Evaluation of pain

[Little_Girl]

Neither examinations nor tests can prove that a person is in pain (see also Overview of Pain). Consequently, doctors ask the person about the history and characteristics of pain. The person’s answers help them identify the cause and develop a treatment strategy. Questions can include the following:

Where is the pain? What is the pain like?
When did the pain start? Was there any injury?
How did the pain start? Did it begin suddenly or gradually?
Is the pain always present, or does it come and go?
Does it occur predictably after certain activities (such as meals or physical exertion) or in certain body positions? What else makes the pain worse?
What, if anything, helps relieve the pain?
Does pain affect the ability to do daily activities or to interact with other people? Does it affect sleep, appetite, and bowel and bladder function? If so, how?
Does pain affect mood and sense of well-being? Is the pain accompanied by feelings of depression or anxiety?

To evaluate the severity of pain, doctors sometimes use a scale of 0 (none) to 10 (severe) or ask the person to describe the pain as mild, moderate, severe, or excruciating. For children or for people who have difficulty communicating (for example, because of a stroke), drawings of faces in a series—from smiling to frowning and crying—can be used to determine the severity of pain.
Doctors always try to determine whether a physical disorder is causing the pain. Many chronic disorders (such as cancer, arthritis, sickle cell anemia, and inflammatory bowel disease) cause pain, as do acute disorders (such as wounds, burns, torn muscles, broken bones, sprained ligaments, appendicitis, kidney stones, and a heart attack).
Doctors use specific techniques to check for sources of pain. Doctors move the person’s arms and legs through their normal range of motion to see if these motions cause pain. Injury, repetitive stress, chronic pain, and other disorders can make certain areas of the body (called trigger points) become hypersensitive. Doctors touch various spots to see whether they are trigger points for pain. Different objects (such as a blunt key and a sharp pin) may be touched to the skin to check for loss of sensation or abnormal perceptions.
Doctors also consider psychologic causes. Psychologic factors (such as depression and anxiety) can worsen pain. Because depression and anxiety may result from chronic pain, distinguishing cause and effect may be difficult. Sometimes in people with pain, there is evidence of psychologic disturbances but no evidence of a disorder that could account for the pain or its severity. Such pain is called psychogenic or psychophysiologic pain.
Doctors ask about which drugs (including over-the-counter drugs) and other treatments the person has used to treat the pain and whether they are effective.
Few people exaggerate the pain they feel. Nonetheless, doctors usually also ask questions to make sure there are no ulterior motives for reporting pain, such as time off from work with pay or extra attention from family members. Such questions are routine.

[Justin Bieber]

Clinicians should evaluate the cause, severity, and nature of the pain and its effect on activities, mood, cognition, and sleep. Evaluation of the cause of acute pain (eg, back pain, chest pain) differs from that of chronic pain.
(See also Overview of Pain.)
The history should include the following information about the pain:

Quality (eg, burning, cramping, aching, deep, superficial, boring, shooting)
Severity
Location
Radiation pattern
Duration
Timing (including pattern and degree of fluctuation and frequency of remissions)
Exacerbating and relieving factors

The patient’s level of function should be assessed, focusing on activities of daily living (eg, dressing, bathing), employment, avocations, and personal relationships (including sexual).
The patient#39;s perception of pain can represent more than the disorder#39;s intrinsic physiologic processes. What pain means to the patient should be determined, with emphasis on psychologic issues, depression, and anxiety. Reporting pain is more socially acceptable than reporting anxiety or depression, and appropriate therapy often depends on sorting out these divergent perceptions. Pain and suffering should also be distinguished, especially in cancer patients; suffering may be due as much to loss of function and fear of impending death as to pain.
Whether secondary gain (external, incidental benefits of a disorder—eg, time off, disability payments) contributes to pain or pain-related disability should be considered. The patient should be asked whether litigation is ongoing or financial compensation for injury will be sought.
A personal or family history of chronic pain can often illuminate the current problem. Whether family members perpetuate chronic pain (eg, by constantly asking about the patient#39;s health) should be considered.
Patients and sometimes family members and caregivers should be asked about the use, efficacy, and adverse effects of prescription and over-the-counter drugs and other treatments and about alcohol and recreational or illicit drug use.