Comprehensive pain assessment is the starting point
The starting point for effective pain management is a comprehensive clinical assessment.
Examination and evaluation of the patient with chronic pain requires a thorough patient case history. This should explore not only the patient’s pain history and general medical history, but also their pain treatment history and close evaluation of psychosocial factors.
The case history is the mainstay of understanding and diagnosing chronic pain conditions. Underlying causes of pain should be explored and comorbid conditions should be considered, since these may contribute to pain or be missed diagnoses exacerbating pain. The patient’s physical condition, psychosocial status, and functional status, such as mood, sleep, and coping skills should each be determined.
History-taking also contributes to and reinforces a stable physician-patient relationship founded in trust and empathy. As required, further examinations or referral may be initiated. At all times the patient should be informed and cooperative with planned evaluations.
Pain measurement is more than measuring pain intensity
During the initial examination and whilst monitoring therapy the patient must assess pain intensity. Since there are no practical objective methods of measuring pain, we must resort to scales to obtain information. Recording pain intensity is always subjective. However, the advantage is that the physician obtains a direct idea of the patient’s pain perception.1-4
Whereas in acute pain questions can be restricted to a small number, the assessment of chronic pain requires a comprehensive analysis of overall pain processing, including pain perception and pain-related experience and behaviour, for example pain perception, handicap and impairment due to pain, quality of life or depression.
Pain symptoms differ
Furthermore the characterization of the pain itself is important. For example: Localised Neuropathic Pain (LNP) is often described with symptoms such as shooting, burning, stabbing, or being like an electric shock.
Tools like questionnaires, assessment tools, pain scales and diagnostic tools are helpful for a comprehensive and correct pain assessment.
For therapeutic monitoring it is of value that the patient keeps a pain diary. In a pain diary patients can note the intensity of their pain, medicine administration, side-effects, activities and well-being. This helps the physician find the right therapy for the individual patient and jointly agreed treament goals. It also requires the patients’ active cooperation and involves them more in the therapy.
1 Ragab AA. Validity of self-assessment outcome questionnaires: patient-physician discrepancy in outcome interpretation. Biomed Sci Instrum 2003;39:579–84.
2 Younger J, McCue R, Mackey S. Pain outcomes: a brief review of instruments and techniques. Curr Pain Headache Rep 2009;13:39–43.
3 Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378–81.
4 Josephine Teo. Systematic Review of unidimensional Pain Assessment Tools.