twisting ★ 6. Physiotherapy referral I'll refer you to physiotherapy. A physio can help strengthen the area. Predictable words: physiotherapy, exercises, strengthening, stretching. ★ 7. Imaging if needed Doctors often recommend: We may need an X-ray. Let's arrange a scan. Predictable words: X-ray, scan, ultrasound, MRI ★ 8. Monitoring symptoms Doctors frequently say: Keep an eye on your symptoms. Come back if it gets worse. Predictable words: monitor, follow- up, review, come back ★ 9. Avoiding triggers Doctors often advise: Avoid heavy lifting. Avoid long periods of standing. Predictable words: avoid, lifting, standing, strenuous activity ★ 10. Hydration & general care Common in abdominal pain, headaches, muscle pain: Drink plenty of fluids. Stay hydrated. Predictable words: fluids, hydration, restCHAPTER 1 - PAINMEDICAL LANGUAGE3

REAL DIALOGUES Listening Practice 1.1 Medical Interventions for Pain Audio Script at the End of This Chapter Listening 1: Lower Back Pain Listen and complete the sentences The doctor advised the patient to ______ the area.1. The doctor offered to prescribe some ______.2. The patient was advised to apply an ______ if there was swelling.3. Listening 2: Shoulder Pain Listen and complete the sentences The patient was advised to avoid ______ the arm repeatedly.1. A ______ may help relax the muscles.2. The nurse may refer the patient to ______.3. Listening 3: Neck Pain After Exercise Listen and complete the sentences The doctor recommended using a ______ to relax the muscles. Simple ______ may be taken if needed.1. The patient should return for a ______ if the pain gets worse.2.CHAPTER 1 - PAINMEDICAL LANGUAGE4

Listening 4: Knee Pain Listen and complete the sentences The doctor advised the patient to ______ the knee.1. An ______ can help reduce swelling.2. The doctor may arrange an ______ if the symptoms continue.3. Listening 5: Abdominal Pain Listen and complete the sentences The doctor advised the patient to drink plenty of ______.1. The patient should take the prescribed ______ as directed.2. The patient should return for a ______ if the symptoms worsen.3. Listening 6: Wrist Pain Listen and complete the sentences The doctor advised keeping the wrist in a comfortable ______.1. The doctor may arrange an ______ if the pain continues.2. The patient can take simple ______ for pain relief.3. Listening 7: Persistent Back Pain Listen and complete the sentences The doctor wants to refer the patient to ______.1. The exercises will help with ______ and stretching.2. The doctor may arrange an ______ if further investigation is needed.3.CHAPTER 1 - PAINMEDICAL LANGUAGE5

Grammar for Pain Grammar Focus (Pain + Adverbs of Degree) Pain is often described with degree adverbs: slightly / moderately / severely / extremely / fairly / intensely Examples: The pain is moderately severe. It becomes extremely sharp when I move. 2. Present Perfect vs Past Simple Used to describe duration and onset. Examples: I have had this pain for two days. (present perfect → ongoing) / "The pain started this morning. (past simple → specific time) 3. Continuous Tenses Used when pain is happening right now or changing. Examples: The pain is getting worse. It is spreading to my back. 4. Comparatives & Superlatives Used to compare pain intensity. Examples: It's worse when I walk. The pain is better after resting. This is the worst pain I've ever felt. 5. Cause & Effect Grammar Used to explain what triggers or relieves pain. Examples: Walking makes the pain worse. Resting helps reduce the pain. The medication relieved the pain." This is essential for Writing. 6. Modal Verbs for Pain Management Used to give advice or explain treatment. Examples: You may feel some discomfort. We can give you something for the pain. You should avoid lifting heavy objects.CHAPTER 1 - PAINMEDICAL LANGUAGE6

Prepositions of Pain Location Use on when something is touching the surface of the body. Examples: The doctor put cream on my arm. I have a rash on my back. She wears a ring on her finger. There is a bruise on my leg. He has glasses on his face. This grammar appears in all four subtests. ❌ When NOT to use on Do not use on when you mean inside or in a body part. Examples: Pain in my stomach. (not on) Injury in the knee joint. Something stuck in my eye. Easy rule to remember On = surface In = inside At = specific point (e.g., pain at the back of my neck”) Examples on the skin — rash, bruise, cut on the face — glasses, makeup on the hand — ring, cream in the stomach — pain, food in the ear — infection, water ON vs WITH: Describing Pain During Activity ON + movement Clinical: Reports shoulder pain on movement. WITH + stretching Clinical: Reports pulling pain with stretching. Remember ON → movement 🚶 WITH → stretching 🤸 Mini practice Complete the phrases: Pain ___ movement1. Pain ___ stretching2. Pain ___ walking3. Pain ___ exercise4. Answers: on movement1. with stretching2. on walking3. with exercise4.CHAPTER 1 - PAINMEDICAL LANGUAGE7

Skill-Building Exercise 1.1 Gap Filling-Prediction Skill The doctor suggests starting simple _____ for pain relief.1. Advises using an _____ medication to reduce inflammation.2. Recommends applying _____ to help with swelling.3. Suggests using _____ therapy to relax tight muscles.4. Advises the patient to _____ the affected area for a few days.5. Recommends avoiding heavy _____ to prevent worsening symptoms.6. Suggests avoiding prolonged _____ or standing.7. Advises gentle _____ exercises to improve mobility.8. Plans to refer the patient to _____ for strengthening work.9. Recommends doing regular _____ and stretching exercises.10. Advises the patient to keep the back _____ while sitting.11. Suggests using a pillow for extra _____ at night.12. Doctor plans to arrange an _____ if symptoms don't improve.13. Advises the patient to _____ symptoms and return if worse.14. Recommends drinking plenty of _____ to stay hydrated.15. Suggests avoiding sudden _____ or twisting movements.16. Advises the patient to take breaks and avoid _____ activity.17. Recommends using a _____ pack for 10–15 minutes.18. Suggests trying a warm _____ to ease muscle tension.19. Advises the patient to follow up for a _____ appointment.20.CHAPTER 1 - PAINMEDICAL LANGUAGE8

Grammar Exercise 1.2 Adverbs of Degree The pain is ______ sharp when I bend forward.1. She reports ______ severe abdominal pain after eating.2. The headache is only ______ noticeable in the morning.3. The pain becomes ______ worse when he lifts heavy objects.4. The discomfort is ______ intense during the night.5. Present Perfect vs Past Simple (duration vs specific time) Choose the correct option (A or B). I ______ this pain for three days. A. have had B. had1. The pain ______ suddenly this morning. A. has started B. started2. She ______ back pain since last week. A. has had B. had3. The pain ______ after he fell yesterday. A. has begun B. began4. I ______ this discomfort before. A. have felt B. felt5. Continuous Tenses (pain changing now) Fill in the blank with the correct continuous form. The pain ______ (get) worse.1. It ______ (spread) to my lower back.2. The discomfort ______ (increase) when I walk.3. The pain ______ (become) more intense today.4. The swelling ______ (go down) after the medication.5. Comparatives & Superlatives Choose the correct form: worse / better / the worst / the best. The pain is ______ when I lie on my left side.1. It feels ______ after taking the tablets.2. This is ______ pain I’ve ever experienced.3. Walking makes it ______.4. Resting gives me ______ relief.5. Cause & Effect Grammar Complete the sentence with the correct verb: makes / helps / relieves / worsens. Walking ______ the pain.1. Resting ______ reduce the discomfort.2. The injection ______ the pain immediately.3. Cold weather ______ the joint pain.4. Gentle stretching ______ ease the stiffness.5.CHAPTER 1 - PAINMEDICAL LANGUAGE9

Modal Verbs for Pain Management Choose the correct modal verb: may / can / should. You ______ feel some pressure during the examination.1. We ______ give you something stronger for the pain.2. You ______ avoid lifting heavy objects for a few days.3. This medication ______ cause mild nausea.4. You ______ take paracetamol if the pain increases.5. Prepositions of Pain Location (on / in / at) Choose the correct preposition. I have a rash ______ my arm.1. There is pain ______ my stomach.2. She has a bruise ______ her leg.3. The discomfort is ______ the back of my neck.4. Something is stuck ______ my eye.5. Mixed Practice – OET Style Sentence Completion Fill in the blank with the correct grammar form. The pain is ______ (adverb) severe when I move.1. I ______ (present perfect) this pain since yesterday.2. It ______ (continuous) spreading to my shoulder.3. The pain is ______ (comparative) after resting.4. Walking ______ (cause & effect verb) the pain worse.5.CHAPTER 1 - PAINMEDICAL LANGUAGE10

Sports That Commonly Cause Pain & Injuries 🏃 Running Why it leads to pain: High impact on knees and ankles / Repetitive movement / Poor footwear / Hard surfaces Common injury types: Shin splints / Runner's knee / Achilles tendonitis / Stress fractures (this word could be confusing for us as not native speaker, stress usually used with emotions and maybe think we can say pressure fracture... but it is stress fractures) be careful .. it means the bone Spoken (patient) language: My legs feel really sore after running. I get a sharp pain in my knee when I run. My heel hurts every time I take a step. Clinical language: The patient reports exercise-induced knee pain. Symptoms are consistent with Achilles tendonitis. Pain is aggravated by weight-bearing activities. ⚽ Football / Soccer Why it leads to pain: Twisting movements / Collisions / Sudden acceleration / Overstretching Common injury types: Ankle sprains / Hamstring tears / ACL injuries / Groin strain Weightlifting / Gym Training Why it leads to pain: Poor posture / Overloading muscles / Incorrect lifting technique Common injury types: Lower-back strain / Shoulder impingement / Muscle tears / Wrist strain Spoken (patient) language: I lifted something too heavy. My back suddenly pulled. My shoulder hurts when I raise my arm. Clinical language: The patient presents with lower-back strain after lifting weights. Pain is exacerbated by flexion and extension. Likely musculoskeletal injury. 🏀 Basketball Why it leads to pain: Jumping and landing / Sudden direction changes / High-speed movement Common injury types: Ankle sprains / Knee pain / Finger dislocations / Back strainCHAPTER 1 - PAINMEDICAL LANGUAGE11

