Initially, it becomes essential to obtain a detailed history of the characteristics of the pain. Toward this end, the physician must inquire into the onset of the pain, its quality or characteristics, its location, its duration, and temporal course and factors that precipitate, aggravate, and those that alleviate the discomfort (Table 12.1). Consideration must be given to the treatments and diagnostic assessments that had been undertaken previously and the perceived effectiveness of previous treatment interventions.
Rating the severity of pain can be a useful parameter upon which to rely to track responsiveness to implemented treatment strategies. As described in the introduction of this chapter, ratings of pain intensity should never be treated as a standalone measure as pain ratings can be influenced by psychosocial distress. Most commonly, an 11-point numeric rating scale (NRS), rated from 0 = no pain to 10 = worst pain possible, is employed. Alternative pain intensity measures include the visual analog scale (VAS) and the verbal rating scale (VRS). The VAS is composed of a 10-cm line with the anchors "no pain" and "pain as bad as it could be." (The patient is asked to place a mark on the line in a position that best reflects his/her pain intensity; a score is derived by measuring the distance from the "no pain" end of the line.) This instrument may be slightly more cumbersome than the NRS, but it can be an effective tool for use with patients who have a difficult time providing a numerical rating for their pain. The VRS includes a list of pain descriptors ordered by level of intensity; patients are asked to select the descriptor that best indicates their pain (the corresponding score indicates pain intensity). This measure is easy to administer and score, but it can be difficult for people with language difficulties. Each of the aforementioned instruments is a valid measure
Table 12.1 Biological component of chronic pain assessment.
Have the patient identify the specific physical area(s) where the pain is felt and related radiation patterns Onset:
Have the patient describe when and how the pain started, e.g., precipitating injury or inciting events Pattern:
Have the patient describe the current frequency of pain, how long it lasts, and whether it has changed over time
Intensity of the pain:
Have the patient rate the pain severity; useful anchors include current pain, pain at its worst, pain at its best, and on average Description of pain:
Have the patient describe how the pain feels, whether it is superficial or deep, constant or intermittent, and whether it fluctuates in intensity. Encourage a description of associated symptoms, e.g., including nausea, vomiting, weakness, or confusion Aggravating and relieving factors:
Have the patient describe those factors that increase or decrease the experience of pain, e.g., sitting, lying down, standing, heat, cold, exercises, or particular movements of pain intensity and has demonstrated sensitivity to change in the context of pain treatment (Jensen and Karoly 2001).
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