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.