Spoken (patient) language: I twisted my ankle during the match. My hamstring pulled when I tried to sprint. My knee gave way when I turned. Clinical language: The patient presents with acute ankle swelling following a football injury. There is reduced range of motion in the knee. Findings suggest a possible ligament strain. 🥊 Boxing / Martial Arts Why it leads to pain: Punching impact / Falls / Joint overextension Common injury types: Wrist injuries / Shoulder dislocation / Rib pain / Facial injuries Spoken (patient) language: I hurt my wrist when I punched. My shoulder popped out. My ribs are sore. Clinical language: The patient presents with wrist trauma after boxing. Possible shoulder subluxation. Tenderness over the rib cage. Spoken (patient) language: I landed badly and twisted my ankle. My knee hurts when I jump. I bent my finger backwards. Clinical language: The patient reports acute ankle pain following a mis-landing. There is localized tenderness around the joint. Possible ligament sprain. 🏊 Swimming Why it leads to pain: Overuse of shoulder muscles / Poor stroke technique Common injury types: Swimmer's shoulder / Neck strain / Lower-back pain Spoken (patient) language: My shoulder feels sore after swimming. I get pain when I lift my arm. My neck feels stiff. Clinical language: Symptoms suggest rotator cuff irritation. Pain is triggered by overhead movement. Possible overuse injury.CHAPTER 1 - PAINMEDICAL LANGUAGE12

⛷ Skiing / Snowboarding Why it leads to pain: Falls / Twisting motions / High impact Common injury types: Knee ligament tears / Shoulder dislocation / Wrist fractures / Back injuries Spoken (patient) language: I fell hard on the slope. My knee twisted badly. My wrist hurts after landing. Clinical language: The patient reports acute knee pain following a fall. Possible ligament injury. Pain is associated with reduced mobility. 🚴 Cycling Why it leads to pain: Long periods in one position / Poor bike fit / Repetitive pedalling Common injury types: Knee pain / Lower- back pain / Wrist numbness / Neck strain Spoken (patient) language: My knees hurt after long rides. My back aches when I cycle uphill. My hands go numb. Clinical language: The patient reports overuse-related knee pain. Symptoms indicate postural strain. Likely nerve compression in the wrist.CHAPTER 1 - PAINMEDICAL LANGUAGE13

Listening Practice 1.2: Sports & Exercise Injuries Listening 1 : Running: The Persistent Shin Pain Listen to each recording and choose the correct option 1. What is the main reason the clinician is concerned about the patient’s symptoms? A. The patient has recently changed their running shoes. B. The pain has begun occurring during exercise rather than only afterwards. C. The patient experiences pain in both shoulders. D. The patient has completely stopped experiencing pain with rest. 2. What does the clinician say may need to be considered if the pain persists? A. A muscle tear B. An ankle sprain C. A stress fracture D. Achilles tendonitis 3. What advice is given at this stage? A. Increase the running distance gradually. B. Continue running but use softer surfaces. C. Avoid high-impact exercise temporarily. D. Start strengthening exercises immediately. Listening 2 : Football: The Knee That Gave Way 4. Which detail most strongly suggests a possible ligament injury? A. The patient felt pain while sitting. B. The knee became swollen several days later. C. The knee twisted while the foot remained planted. D. The patient had experienced mild muscle soreness previously. 5. Why is the clinician asking about weight-bearing? A. To determine whether the patient can return to football B. To assess the functional impact of the injury C. To check whether the patient has a hamstring tear D. To determine the patient’s fitness level 6. What is the clinician mainly concerned about? A. A ligament injury B. A skin infection C. A chronic back problem D. An Achilles tendon injuryCHAPTER 1 - PAINMEDICAL LANGUAGE14

Listening 3 : Weightlifting: My Back Suddenly Pulled 7. What does the clinician think is the most likely explanation at this stage? A. A neurological disorder B. A musculoskeletal strain C. A knee ligament injury D. A stress fracture 8. Which activity appears to have triggered the pain? A. Running uphill B. Swimming C. Deadlifting D. Cycling 9. Which symptom does the patient specifically deny? A. Pain when standing B. Difficulty getting up C. Leg numbness or weakness D. Pain when bending forward Listening 4 : Basketball: The Finger Injury 10. Why does the clinician recommend an X-ray? A. The patient cannot move their wrist. B. The mechanism of injury could have caused a more serious injury. C. The swelling has already disappeared. D. The patient has a history of shoulder problems. 11. How did the injury occur? A. The patient fell onto the hand. B. The finger was struck by another player. C. The finger was forced backwards while catching the ball. D. The patient deliberately bent the finger backwards. 12. What is the clinician trying to exclude? A. A fracture or joint injury B. A muscle strain C. A nerve infection D. Achilles tendonitisCHAPTER 1 - PAINMEDICAL LANGUAGE15

Listening 5 : Swimming: Shoulder Pain 13. What feature makes an overuse injury more likely? A. The patient fell onto the shoulder. B. The pain developed gradually after increased training. C. The patient injured the shoulder in a collision. D. The patient has severe pain at rest. 14. When is the pain particularly noticeable? A. When the patient bends the knee B. When the patient lifts the arm overhead C. When the patient lies down D. When the patient grips an object 15. What will the clinician assess? A. Blood pressure and temperature B. Hearing and balance C. Shoulder movement and strength D. Running speed and endurance Listening 6 : Skiing: A Difficult Landing 16. Which combination of symptoms concerns the clinician most? A. Mild soreness and normal movement B. Twisting injury and knee instability C. Shoulder pain and wrist numbness D. Back pain and muscle stiffness 17. What happened immediately after the injury? A. The patient continued skiing. B. The patient lost consciousness. C. The knee became unstable. D. The swelling disappeared. 18. What does the clinician advise? A. Return to skiing gradually. B. Keep using the leg normally. C. Stay off the leg until assessment is completed. D. Start running to test the knee.CHAPTER 1 - PAINMEDICAL LANGUAGE16

Listening 7 : Cycling: Numb Hands 19. What appears to trigger the patient’s symptoms? A. Short periods of walking B. Long periods of cycling C. Swimming several times a week D. Weightlifting 20. Why does the clinician think the handlebars may be relevant? A. The patient is gripping them too loosely. B. The patient places prolonged pressure through the hands. C. The handlebars are causing shoulder dislocation. D. The patient is cycling too slowly. 21. What is the first practical step suggested? A. Stop all physical activity permanently. B. Have the bicycle position assessed. C. Start running instead. D. Wear heavier gloves. Listening 8 : Boxing: The Shoulder Popped Out 22. What happened during the boxing session? A. The patient fractured their wrist. B. The patient’s shoulder became dislocated. C. The patient injured their ribs. D. The patient tore a hamstring. 23. Why is the previous injury significant? A. It suggests the patient has poor cardiovascular fitness. B. It means the patient cannot experience pain again. C. Previous dislocation may increase the risk of further instability. D. Previous injuries always cause permanent nerve damage. 24. What does the clinician specifically want to check? A. Nerve and blood vessel function B. Lung capacity C. Knee stability D. Achilles tendon functionCHAPTER 1 - PAINMEDICAL LANGUAGE17

Describing Pain When patients describe pain, they may talk about: Quality – What does it feel like?1. Severity – How strong is it?2. Pattern & Duration – Is it constant or does it come and go?3. Location & Spread – Where is it and does it travel?4. Impact & Emotional Effect – How does it affect the patient?5.CHAPTER 1 - PAINMEDICAL LANGUAGE18

Describing Pain 1. Describing the Quality This answers: What does the pain feel like? 🔥 Burning Pain Meaning: feels hot, like fire. Patient: It's a burning pain in my feet. Clinical: Reports burning neuropathic pain. 🔪 Stabbing Pain Meaning: sharp, sudden, like a knife. Patient: I get stabbing pains in my chest. Clinical: Intermittent stabbing chest pain. ❤ Throbbing Pain Meaning: pulsing, rhythmic, like a heartbeat. Patient: My head is throbbing. Clinical: Presents with a throbbing temporal headache. 🦷 Gnawing Pain Meaning: dull, constant, "eating away" feeling. “Gnaw” literally means to bite or chew repeatedly. Patient: It's a gnawing pain in my stomach. Clinical: Reports persistent gnawing abdominal pain.CHAPTER 1 - PAINMEDICAL LANGUAGE19

🪡Pins and Needles Meaning: a tingling or prickling sensation, often described as tiny needles. Patient: I keep getting pins and needles in my hands. Clinical: Reports intermittent pins and needles in both hands. ⚡ Shooting Pain Meaning: travels quickly along a nerve. Patient: It shoots down my leg. Clinical: Reports shooting pain radiating to the leg. 😣 Aching Pain Meaning: dull, sore, heavy. Patient: My back is aching all day. Clinical: Chronic aching lower-back pain. 🔄 Cramping Pain Meaning: tight, squeezing, like a muscle spasm. Patient: I get cramping pain in my stomach. Clinical: Reports cramping abdominal pain. ✊Grabbing Pain Meaning: sudden tight gripping sensation Patient: It grabs me suddenly. Clinical: Intermittent gripping painCHAPTER 1 - PAINMEDICAL LANGUAGE20

