The Basics of History Taking

To accurately determine the cause of an individual's pain, physicians need an initial assessment including a thorough history and physical (Harden and Bruehl 2006). Physicians can differentiate pain into acute and chronic, malignant and non-malignant, somatic and neuropathic, but because management strategies may differ, accurate assessment of an individual's pain complaint is essential for formulating treatment plan.

While many lab tests and diagnostic studies help aid in the diagnosis of an individual's pain, initial history often plays the most important role in the evaluation of that individual. Most experienced clinicians rely on a detailed history obtained from a patient in order to successfully arrive at a diagnosis that can explain the individual's pain.

While taking a patient's history, the physician should avoid a hasty interaction. This legitimizes the patient's concerns and ultimately strengthens the patient-physician relationship. While the natural tendency for interviewing a patient is to follow a stereotyped form or a list of questions, each patient brings a unique history. As such, each patient should tell his/her own story, while the physician obtains a complete, logical, and well-organized history.

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8_5, © Springer Science+Business Media, LLC 2011

Detailed information about the onset of a patient's pain is essential to help determine the underlying cause. Information regarding the precise start of the pain, circumstances surrounding the cause, the location, distribution, quality, intensity or severity, and duration should all be ascertained. The patient should also be questioned about any sensory, motor, or autonomic disturbances around the initial time of the injury as disorders such as complex regional pain syndrome is often associated with these types of disturbances. After describing the patient's initial onset of pain, information should then be gathered about the patient's subsequent pain state. Has the pain or location changed over time are important questions.

Because a patient may visit multiple doctors prior to seeing a pain specialist that individual may have tried many medication regimens. Physicians must be aware of therapies which were effective and alternatives not used. Accordingly, interventional and surgical procedures should be discussed before deciding on a pain treatment plan. If a certain medication or procedure relieved aspects of a patient's initial pain that information may lead to future therapies for the patient.

Focusing on both alleviating and aggravating factors of a patient's pain complaint often proves beneficial. Factors that could potentially affect one's pain, such as emotional disturbances, exercise, pressure, temperature, sneezing, and straining, should be investigated and recorded. Questions about the effect of one's pain on his/her daily life should also be asked, including the effect of pain on a patient's ability to perform activities and to sleep. All these discussions help a physician tailor an appropriate pain treatment regimen.

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