Social Component

Lastly, it is important to assess the impact of pain on the patient's social functioning. Assessment into the patient's social functioning is broad-based and would necessitate inquiry into the impact of pain on lifestyle, personal relationships, work or school, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) (Table 12.3). Inquiry should be focused on what the patient is able to do and what activities are avoided due to the pain. It is pertinent to assess the patient's general life satisfaction, e.g., how free time is spent and pursuit of interests; along with the economic impact of pain by inquiring into restriction in the types of work activity and job loss, the resultant restrictions in income, financial

Table 12.3 Social component of chronic pain assessment.

Adaptation and function:

Have the patient describe the extent to which one is capable of managing ADLs, e.g., bathing, grooming, dressing, and toileting, and IADLs, e.g., meal preparation, payment of bills, laundry, house cleaning, use of public transportation, and driving Vocational:

Have the patient describe how work/academic pursuits are affected, e.g., restriction in work activity or job loss; if unemployed, how one is supported

Economic:

Have the patient describe whether there has been reduction in income, financial hardships imposed my medical treatment, and the impact on family/others with who one resides Recreational and life satisfaction:

Have the patient describe what is done to derive pleasure; what hobbies and interests have been given up due to pain, what is maintained despite the pain; and how satisfying life is despite pain Social support network:

Have the patient describe the impact of pain on relationships; the accessibility and availability of significant persons in the patient's life; and capacity for intimacy, sexuality, and shared experiences with friends/family Legal issues:

Have the patient describe whether there are pending legal issues, e.g., litigation related to injuries, workers' compensation, and social security disability claims hardships imposed by medical treatment, concerns over the accessibility and cost of medical care, whether litigation related to the cause of pain is pending, and whether applications for disability are under review.

It is helpful to identify the significant persons in the patient's life and how pain has influenced relationships with those persons, e.g., changes in role responsibilities within the home can strain relationships. Given that interpersonal relationships are bidirectional, it is equally important to ascertain the extent to which one's adaptation in the context of pain may be shaped or reinforced by the responses of others in one's life (Turk and Okifuji 2002). The clinician needs to listen for elements that suggest the patient assumes an "invalid role" in all or some aspects of life and assess the function that role serves for the patient.

Careful histories of alcohol and drug use are also imperative. This may be predictive of future risks of addiction and may assist in determining what types of medical and pharmacologic approaches best suit the patients' needs.

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