🫸Squeezing Pain Meaning: tight, pressure-like Patient: It feels like something is squeezing my chest." Clinical: Chest pain with squeezing sensation. 📍Pricking Pain Meaning: tiny sharp needle-like sensations Patient: It feels like little needles. Clinical: Reports pricking sensations. ✂Cutting Pain Meaning: sharp, slicing sensation Patient: It feels like a cutting pain. Clinical: Sharp, cutting pain. 🤕Sore / Soreness Meaning: painful, tender, or uncomfortable, especially when touched or moved. Patient: My muscles feel really sore after work. Clinical: Reports generalized muscle soreness. 🔥Searing Pain Meaning: extremely hot, burning, intense Patient: It's a searing pain. Clinical: "Severe burning pain.CHAPTER 1 - PAINMEDICAL LANGUAGE21

🩸Lacerating Pain Meaning: feels as though the tissue is being cut, torn, or ripped. Patient: “It feels like something is ripping inside.” Clinical: Describes severe lacerating abdominal pain. ↔Pulling Pain Meaning: feels as though something is being pulled, stretched, or tugged. Patient: I get a pulling pain in my calf when I walk. Clinical: Reports pulling pain in the left calf on exertion. 🪨Crushing Pain Meaning: extremely heavy or intense pressure, commonly used to describe chest pain. Patient: It feels like a crushing pain in my chest. Clinical: Reports severe crushing central chest pain. 🐝Stinging Pain Meaning: sharp, burning, or prickling, like an insect sting. Patient: It’s a stinging pain when I pee. Clinical: Reports stinging pain on urination. ➡Piercing Pain Meaning: very sharp, as though something is going straight through the body. Patient: It’s a piercing pain behind my eye. Clinical: Reports piercing periorbital pain. ⚡⚡Electrical Pain Meaning: feels like an electric shock or current, often associated with nerve pain. Patient: I get electrical shocks down my arm. Clinical: Reports electrical, shock-like neuropathic pain.CHAPTER 1 - PAINMEDICAL LANGUAGE22

2. Describing the Severity of Pain This answers: How strong is it? These words describe how strong or intense the pain is. 1 Mild Pain Meaning: pain that is present but causes relatively little discomfort or interference. Patient: It’s only mildly painful. Clinical: Reports mild abdominal pain. 2 Moderate Pain Meaning: pain that is between mild and severe in intensity. Patient: It’s not terrible, but it’s quite painful. Clinical: Pain described as moderate. 3 Intense Pain Meaning: very strong or high in intensity. Patient: The pain is really intense right now. Clinical: Reports intense pain, rated 9/10. 4 Severe Pain Meaning: very intense or serious pain that significantly affects the patient. Patient: The pain is severe. I can barely move. Clinical: Reports severe abdominal pain. 5 Unbearable Pain Meaning: pain the patient cannot tolerate Patient: It's unbearable. Clinical: Severe, intolerable pain. 6 Excruciating Pain Meaning: extremely severe, almost unbearable Patient: The pain is excruciating. Clinical: Pain rated 10/10. 7 Severe Pain Meaning: very intense or serious pain that significantly affects the patient. Patient: The pain is severe. I can barely move. Clinical: Reports severe abdominal pain. 8 Persistent Pain Meaning: pain that continues for a prolonged period and does not easily go away. Patient: The pain has been there for several days and won't go away. Clinical: Reports persistent lower-back pain.CHAPTER 1 - PAINMEDICAL LANGUAGE23

3. Pattern & Duration of Pain Question: When does the pain occur, and how long does it last? 1 Constant Pain Meaning: pain that is present continuously and does not stop. Patient: The pain is constant, it’s there all the time. Clinical: Reports constant abdominal pain. 2 Intermittent Pain Meaning: pain that comes and goes, with periods when it improves or disappears. Patient: The pain comes and goes throughout the day. Clinical: Reports intermittent abdominal pain. 3 Persistent Pain Meaning: pain that continues for a prolonged period and does not easily go away. Patient: The pain has been there for several days and won’t go away. Clinical: Reports persistent lower-back pain. 4 Nagging Pain Meaning: annoying, persistent pain that continues to bother the patient. Patient: It’s a nagging pain that just won’t go away. Clinical: Reports chronic, low-grade nagging painCHAPTER 1 - PAINMEDICAL LANGUAGE24

4. Location & Spread of Pain Question: Where is the pain, and does it move anywhere else? 1 Localised Pain Meaning: pain that is limited to one particular area. Patient: “he pain is just in this one spot. Clinical: Reports localized abdominal pain. 2 Radiating Pain Meaning: pain that starts in one area and spreads or travels to another area. Patient: It starts in my back and radiates down my leg. Clinical: Reports lower- back pain radiating to the left leg. 3 Referred Pain Meaning: pain felt in a different area from where the problem originates. Patient: My shoulder hurts, but the doctor said the problem is somewhere else. Clinical: Reports referred shoulder pain. 4 Widespread Pain Meaning: pain affecting a large or multiple areas of the body. Patient: The pain is all over my body. Clinical: Reports widespread musculoskeletal pain.CHAPTER 1 - PAINMEDICAL LANGUAGE25

5. Emotional Impact of Pain Question: How does the pain affect you emotionally or physically? Fearful Meaning: describes pain that makes the patient feel frightened or worried. Patient: This pain makes me feel frightened, like something is very wrong. Clinical: Pain associated with significant anxiety and fear. Terrifying / Horrible / Dreadful Pain Meaning: pain that feels extremely frightening, unpleasant, or emotionally overwhelming. Patient: The pain is horrible. I’m really frightened. Clinical: Reports severe pain causing significant emotional distress. Wretched Meaning: feeling extremely unwell, miserable, or physically and emotionally affected by pain. Patient: I feel wretched with this pain. Clinical: Pain significantly affecting mood and wellbeing. Miserable Meaning: describes feeling extremely unhappy or uncomfortable because of ongoing pain. Patient: I’ve been miserable with this pain for weeks. Clinical: Chronic pain causing low mood and distress. Distressing Pain Meaning: pain that causes significant emotional discomfort, worry, or anxiety. Patient: The pain is very distressing. It’s making me anxious. Clinical: Reports distressing pain associated with significant emotional discomfort. Tiring / Exhausting Pain Meaning: pain that makes the patient feel tired and reduces their energy. Patient: This pain is exhausting me. Clinical: Reports pain associated with significant fatigue.CHAPTER 1 - PAINMEDICAL LANGUAGE26

Gruelling Pain Meaning: extremely difficult, exhausting, and draining; pain that wears the patient down physically or emotionally. Patient: The pain has been gruelling. I’m exhausted and finding it difficult to cope. Clinical: Describes the pain as severe and gruelling, with a significant impact on daily functioning. Draining Pain Meaning: pain that gradually takes away energy and leaves the patient exhausted. Patient: The pain is draining. I feel exhausted all the time. Clinical: Reports persistent, draining pain affecting daily activities.CHAPTER 1 - PAINMEDICAL LANGUAGE27

Listening 3.1: A Nurse-Patient Assessment You hear a nurse assessing a patient who is experiencing several types of pain. For questions 1–12, complete the notes with a word or short phrase that you hear. Current pain Pain initially described as (1) ____________________ in the lower back Has since become (2) ____________________ At times, pain is reported as (3) ____________________ Pain occasionally radiates down the (4) ____________________ Description of pain Radiating pain compared with (5) ____________________ running down the thigh Abdominal pain described as a (6) ____________________ sensation Cramping episodes particularly occur (7) ____________________ Back pain sometimes becomes stabbing and at other times (8) ____________________ Effect on daily life Pulsing sensation compared with having a (9) ____________________ in the back By afternoon, pain completely (10) ____________________ the patient Patient reports difficulty moving around the house Additional symptoms Occasional (11) ____________________ sensation in the feet Shoulder pain is persistent but not severe Most severe episode described as (12) ____________________ Plan Symptoms to be documented Appropriate care to be arrangedCHAPTER 1 - PAINMEDICAL LANGUAGE28

Listening 4.1 : Describing Pain in the Patient’s Own Words You hear a nurse assessing a patient who is experiencing pain in several areas. For questions 1–12, complete the notes with a word or short phrase that you hear. Chest and facial pain Chest pain described as intense and (1) ____________________ Sensation of pressure compared with something heavy pressing down Pain behind right eye described as (2) ____________________ Back and leg symptoms Lower back is constantly (3) ____________________, particularly with movement or pressure Left leg affected by electrical sensations and (4) ____________________ Patient also experiences small shocks extending towards the foot Other pain (5) ____________________ pain experienced when passing urine Twisting suddenly causes a (6) ____________________ sensation around the ribs Abdominal pain described as (7) ____________________, with a sensation of cutting or tearing Headaches sometimes become (8) ____________________ Severity and emotional impact Pain is generally (9) ____________________ in severity Chest pain can become almost unbearable During severe episodes, patient feels (10) ____________________ that something serious may be happening Ongoing pain has left the patient feeling (11) ____________________ By evening, patient describes feeling completely (12) ____________________CHAPTER 1 - PAINMEDICAL LANGUAGE29

