Knee Pain - the History

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's 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.

Published 2007