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Pain Assessment

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Pain is a uniquely personal experience and every individual who suffers pain, feels and reacts to it differently. Therefore, assessment of pain is important before deciding the treatment options to ensure that the clinician has a clear idea of patient’s needs and areas of difficulty. Poor assessment by the clinician may lead to undertreatment of pain. To avoid this, the American Pain Society (APS) has introduced pain as the ‘5th vital sign’. Meaning, pain can be considered to monitor level of physical functioning in an individual. In addition, Joint Commission on Accreditation of Healthcare Organization (JCAHO) has introduced standards that stresses on the patients’ right to appropriate assessment and treatment of pain. The nature of pain assessment varies based upon the purpose of the assessment, the setting, patient population, and clinician. However, the assessment is conducted mainly through the patient history, physical examination, and appropriate diagnostic studies.

Patient History

Self-reporting is the most reliable indicator of pain and hence talking to patients and asking them about they feel is an integral part of pain assessment. The therapist may also want to know about your past medical history, medications, lifestyle (e.g., smoking, alcohol intake), family history, and psychosocial history.

It is important that you spend considerable time with the therapist and tell in detail about the pain you are suffering. The therapist would want to gather information regarding the characteristics of pain, its location, duration and intensity,etc. The following table 1 gives a clear picture of the questions that your therapist is likely to ask to get your health history and understand your condition well.

 

Table 1: Patient History for Assessment of Pain

The Clinical Parameter The Information for Clinician Possible Question for Patient
Pain Characteristics Onset and duration of pain
  • When did your pain start?
  • How often does it occur?
  • How long does it last?
Location
  • Where does it hurt? Is there more than one site?
Intensity On a scale of 0 (no pain) to 10 (worst pain),

  • How much does it hurt right now?
  • How much does it hurt at its worst?
Description
  • What does your pain feel like?
  • Is it stabbing, burning, pricking, etc.?

 

  Aggravating and relieving factors
  • What makes your pain better?
  • What makes your pain worse?
Management Strategies Treatment options given in past and at present
  • What methods have you tried to relieve your pain?
  • Were they or are they effective?
Medical History Prior illnesses
  • How is your general health?
  • Have you had any illnesses in the past?
Family History Family history of chronic pain
  • Is anyone in your family has problems with pain?
Psychosocial
Assessment
Depressive symptoms
  • Are you suffering from any kind of stress?
  • Does the pain affect your mood?
Impact on Daily Life Impact of pain on work, sleep, and relationships
  • Is pain affecting your daily activities?
  • Your work?
  • Relationships?
Patients Expectations Expectations and goal in pain management
  • What expectations do you have from the treatment that you will be undergoing?

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