Spoken Idioms, Everyday Phrases & Patient Language 1. It wipes me out. Meaning: the pain makes me extremely tired. Patient: The pain wipes me out by the end of the day. Clinical: Pain is very fatiguing for the patient. 2. Pulled muscle (muscle strain) Meaning: muscle fibres overstretched or torn. Patient: I think I've pulled a muscle in my leg. Clinical: Likely muscle strain in the right calf. 3. As fit as a fiddle. Meaning: very healthy, no pain or problems. Patient: Before this injury, I was as fit as a fiddle. Clinical: Previously fit and well. 4. Hard to get about. Meaning: difficult to move around because of pain. Patient: It's hard to get about with this knee pain. Clinical: Mobility is significantly limited by pain. 5. Little by little / bit by bit. Meaning: gradually, slowly improving or worsening. Patient: The pain is getting better little by little. Patient: It got worse bit by bit over a few weeks. Clinical: Pain has gradually worsened/improved. 6. A feeling of pressure. Meaning: heavy, pressing sensation. Patient: I have a feeling of pressure in my chest. Clinical: Reports pressure-like chest discomfort. 7. Comes and goes Meaning: pain that becomes stronger and then weaker repeatedly; it comes and goes. Patient: The pain comes and goes throughout the day. Clinical: Reports pain that waxes and wanes throughout the day. 8.Once in a blue moon Meaning: very rarely Patient: I only get the pain once in a blue moon. Clinical: Reports rare, infrequent episodes of pain.CHAPTER 1 - PAINMEDICAL LANGUAGE30

9. Out of the blue Meaning: suddenly Patient: The pain hit me out of the blue. Clinical: Reports sudden-onset pain with no obvious warning. 10. My stomach is in knots Meaning: anxious, stressed Patient: Before the procedure, my stomach was in knots. Clinical: Reports significant anxiety before the procedure. 11. A pain in the neck Meaning: annoying, frustrating (NOT medical pain) Patient: This paperwork is a pain in the neck. Clinical: Describes the administrative process as frustrating. 12. It feels tight Meaning: pressure or tension Patient: My chest feels tight. Clinical: Reports a sensation of chest tightness. 13. It’s Killing Me Meaning: the pain is extremely severe or difficult to tolerate. Patient: This pain is killing me. Clinical: Reports severe, intolerable pain. 14. It Feels Like Fire Meaning: the pain feels extremely hot or burning. Patient: It feels like fire in my feet. Clinical: Reports burning pain in the feet. 15. It Shoots Down My Leg Meaning: the pain travels suddenly from one area down the leg, often following a nerve. Patient: The pain shoots down my left leg. Clinical: Reports shooting pain radiating down the left leg. 16. It’s Like Pressure on My Chest Meaning: the patient feels heaviness, pressure, tightness, or squeezing in the chest. Patient: It’s like someone is putting pressure on my chest. Clinical: Reports pressure-like or squeezing chest discomfort.CHAPTER 1 - PAINMEDICAL LANGUAGE31

Listening 5.1 : Assessment of Multiple Pain Symptoms You hear a nurse assessing Mr Harris, who has recently experienced several types of pain. Main symptoms Pain mainly affecting the (1) ____________________ and lower back Pain in feet described as feeling like (2) ____________________ beneath the skin Pain travels down the (3) ____________________, particularly after prolonged standing Occasional tingling reported in the foot Pattern and severity Symptoms are intermittent; pain (4) ____________________ Chest discomfort described as a feeling of (5) ____________________ Usually moderate, but can become (6) ____________________ Severe chest pain generally lasts around (7) ____________________ Effect on mobility and daily life Pain leaves patient extremely tired and (8) ____________________ Lower back pain is mainly aching but can become intense Increasing difficulty with mobility; patient finds it (9) ____________________ Episodes of severe pain Severe chest pain occurs very infrequently — approximately (10) ____________________ Most recent episode began unexpectedly while patient was (11) ____________________ Patient became very anxious before attending the clinic Progression Patient feels symptoms are worsening (12) ____________________ Concerned that pain may continue to deteriorate.CHAPTER 1 - PAINMEDICAL LANGUAGE32

Verbs That Describe Pain (Action Collocations) These verbs describe how pain acts, moves, or changes. Pain spreads Meaning: moves slowly from one area to another. Spoken: The pain spreads from my back to my hip. Pain radiates Meaning: travels along a nerve pathway. Spoken: The pain radiates down my leg. Pain shoots Meaning: sudden, sharp, fast pain. Spoken: The pain shoots down my arm. Pain radiates Meaning: travels along a nerve pathway. Spoken: The pain radiates down my leg. Pain worsens Meaning: becomes stronger. Spoken: The pain worsens when I walk. Pain eases Meaning: becomes less severe. Spoken: It eases when I lie down. Pain flares up Meaning: suddenly becomes worse. Spoken: It flares up when I walk too much. Pain builds up Meaning: increases gradually. Spoken: The pain builds up during the day. Pain settles Meaning: becomes stable or less intense. Spoken: It settles after I take my medication.CHAPTER 1 - PAINMEDICAL LANGUAGE33

Pain returns Meaning: comes back after improving. Spoken: The pain returned last night. Pain spikes Meaning: sudden sharp increase. Spoken: I get sudden spikes of pain. Pain throbs Meaning: rhythmic, pulsing pain. Spoken: My tooth throbs constantly. Pain lingers Meaning: stays longer than expected. Spoken: The pain lingers even after resting. Pain subsides Meaning: decreases or goes away. Spoken: The pain subsided after an hour. Pain intensifies Meaning: becomes stronger. Spoken: The pain intensifies when I bend. Pain pulsates Meaning: beats like a pulse. Spoken: I feel a pulsating pain in my temple. Pain creeps up Meaning: increases slowly without noticing. Spoken: The pain creeps up on me by evening. Pain stabs Meaning: sharp, knife-like pain. Spoken: It stabs me suddenly when I twist. Pain grips Meaning: sudden tight, squeezing pain. Spoken: A gripping pain hits my chest. Pain shoots across / shoots up Meaning: fast, electric-like movement. Spoken: The pain shoots across my lower back.CHAPTER 1 - PAINMEDICAL LANGUAGE34

Listening 6.1 :How Patients Talk About Their Pain You will hear 20 patients describing their pain. Patient 1 : Sarah The pain: ______________________________________ Patient 2 : James The pain: ______________________________________ Patient 3 : Maria The pain: ______________________________________ Patient 4 : David The pain: ______________________________________ Patient 5 : Emma The pain: ______________________________________ Patient 6 : Michael The pain: ______________________________________ Patient 7 : Olivia The pain: ______________________________________ Patient 8 : Daniel The pain: ______________________________________ Patient 9 : Sophie The pain: ______________________________________ Patient 10 : Robert The pain: ______________________________________ Patient 11 : Emily The pain: ______________________________________ Patient 12 : Thomas The pain: ______________________________________ Patient 13 : Grace The pain: ______________________________________ Patient 14 : William The pain: ______________________________________ Patient 15 : Lily The pain: ______________________________________ Patient 16 : George The pain: ______________________________________ Patient 17 : Anna The pain: ______________________________________ Patient 18 : John The pain: ______________________________________ Patient 19 : Charlotte The pain: ______________________________________ Patient 20 : Henry The pain: ______________________________________CHAPTER 1 - PAINMEDICAL LANGUAGE35

Listening 7.1: Pain in Clinical Communication Extract 1: Abdominal Pain Question 1 You hear a nurse updating a doctor about a patient with worsening abdominal pain. What is the nurse's main reason for contacting the doctor? A. To report that Mrs Patel is experiencing nausea and a raised temperature despite being kept nil by mouth. B. To request an urgent review because the patient's abdominal pain is becoming more severe and localised, with guarding. C. To confirm that Mrs Patel's current management is being followed while her symptoms are monitored. Extract 2: Chest Pain Question 2 You hear a nurse updating a doctor about a patient with sudden chest pain. What is the nurse most concerned about? A. The combination of sudden chest pain, radiation, sweating, and elevated blood pressure requires immediate assessment. B. The patient's anxiety has increased because his chest pain started unexpectedly. C. The patient's blood pressure remains elevated despite the oxygen and cardiac monitoring already provided.CHAPTER 1 - PAINMEDICAL LANGUAGE36

Listening 7.1: Pain in Clinical Communication Extract 3: Neuropathic Leg Pain You hear a nurse updating a doctor about a patient whose lower back pain is affecting his leg. Question 3 Why does the nurse think Mr Lewis needs further evaluation? A. His pain is severe when standing and has not responded sufficiently to the analgesia given. B. His increasing anxiety is making it difficult for him to cope with intermittent lower back pain. C. His worsening radiating pain and increasing neurological type sensations suggest that his condition requires further assessment. Extract 4: Tooth Pain You hear a nurse updating a dentist about a patient with severe tooth pain. Question 4 Why does the nurse want the patient reviewed as soon as possible? A. The patient's pain is preventing sleep and is particularly sensitive to cold drinks. B. The combination of severe dental pain, facial swelling, and marked gum tenderness raises concern about an abscess. C. The patient's pain has become difficult to manage because he is experiencing several different types of pain.CHAPTER 1 - PAINMEDICAL LANGUAGE37

Verbs Related to Body Movement, Position & Activity 1. Bend Meaning: lean forward or curve the body. Patient: It hurts when I bend down to pick something up. Clinical: Pain aggravated by bending forward. 2. Squat Meaning: lower the body by bending knees. Patient: I get knee pain when I squat. Clinical: "Reports pain on squatting. 3. Stand Meaning: be upright on feet. Patient: My back aches when I stand for too long. Clinical: Pain worsens with prolonged standing. 4. Sit Meaning: rest on the buttocks. Patient: It's uncomfortable to sit for more than 10 minutes. Clinical: Sitting exacerbates lower-back pain. 5. Lie down Meaning: rest horizontally. Patient: The pain eases when I lie down. Clinical: Pain relieved by lying supine. 6. Get up / Rise Meaning: move from sitting/lying to standing. Patient: I feel a sharp pain when I get up from bed. Clinical: Pain triggered on rising from seated position.CHAPTER 1 - PAINMEDICAL LANGUAGE38

