A POEM

As Orthopaedic surgeons we are now

Informed quite well in all the details how

Pain within the knee is generated

And how it can be treated and ablated.

Remember, pain is not what you can see

With X-ray, MRI or with CT

For all the images that you may make

Cannot remotely quantify that ache.

Pain scores

Assessment of this symptom - most arcane-

The patient must himself assess his pain

According to the IKDC score

Where "mild" is 1 and most severe is 4.

The Borg score is another option when

He scores pain on a scale of one to ten,

"One" most mild and easy to withstand,

"Ten" is worst upon the other hand.

Rest pain

Does pain disturb your patient when at rest

He cannot find positions to divest

Himself of symptoms  so severe

He sometimes wishes that his end was near.

Dependence on support

Does he depend upon a stick or crutch?

(Or is his pride a little bit too much?)

Are stairs a problem going up or down?

Is it painful shopping in the town?

Pain on activity

For instance, can your patient walk for miles,

On rough ground through fields with gates and styles?

Or does he have to stop because of pain

And rest awhile before he can regain

His courage to limp home, both tired and sore

Disappointed and distressed once more?

Can he time his tolerance to walking,

Or to shopping or standing and just talking?

All of this is evidence of how

Much nuisance is his pain to him right now.

Stairs

Is he free of pain when on the flat

But stairs are just the opposite of that?

Whilst going up is not too bad at all

But coming down is quite another call.

Painful giving way on stairs can be 

A real threat to life and limb, you see.

Pain with stiffness

Has pain with stiffness now become a curse?

Does exercise now make this symptom worse?

Is his range of motion getting less?

Does he find it difficult to dress?

Night pain

Does he sleep, or toss and turn at night

Searching for positions that are right

To minimise the pain and get some sleep

Although he knows his slumber's never deep?

Dependence on drugs

Does he take NSAIDS and pills for pain?

Do his knees ache when it's going to rain?

How many tablets does he take

To get relief from that persistent ache?

Assessing the quality of life

The answers to these questions are indeed

Important in decisions to proceed

Towards the treatment of the ache or pain

His quality of life once more to gain.

Your patient's quality of life depends 

On his ability to meet those ends

Required of him at home, at work and leisure

If acting out these tasks has lost its pleasure.

The importance of his symptoms yet are such

One cannot emphasise this point too much

Assess your patient's quality of life

To indicate,or not, the surgeon's knife.

 

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