7. Climb (stairs) Meaning: go up steps. Patient: My knee hurts when I climb stairs. Clinical: Reports pain on stair climbing. 8. Go down (stairs) Meaning: descend steps. Patient: It's worse when I go down the stairs. Clinical: Descending stairs increases pain. 9. Twist Meaning: rotate the body suddenly. Patient: I twisted my back reaching for something. Clinical: Back pain following twisting movement. 10. Stretch Meaning: extend muscles or limbs. Patient: I feel a pulling pain when I stretch my arm. Reports pulling pain in the left shoulder with stretching/ with movement 11. Lift Meaning: raise something using strength. Patient: I hurt my back lifting a heavy box. Clinical: Back strain after lifting.CHAPTER 1 - PAINMEDICAL LANGUAGE39

12. Carry Meaning: hold and move an object. Patient: My shoulder aches when I carry shopping bags. Clinical: Pain associated with carrying weight. 13. Push Meaning: apply force away from the body. Patient: I get elbow pain when I push the door open. Clinical: Pain on pushing movements. 14. Pull Meaning: draw something toward the body. Patient: I feel a sharp pain when I pull heavy objects. Clinical: Pain triggered by pulling action. 15. Reach Meaning: extend arm to grab something. Patient: It hurts when I reach overhead. Clinical: Pain on overhead reaching. 16. Turn Meaning: rotate the body or head. Patient: I get neck pain when I turn my head. Clinical: Pain on cervical rotation. 17. Walk Meaning: move on foot. Patient: My hip hurts when I walk. Clinical: Pain aggravated by walking.CHAPTER 1 - PAINMEDICAL LANGUAGE40

18. Bend backward / arch Meaning: extend spine backwards. Patient: I feel a stabbing pain when I bend backward. Clinical: Pain on lumbar extension. 19. Lean Meaning: incline the body. Patient: I can't lean to the left without pain. Clinical: Pain on lateral flexion. 20. Roll over Meaning: turn body while lying down. Patient: It hurts when I roll over in bed. Clinical: Pain on positional change. 21. Get in/out (of bed, car) Meaning: transition movements. Patient: I get a pulling pain getting out of the car. Clinical: Pain during transitional movements. 22. Bend knees / kneel Meaning: lower body onto knees. Patient: My knee hurts when I kneel. Clinical: Pain on kneeling. 23. Hunch / slouch Meaning: poor posture. Patient: My back aches when I hunch over my desk. Clinical: Pain associated with poor posture. 24. Straighten Meaning: return to upright position. Patient: I feel a sharp pain when I straighten my back. Clinical: Pain on extension.CHAPTER 1 - PAINMEDICAL LANGUAGE41

25. Step / stride Meaning: take a step. Patient: I get a shooting pain with every step. Clinical: Pain on weight-bearing steps. 26. Bend sideways Meaning: lateral movement. Patient: It hurts when I bend to the side. Clinical: Pain on lateral bending. 27. Rotate Meaning: circular movement. Patient: My shoulder clicks when I rotate it. Clinical: Pain on rotational movement. 28. Flex / extend Meaning: medical terms for bending/straightening. Patient: It hurts when I flex my wrist. Clinical: Pain on wrist flexion. 29. Squirm / wriggle / wiggle Meaning: restless movements due to discomfort. Patient: I keep wriggling because I can't get comfortable. Clinical: Patient appears restless. 30. Collapse / buckle Meaning: knee gives way. Patient: My knee buckled when I stepped forward. Clinical: Knee instability reported.CHAPTER 1 - PAINMEDICAL LANGUAGE42

31. Overstretch / overextend Meaning: move beyond normal range. Patient: I overstretched my hamstring. Clinical: Pain due to overstretching. 32. Trip Meaning: catch your foot and almost or actually fall. Patient: I tripped over the step and hurt my ankle. Clinical: Ankle pain after tripping on a step. 33. Tumble Meaning: fall in an uncontrolled way. Patient: I tumbled down the stairs. Clinical: Back pain following a tumble down stairs.CHAPTER 1 - PAINMEDICAL LANGUAGE43

Skill-Building Exercise 2.1 Mixed Gap-Fill Sentences: Movement Verbs and Pain Triggers Complete each sentence with the most appropriate movement verb. The pain gets worse when I ______ down to tie my shoes.1. I feel a sharp pain when I ______ the stairs.2. My back hurts when I ______ for something on the top shelf.3. I get a pulling sensation when I ______ heavy boxes.4. It’s painful when I ______ up from a chair.5. My knee hurts when I ______ on the floor.6. I feel a stabbing pain when I ______ my body suddenly.7. The pain increases when I ______ still for long periods.8. I get pins and needles when I ______ over in bed.9. My hip aches when I ______ for more than ten minutes.10. I ______ over the curb and twisted my ankle.11. I ______ down the stairs and hurt my back.12. I feel a pulling pain when I ______ to reach the cupboard.13. The discomfort starts when I ______ forward too quickly.14. My shoulder hurts when I ______ something heavy off the ground.15. I get a sharp pain when I ______ my head to the left.16. The pain flares up when I ______ down onto my knees.17. I feel pressure in my chest when I ______ up the hill.18. My lower back hurts when I ______ out of the car.19. I get a shooting pain when I ______ suddenly while walking.20.CHAPTER 1 - PAINMEDICAL LANGUAGE44

Types of Pain: Where Pain Comes From Question: Where does the pain originate, and what type of tissue or system is involved? 1. Localised Pain Meaning: Pain in one specific area. I have a localised pain in my lower back. There's a sharp pain in my right knee. 2. Generalised Pain Meaning: Pain all over the body or in multiple areas. I feel pain all over. My whole body aches. 3. Neuropathic Pain Meaning: Pain caused by nerve damage or nerve irritation. It feels like electric shocks in my leg. I get burning and tingling in my feet. 4. Visceral Pain Meaning: Pain from internal organs (stomach, intestines, kidneys, uterus, etc.) I have a deep, cramping pain in my abdomen. It feels like a pressure inside. 5. Superficial Pain Meaning: Pain arising from the skin or tissues close to the body's surface. It's a burning pain on the skin. It hurts when I touch it. 6. Somatic Pain Meaning: Pain in muscles, joints, bones, or connective tissue. I've got a dull ache in my shoulder. My muscles feel tight and sore.CHAPTER 1 - PAINMEDICAL LANGUAGE45

Listening 8.1: Types of Pain 1) Types of Pain Listen to the audio carefully and choose the best answer. 1) What is the speaker's main point about using patients' descriptions to classify pain? A. The quality of pain is generally more reliable than its location when determining its underlying cause. B. Certain descriptions can provide useful clues, but they should not be used in isolation to determine the underlying type of pain. C. Patients with neuropathic pain can usually identify the affected nerve by describing the sensation. D. The distinction between different types of pain depends primarily on whether the patient can localise the pain accurately. 2) Understanding Chronic Pain Listen to the audio carefully and choose the best answer. What is the speaker's main point about assessing chronic pain? A. The intensity of chronic pain can usually be predicted from the extent of tissue damage identified during examination. B. Psychological factors are generally more important than physical findings when assessing patients with chronic pain. C. A comprehensive assessment should consider the patient's broader experience of pain rather than relying solely on pain intensity or physical findings. D. Numerical pain-rating scales should be avoided because patients' reports of chronic pain are often unreliable.CHAPTER 1 - PAINMEDICAL LANGUAGE46

Skill-Building Exercise 3.1- Gap Filling-Prediction Skill Instructions: Read each sentence carefully and predict the word or phrase that best completes the gap. More than one answer may be possible. Cause of injury: The patient __________ on the pavement and fell.1. Mobility: The patient reports that it is __________ because of the pain.2. Cause: The patient thinks they __________ at the gym.3. Progress: The pain is improving __________.4. Pain sensation: The patient describes a __________ feeling, as though everything is twisted inside.5. Chest/abdominal sensation: The patient reports __________ in the affected area.6. Morning symptom: The patient reports feeling __________ on waking.7. Child's night-time symptom: The child experiences __________ in his legs at night.8. Pain quality: The patient describes a __________ in the chest.9. Progression: The pain has __________ over the last week.10. The 52-year-old is presenting with __________ lower-back pain.11. The pain began while __________ stairs yesterday afternoon.12. It was initially described as __________ and aching.13. The pain became __________ overnight and is now constant.14. The pain __________ down the left leg.15. The patient reports __________, shooting sensations.16. The pain sometimes __________ across the hip area.17. The pain __________ up when bending or getting up.18. The patient experiences burning pain when __________ for long periods.19. There is stabbing pain when __________ the body suddenly.20. The patient occasionally experiences __________ pain in the stomach after eating.21. The patient describes sudden __________ pain that makes her hunch forward.22. The patient reports __________ and needles in both feet when rolling in bed.23. Shoulder pain is triggered when __________ overhead.24. The pain sometimes becomes almost __________ at night.25. The patient feels __________ and wiped out by the afternoon.26. The patient describes the pain as exhausting, miserable, and __________.27. The pain __________ and goes throughout the day.28. Symptoms gradually __________ up with activity.29. The pain occasionally __________ after resting.30.CHAPTER 1 - PAINMEDICAL LANGUAGE47

Audio Script Listening 1.1 Chapter 1: Pain Listening 1: Lower Back Pain Doctor: Where exactly is the pain? Patient: It’s mainly in my lower back. It gets worse when I bend or lift something heavy. Doctor: It sounds like you may have strained the area. For now, try to rest the area and avoid heavy lifting. Patient: Should I take anything for the pain? Doctor: Yes. I can prescribe some pain relief. You could also try an anti-inflammatory gel. Patient: Should I use ice? Doctor: Yes, apply an ice pack for about 15–20 minutes at a time if the area is swollen. Listening 2: Shoulder Pain Nurse: How is your shoulder today? Patient: It’s still painful, especially when I raise my arm. Nurse: Try to reduce your activity for a few days and avoid lifting the arm repeatedly. Patient: Would heat help? Nurse: Yes. A heat pack may help relax the muscles. Patient: Do I need to see a physiotherapist? Nurse: If the pain continues, I’ll refer you to physiotherapy. They can give you exercises to improve strength and movement.CHAPTER 1 - PAINMEDICAL LANGUAGE48

Audio Script Listening 1.1 Chapter 1: Pain Listening 3: Neck Pain After Exercise Doctor: When did the neck pain start? Patient: Yesterday, after I went to the gym. It feels tight when I turn my head. Doctor: You should avoid strenuous activity for a few days. Try using a warm compress to relax the muscles. Patient: Should I take painkillers? Doctor: You can take simple analgesics if needed. An anti-inflammatory medication may also help. Patient: What should I do if it doesn’t improve? Doctor: Keep an eye on your symptoms and come back for a review if the pain gets worse. Listening 4: Knee Pain Doctor: Tell me about your knee pain. Patient: It started after I began running again. It’s worse after exercise. Doctor: For now, try to rest the knee and reduce your activity. Patient: Should I put ice on it? Doctor: Yes. An ice pack can help reduce swelling. Patient: Do I need an X-ray? Doctor: Not necessarily at this stage. If it doesn’t improve, we may arrange an X-ray.CHAPTER 1 - PAINMEDICAL LANGUAGE49

Audio Script Listening 1.1 Chapter 1: Pain Listening 5: Abdominal Pain Doctor: How is the abdominal pain now? Patient: It’s still uncomfortable, but it’s not as severe as yesterday. Doctor: Make sure you drink plenty of fluids and stay well hydrated. Patient: Should I continue taking the medication? Doctor: Yes, take the prescribed medication as directed. Patient: When should I come back? Doctor: If the pain becomes severe or your symptoms get worse, come back for a review. Listening 6: Wrist Pain Doctor: How did you injure your wrist? Patient: I fell yesterday. It hurts when I move it. Doctor: Try to keep the wrist in a comfortable position and use a cold pack to reduce swelling. Patient: Should I move it normally? Doctor: Avoid unnecessary movement for now. If the pain continues, we may arrange an X-ray to check for a fracture. Patient: And what about pain relief? Doctor: You can take simple analgesics if you need them.CHAPTER 1 - PAINMEDICAL LANGUAGE50

Audio Script Listening 1.1 Chapter 1: Pain Listening 7: Persistent Back Pain Doctor: Has your back pain improved? Patient: Not really. I’ve had it for nearly three weeks. Doctor: In that case, I’d like to refer you to physiotherapy. Patient: What will they do? Doctor: They can assess your movement and teach you exercises for strengthening and stretching. Patient: Will I need a scan? Doctor: We may arrange an MRI if your symptoms suggest that further investigation is needed. Listening 8: Headache Doctor: How often have you been getting these headaches? Patient: Several times a week, especially when I haven’t drunk enough water. Doctor: Make sure you maintain good hydration throughout the day. Patient: Can I take something for the headache? Doctor: Yes. You can take simple analgesics when necessary. Patient: Is there anything else I should do? Doctor: Try to get enough rest and avoid anything that seems to trigger your headaches.CHAPTER 1 - PAINMEDICAL LANGUAGE51

Audio Script Listening Practice 1.2: Sports & Exercise Injuries Listening 1 : Running: The Persistent Shin Pain Before we start, could you tell me a little more about the pain in your legs? You mentioned it began after you increased your running distance. Yes, I used to run about three kilometres, but recently I started doing nearly eight. My legs feel really sore afterwards, especially along the front of my shins. Does the pain disappear when you rest? Mostly, yes. But lately I’ve noticed it starting during the run rather than afterwards. That change is important. Given the repetitive impact and the increase in your training, I’d like to examine you for possible shin splints. We should also consider a stress fracture if the pain becomes very localised or persists despite rest. So I should stop running for now? Yes. Avoid high-impact exercise until we know what’s causing it. Listening 2 : Football: The Knee That Gave Way Mr Khan, can you tell me what happened during the match? I was turning quickly to follow the ball when my right foot stayed planted, but my knee twisted. I felt a sudden sharp pain, and then my knee just gave way. Did you hear or feel anything unusual at the time? I felt something move inside the knee, but I didn’t hear a loud crack. It became swollen quite quickly. I see. And can you put your full weight on it? Not comfortably. I can walk, but I’m avoiding putting too much weight on that leg. The combination of the twisting injury, immediate swelling and the feeling that the knee gave way means we need to assess the ligaments carefully. I’m particularly interested in ruling out a significant ligament injury.CHAPTER 1 - PAINMEDICAL LANGUAGE52

Audio Script Listening Practice 1.2: Sports & Exercise Injuries Listening 3 : Weightlifting: My Back Suddenly Pulled Audio script Let’s go back to when your back pain started. Were you doing anything unusual that day? I was at the gym doing deadlifts. I increased the weight because I thought I could manage it. And what happened when the pain started? I was lifting the bar when I suddenly felt something pull in my lower back. It wasn’t unbearable at first, but it became much worse when I bent forward afterwards. Have you noticed any numbness or weakness in your legs? No, neither. It’s mainly the lower back. I can walk normally, but getting up from a chair is uncomfortable. That makes a straightforward musculoskeletal strain more likely, although we’ll examine you to make sure there are no warning signs. Listening 4 : Basketball: The Finger Injury Your finger is quite swollen. How did you injure it? It happened during basketball. The ball came towards me really quickly, and my finger was pushed backwards when I tried to catch it. Were you able to continue playing? For a few minutes, yes, but it became too painful. I can move it a little, although it hurts. Did it look abnormal immediately after the injury? It looked slightly crooked at first, but the swelling made it difficult to tell. We’ll need an X-ray because a forceful backward movement can cause more than a simple soft-tissue injury. I want to exclude a fracture or joint injury before we advise you about returning to sport.CHAPTER 1 - PAINMEDICAL LANGUAGE53

Audio Script Listening Practice 1.2: Sports & Exercise Injuries Listening 5 : Swimming: Shoulder Pain Your referral says you’ve been experiencing shoulder pain after swimming. How often are you training? Usually five days a week. I’ve recently increased the number of lengths because I’m preparing for a competition. And when do you notice the pain? It’s worse when I lift my arm above my head. I can manage everyday activities, but swimming has become uncomfortable. Have you had any direct injury to the shoulder? No, nothing like that. It gradually started getting sore. That history makes an overuse problem more likely than an acute injury. The repetitive overhead movement may have irritated the structures around the shoulder. We’ll assess your range of movement and strength. Listening 6 : Skiing: A Difficult Landing Can you tell me what happened on the slope? I was coming down quite fast when I lost my balance. I landed awkwardly and my left knee twisted. It hurt immediately. Did you continue skiing? No. I tried to stand, but the knee felt unstable. Has it swollen? Yes, quite a lot. I’ve also found it difficult to bend. Given the twisting mechanism and the instability, I’m concerned about an internal knee injury, particularly a ligament problem. We’ll arrange imaging if necessary and keep you off the leg until we’ve assessed it properly. Will I be able to ski again this week? I wouldn’t recommend that. We need to establish the extent of the injury first.CHAPTER 1 - PAINMEDICAL LANGUAGE54

Audio Script Listening Practice 1.2: Sports & Exercise Injuries Listening 7 : Cycling: Numb Hands Your main complaint is numbness in your hands rather than pain, is that right? Yes. It usually happens on longer rides. At first, I thought my gloves were too tight, but recently my fingers have started going numb after about an hour. Do you notice it more when you’re leaning heavily on the handlebars? Yes, actually. I tend to put quite a lot of weight through my hands, especially when I’m cycling uphill. That may be contributing to the problem. Prolonged pressure on the hands and an unsuitable riding position can irritate or compress the nerves. I’d like you to have your bike position checked before we consider any further treatment. Listening 8 : Boxing: The Shoulder Popped Out Tell me exactly what happened to your shoulder. I was practising punches when I reached too far forward. I felt my shoulder pop out, and I couldn’t move my arm properly. Did it go back into place by itself? Yes, after a few minutes. It was extremely painful at first, but the pain settled somewhat afterwards. Have you injured this shoulder before? Yes, actually. Something similar happened about six months ago. That history is important. A shoulder that has dislocated previously can become unstable and may be more likely to dislocate again. We’ll examine the joint carefully and check that there’s no nerve or blood vessel problem.CHAPTER 1 - PAINMEDICAL LANGUAGE55

Audio Script Listening 3.1: A Nurse-Patient Assessment Good morning, I'm here to assess your pain. Can you tell me what you're feeling right now? Honestly... it's a mix of things. The pain is unbearable at times. It started as a dull, aching pain in my lower back yesterday, but overnight it became constant. It just won't stop. Okay, constant aching pain. Does it change or move anywhere? Yes... sometimes it radiates down my left leg. When it does that, it feels like a shooting pain, like electricity running down my thigh. I see. Any other sensations? Yes... there's also this gnawing pain in my stomach like something is eating away inside. And occasionally I get a cramping pain, especially after I eat. It grabs me suddenly like a grabbing pain and then eases off. That sounds very uncomfortable. What about the back pain itself , how would you describe it? Sometimes it becomes stabbing, like someone is sticking a knife in my spine. Other times it's more of a burning pain, especially when I try to stand up. And when I lie down, I feel a pulsing or pounding sensation, almost like my back has a heartbeat. Does the pain ever feel sharp or cutting?. Yes , absolutely. There are moments when it feels like a cutting pain, like something is slicing inside. And then it turns into a searing pain, like fire shooting across my lower back. That sounds very intense. How is it affecting your energy? It's exhausting. By the afternoon, the pain completely wipes me out. It's so tiring that I can barely move around the house. Honestly, it's gruelling I feel drained. Any other sensations? Even small ones? Yes... sometimes I feel a pricking sensation, like tiny needles in my feet. Other times it's a squeezing pain in my chest not constant, but it comes and goes. And I get this nagging pain in my shoulder that just won't go away. It's not severe, but it's annoying always there. Has the pain ever felt frightening? Honestly... yes. Last night it became excruciating I almost cried. It was so intense it felt terrifying. I thought something dreadful was happening. It was just horrible. Thank you for explaining all of that. You've described many different pain qualities, and that helps me understand the full picture. I'm going to document everything and get you the care you need.CHAPTER 1 - PAINMEDICAL LANGUAGE56

Audio Script Listening 4.1 : Describing Pain in the Patient’s Own Words Good afternoon, I'm here to talk about your pain. Can you describe what it feels like? It's hard to explain because it's not just one type of pain. Sometimes it's an intense, almost crushing pain in my chest, like something heavy is pressing down on me. Other times, I get this piercing pain behind my right eye, like something is going straight through it. So you feel crushing pain in your chest and piercing pain behind your eye. Does the pain change in other parts of your body? Yes. My lower back feels constantly sore, especially when I move or when you press on it. And down my left leg, I get these electrical sensations — like pins and needles and little shocks running down to my foot. Electrical, pins-and-needles sensations in the leg. Do you ever feel stinging or burning? Yes, when I go to the toilet, I sometimes get a stinging pain when I pass urine. And around my ribs, if I twist suddenly, I feel a kind of pulling pain, like something is being stretched too far. I understand. How would you rate the pain overall ,mild, moderate, or severe? Most of the time it's moderate, but when that chest pain comes, it becomes really intense almost unbearable. During those moments, I feel fearful, like something terrible is happening. So the pain can be frightening for you. How is it affecting your mood and daily life? Honestly, it's making me feel miserable. I wake up already tired, and by the evening I feel completely wretched. I can't enjoy anything because I'm always waiting for the next wave of pain. That sounds very difficult. Any other ways you would describe the pain? Sometimes, in my abdomen, I get this lacerating pain, like something is cutting or tearing inside. It comes suddenly and makes me double over. And when I have a headache, it's not just a normal headache , it's a splitting one, like my head is going to burst. A splitting headache and lacerating abdominal pain, thank you for explaining that so clearly. When the pain is at its worst, what worries you the most? When the chest pain gets crushing and intense, I feel really fearful that it might be my heart. And when the shocks and pins and needles start in my leg, I worry I might lose feeling or not be able to walk properly. I can see this pain is not only physical but also emotionally distressing. You've used a lot of helpful words , crushing, piercing, stinging, pulling, electrical, splitting, lacerating, sore, moderate, intense, miserable, wretched, fearful. That gives me a very clear picture. I'm going to document everything you've told me and speak to the doctor so we can plan the right investigations and treatment for you. Thank you. Just being able to describe it properly makes me feel a bit better — like someone finally understands how bad it really is.CHAPTER 1 - PAINMEDICAL LANGUAGE57

Audio Script Listening 6.1 :How Patients Talk About Their Pain Audio 1 Sarah: My name is Sarah Ahmed. The pain starts in my lower back and spreads to my hip. It usually worsens when I bend forward, but it eases when I lie down. After resting for a while, it becomes much more manageable. Audio 2 James: My name is James Wilson. I have pain in my lower back, and sometimes the pain radiates down my right leg. It feels almost like it's following a line down to my calf. It becomes worse when I stand for a long time. Audio 3 Maria: My name is Maria Brown. I get a sharp pain in my shoulder, and sometimes the pain shoots down my arm. It happens particularly when I lift something heavy. When I stop and rest, the pain gradually settles. Audio 4 David: My name is David Taylor. The pain in my knee worsens when I walk upstairs. It isn't too bad when I'm sitting, but it gets stronger with activity. Once I sit down and rest, the pain gradually eases. Audio 5 Emma: My name is Emma Jones. I've been having abdominal pain for several days. It flares up after I eat, particularly after a large meal. Between episodes, the pain is much less noticeable. Audio 6 Michael: My name is Michael Smith. The pain in my abdomen comes and goes throughout the day. Sometimes I feel completely comfortable, and then the pain suddenly returns. It usually lasts for about twenty minutes before easing. Audio 7 Olivia: My name is Olivia Green. My headache isn't very bad when I wake up. However, the pain builds up during the day, especially when I'm working at the computer. By the evening, it's much more intense. Audio 8 Daniel: My name is Daniel Harris. I have severe pain in my stomach after eating. I take my medication, and the pain settles after about half an hour. Once it settles, I can carry on with my normal activities. Audio 9 Sophie: My name is Sophie Clark. My back pain improved last week, but the pain returned last night. It came back after I spent several hours gardening. Since then, it has been getting gradually worse. Audio 10 Robert: My name is Robert Evans. Most of the time, my chest discomfort is mild. However, I get sudden spikes of pain when I walk quickly. The pain becomes very strong for a few minutes and then starts to settle. Audio 11 Emily: My name is Emily White. I have a toothache on the left side of my mouth. The pain throbs constantly, particularly at night. Painkillers help a little, but I can still feel the throbbing. Audio 12 Thomas: My name is Thomas Moore. I injured my ankle yesterday. The swelling has gone down, but the pain lingers even after resting. It isn't as severe as it was yesterday, but it hasn't completely disappeared. Audio 13 Grace: My name is Grace Wilson. I had a migraine this morning. The pain was extremely severe at first, but it subsided after about an hour. I still have a mild headache now, but the worst of the pain has gone.CHAPTER 1 - PAINMEDICAL LANGUAGE58

Audio Script Listening 6.1 :How Patients Talk About Their Pain Audio 14 William: My name is William Thomas. I have pain in my lower back. The pain intensifies when I bend forward or try to pick something up. When I stand upright again, it gradually becomes less severe. Audio 15 Lily: My name is Lily Robinson. I have a headache around my right temple. I feel a pulsating pain in my temple, almost as if I can feel my heartbeat there. It becomes more noticeable when I'm in a noisy room. Audio 16 George:My name is George Walker. My hip pain isn't very noticeable in the morning. However, the pain creeps up on me by evening. By the end of the day, it has become quite uncomfortable and makes walking difficult. Audio 17 Anna:My name is Anna Hall. I have a sharp pain in my side. It stabs me suddenly when I twist or turn quickly. The pain is brief, but it is very sharp when it happens. Audio 18 John:My name is John Martin. I've been having some discomfort in my chest. Occasionally, a gripping pain hits my chest and makes me stop what I'm doing. It lasts for several minutes and then gradually eases. Audio 19 CharlotteMy name is Charlotte Lewis. I have pain in my lower back, and sometimes it shoots across my back when I move suddenly. On other occasions, the pain shoots up towards my shoulder. Resting usually makes it less intense. Audio 20 Henry:My name is Henry Adams. I have pain in my right leg that starts around my hip. The pain radiates down towards my foot, especially after walking. It gradually becomes worse, but after sitting down for a few minutes, it begins to ease.CHAPTER 1 - PAINMEDICAL LANGUAGE59

Audio Script Listening 7.1: Pain in Clinical Communication Extract 1: Abdominal Pain You hear a nurse updating a doctor about a patient with worsening abdominal pain. Doctor, I'm calling to update you about Mrs. Patel in Bed 6. She's reporting worsening abdominal pain that she describes as cramping and gnawing, mainly in the lower right quadrant. Over the last hour, the pain has become more intense and she's now guarding the area. Her temperature has risen to 38.4, and she's feeling nauseous. I've kept her nil by mouth as instructed, and I think she needs to be reviewed urgently because the pain is becoming more localised and severe. Extract 2: Chest Pain You hear a nurse updating a doctor about a patient with sudden chest pain. Doctor, I'd like to inform you about Mr. Harris in the assessment bay. He's experiencing sudden onset chest pain that he describes as crushing and squeezing, radiating to his left arm. He's visibly distressed and says the pain came out of the blue. His blood pressure is elevated at 170 over 100, and he's sweating heavily. I've already attached him to the cardiac monitor and given oxygen as per protocol. I believe he needs immediate medical review due to the nature of the pain. Extract 3: Neuropathic Leg Pain You hear a nurse updating a doctor about a patient whose lower back pain is affecting his leg. Doctor, I'm calling regarding Mr. Lewis in Room 12. He's reporting worsening lower back pain that now radiates down his right leg. He describes it as electrical, shooting, and occasionally piercing, with episodes of pins and needles in the foot. The pain waxes and wanes but becomes excruciating when he tries to stand. He's anxious because the sensations are becoming more frequent. I've completed his pain assessment and administered his prescribed analgesia, but he's still struggling. I think he needs further evaluation.CHAPTER 1 - PAINMEDICAL LANGUAGE60

Audio Script Listening 7.1: Pain in Clinical Communication Extract 4: Tooth Pain You hear a nurse updating a dentist about a patient with severe tooth pain. Doctor, I need to update you about the patient in Dental Room 3. He's presenting with severe tooth pain that he describes as throbbing, piercing, and splitting. The pain worsens significantly when he bites down, and he says it's been keeping him awake all night. There's visible swelling on the right side of his face, and the gum around the molar is extremely tender. He also reports a stinging sensation when drinking cold water. I suspect an abscess, and he's becoming increasingly uncomfortable. Could you review him as soon as possible?CHAPTER 1 - PAINMEDICAL LANGUAGE61

Audio Script Listening 8.1: 1) Types of Pain Recent research into pain classification suggests that pain should not be assessed solely according to how intense it feels. Clinicians also need to consider where the pain originates, how it is experienced, and which tissues or systems may be involved. One useful distinction is between localised and generalised pain. Localised pain remains confined to a particular area, whereas generalised pain affects several regions or is experienced more diffusely throughout the body. Pain may also be classified according to its underlying mechanism. Neuropathic pain is associated with damage or irritation of the nervous system and is frequently described using terms such as burning, tingling, or electric shocks. Visceral pain, by comparison, originates from internal organs and is often difficult for patients to pinpoint. It may be experienced as deep, cramping, or poorly defined discomfort. Somatic pain arises from structures such as muscles, bones, joints, and connective tissues. Unlike visceral pain, it is often easier to localise. Superficial pain originates in the skin or tissues close to the body's surface and may be particularly noticeable when the affected area is touched. However, these categories should not be treated as completely separate descriptions. A patient's choice of words does not necessarily identify the underlying type of pain. For example, burning pain may suggest neuropathic involvement, but the description alone is not sufficient to establish the cause. Consequently, clinicians should interpret pain descriptions alongside the location, clinical history, examination findings, and other relevant information.CHAPTER 1 - PAINMEDICAL LANGUAGE62

Audio Script Listening 8.1: 1) Understanding Chronic Pain Pain is often described as a purely physical sensation, but current approaches to pain management recognise that its experience is influenced by a range of biological, psychological, and social factors. This is particularly evident in patients with chronic pain, where the severity of reported symptoms does not always correspond closely to the extent of observable tissue damage. For example, two patients with similar clinical findings may report very different levels of pain. Factors such as sleep disturbance, anxiety, previous experiences of pain, and the patient's expectations about recovery can all influence how symptoms are perceived and reported. This does not mean that the pain is psychological or that the patient's account is unreliable. Rather, it highlights the complex interaction between physical and non-physical factors. Consequently, effective pain assessment should extend beyond asking patients to rate their pain on a numerical scale. Clinicians should also explore how the pain affects sleep, mobility, mood, daily activities, and quality of life. A more comprehensive assessment can help healthcare professionals develop management strategies that address the patient's overall needs rather than focusing exclusively on reducing pain intensity.CHAPTER 1 - PAINMEDICAL LANGUAGE63

Answer Key Listening 1.1 Chapter 1: Pain Listening 1: Lower Back Pain rest1. pain relief2. ice pack3. Listening 2: Shoulder Pain lifting1. heat pack2. physiotherapy3. Listening 3: Neck Pain After Exercise warm compress1. analgesics2. review3. Listening 4: Knee Pain After Running rest1. ice pack2. X-ray3. Listening 5: Abdominal Pain fluids1. medication2. review3. Listening 6: Wrist Injury position1. X-ray2. analgesics3. Listening 7: Persistent Back Pain physiotherapy1. strengthening2. MRI3. Listening 8: Recurrent Headaches hydration1. analgesics2. trigger3.CHAPTER 1 - PAINMEDICAL LANGUAGE64

Answer Key Skill-Building Exercise 1.1 analgesics / pain relief1. anti-inflammatory2. ice3. heat4. rest5. lifting6. standing / sitting7. gentle8. physiotherapy9. strengthening10. straight11. support12. X-ray / scan13. monitor14. fluids15. twisting16. strenuous17. cold18. compress19. review20. Skill-Building Exercise 2.1 bend1. climb2. reach3. lift4. get5. kneel6. twist7. stand8. roll9. walk10. tripped11. fell12. stretch13. bend14. lift15. turn16. kneel17. walk18. get19. turn20.CHAPTER 1 - PAINMEDICAL LANGUAGE65

Answer Key Skill-Building Exercise 3.1 tripped1. hard to get about / difficult to get about / hard to walk / difficult to walk2. pulled a muscle / strained a muscle / pulled something3. little by little / gradually / bit by bit / slowly4. knotted / tight / twisted / cramped5. a feeling of pressure / pressure / tightness / a sense of pressure6. very stiff / stiff / extremely stiff / stiff and sore7. growing pains / aching pains / leg pains / aches8. heavy pressure / a feeling of pressure / a heavy sensation / tightness9. got worse bit by bit / gradually worsened / gradually got worse / become increasingly severe10. severe / intense / significant / considerable11. climbing / going up / walking up12. dull / mild / aching13. worse / more severe / increasingly severe14. radiates / shoots / travels / runs15. electrical / electric / electric-like16. spreads / radiates / travels17. flares / shoots / acts up18. standing / sitting / staying upright19. twisting / turning / moving20. cramping / gnawing / aching / gripping21. grabbing / gripping / cramping / stabbing22. pins23. reaching / reaching up / lifting the arm / raising the arm24. unbearable / severe / intense / excruciating25. exhausted / drained / tired / worn out26. distressing / unbearable / draining / exhausting27. comes and goes / fluctuates / occurs intermittently28. builds / builds up / increases / intensifies29. settles / eases / improves / subsides30.CHAPTER 1 - PAINMEDICAL LANGUAGE66

Answer Key Grammar Exercise 1.2 Adverbs of Degree extremely1. moderately2. slightly3. fairly4. intensely5. Present Perfect vs Past Simple have had1. started2. has had3. began4. have felt5. Continuous Tenses is getting1. is spreading2. is increasing3. is becoming4. is going down5. Comparatives & Superlatives worse better1. the worst2. worse3. the best4. Cause & Effect Grammar makes1. helps2. relieves3. worsens4. helps5. Modal Verbs may1. can2. should3. may4. can5. Prepositions of Pain Location on1. in2. on3. at4. in5. Mixed Practice extremely / moderately / slightly / fairly / intensely 1. have had2. is spreading3. better4. makes5.CHAPTER 1 - PAINMEDICAL LANGUAGE67

Answer Key Listening Practice 1.2: Sports & Exercise Injuries Running B — The pain has changed from occurring mainly afterwards to occurring during running. 1. C — A stress fracture may need to be considered if pain persists or becomes localised. 2. C — The clinician advises avoiding high-impact exercise temporarily. 3. Football C — The foot remained planted while the knee twisted, a concerning mechanism for ligament injury. 1. B — Weight-bearing helps assess how much the injury is affecting function. 2. A — The clinician is particularly concerned about a ligament injury. 3. Weightlifting B — The clinician says a musculoskeletal strain is more likely. 1. C — The pain began during deadlifting.2. C — The patient denies numbness or weakness in the legs. 3. Basketball B — The mechanism could have caused a fracture or joint injury. 1. C — The finger was forced backwards while catching the ball. 2. A — The clinician wants to exclude fracture or joint injury. 3. Swimming B — The pain developed gradually after increased training. 1. B — Overhead movement aggravates the pain. 2. C — The clinician will assess range of movement and strength. 3. Skiing B — Twisting plus instability raises concern for internal knee/ligament injury. 1. C — The knee felt unstable when the patient tried to stand. 2. C — The patient should stay off the leg until assessment. 3. Cycling B — Symptoms occur during longer rides.1. B — Prolonged pressure through the hands may compress or irritate nerves. 2. B — The bicycle/riding position should be checked. 3. Boxing B — The shoulder popped out, suggesting dislocation. 1. C — Previous dislocation can increase the risk of recurrent instability. 2. A — The clinician wants to check for nerve or blood-vessel problems. 3.CHAPTER 1 - PAINMEDICAL LANGUAGE68

Answer Key Listening 3.1: A Nurse-Patient Assessment dull, aching pain1. constant2. unbearable3. left leg4. electricity5. gnawing6. after I eat7. burning8. heartbeat9. wipes me out10. pricking11. excruciating12. Listening 4.1 : Describing Pain in the Patient’s Own Words crushing1. piercing2. sore3. pins and needles4. stinging5. pulling6. lacerating7. splitting8. moderate9. fearful10. miserable11. wretched12. Listening 5.1 : Assessment of Multiple Pain Symptoms feet1. fire2. left leg3. comes and goes4. pressure5. unbearable6. ten to fifteen minutes7. wipes me out8. hard to get about9. once in a blue moon10. watching television11. little by little12. Listening 6.1 :Movement, Changes & PatternsCHAPTER 1 - PAINMEDICAL LANGUAGE69

Answer Key Listening 6.1 :How Patients Talk About Their Pain Sarah: spreads to her hip1. James: radiates down his right leg2. Maria: shoots down her arm3. David: worsens when I walk upstairs4. Emma: flares up after I eat5. Michael: comes and goes6. Olivia: builds up during the day7. Daniel: settles after about half an hour8. Sophie: returned last night9. Robert: spikes of pain10. Emily: throbs constantly11. Thomas: lingers even after resting12. Grace: subsided after about an hour13. William: intensifies when I bend forward14. Lily: pulsating pain15. George: creeps up on me16. Anna: stabs me suddenly17. John: gripping pain hits18. Charlotte: shoots across my back19. Henry: radiates down towards my foot20. Listening 7.1: Pain in Clinical Communication B. To request an urgent review because the patient's abdominal pain is becoming more severe and localised, with guarding. 1. A. The combination of sudden chest pain, radiation, sweating, and elevated blood pressure requires immediate assessment. 2. C. His worsening radiating pain and increasing neurological type sensations suggest that his condition requires further assessment. 3. B. The combination of severe dental pain, facial swelling, and marked gum tenderness raises concern about an abscess. 4. 5. Listening 8.1: Types of Pain 1) B. Certain descriptions can provide useful clues, but they should not be used in isolation to determine the underlying type of pain. 2) C. A comprehensive assessment should consider the patient's broader experience of pain rather than relying solely on pain intensity or physical findings.CHAPTER 1 - PAINMEDICAL LANGUAGE70