Assessment of pain

HISTORY

The onset of the pain
How long ago did it first start?
Was there any apparent cause for the pain then?
Was the start sudden or gradual?

The severity of the pain
You may be asked to describe this in words or to use a pain scale .
Does the severity vary?
Are there any things that worsen the pain (for example lifting, eating) or that reduce the pain (for example rest, painkillers)?

The quality of the pain
You will be asked to describe the pain in words. For example, pain may be sharp (stabbing), dull (aching), burning, like a tight band, etc.
There may be more than one type of pain, for example a constant dull ache with occasional sharp stabs.

The site of the pain
You will be asked to indicate where the pain is, and you may be asked to draw the site of the pain on a picture.
Sometimes the pain starts in one place and then extends (radiates) somewhere else. An example of this is sciatica, when pain in the back radiates down a leg.
You may have more than one site of pain. If so, you may be asked which is the most troublesome.

Timing
When did the pain start?
Does the pain
remain all the time?
appear every now and then?
come and go quite frequently (for example migraine)?
Is the pain worse at a particular
time of the day or night?
time in the menstrual cycle (for women)?

Are there other associated symptoms?
Associated symptoms will vary according to the site and cause of the pain, but could include a bloating feeling in the abdomen, weakness or numbness in the legs, or alterations in vision. It may also include mood symptoms such as depression. Chronic pain often causes depression, and depression in turn increases the perception of pain.

How is the pain affecting functioning (housework, employment, social life)?
The way the pain affects you will vary according to the site of pain, the underlying cause and you as a person. Different people respond differently to their pain, but the effect the pain is having on your life may alter the approach taken to treat it.


PAIN ASSESSMENT TOOLS

The McGill Pain Questionnaire
Contains a list of descriptive words to choose, to indicate the intensity and character of the pain, with a drawing of a body on which you draw in where the pain affects you.

The Brief Pain Inventory
This questionnaire has a number of scales on which to rate, from one to ten, aspects of the pain, the response to treatment and the effect of the pain on function in everyday activities. There is also a drawing of a body to indicate where the pain is, as in the McGill questionnaire.

The Neuropathic Pain Scale
This questionnaire is particularly designed for people suffering from pain due to nerve disease or damage (neuropathic pain). This type of pain can feel very strange and be difficult to describe. This questionnaire involves rating descriptions of the pain (such as hot or itching) from one to ten


PAIN DIARY
This involves recording, usually for one week, your level of pain (on a pain scale) several times a day, and making notes on activities or other things that seem to worsen the pain, as well as of any medication you take and the effect it has. This can be very helpful in establishing whether there is any particular pattern to the pain, or any triggers that could be avoided.


PAIN SCALES
A pain scale is an attempt to assess the degree of pain you are feeling. You may be asked either to
- describe your pain in words as: no pain, mild, moderate or severe
- say or mark on a line a number from one to ten indicating how severe your pain is.

A scale has been developed for use with children, which has a row of face drawings showing different expressions. The child has to choose the face with an expression closest to how they feel.

However, because pain is subjective, and each person has a different past experience of pain, these scales do not allow one person's score to be compared to another person. They are most useful in monitoring an individual's response to treatment, by showing a change in that person's score over time.

PHYSICAL EXAMINATION
Physical examination may be done either to look for a possible cause for the pain, or to rule out possible serious disease. Sometimes areas other than the painful area will need to be examined. Precisely what form this takes will obviously vary according to the type and site of pain.

TEST AND PROCEDURES - check underlying cause of pain
Blood tests , Computerised tomography (CT scan), Electromyography, Magnetic resonance imaging (MRI scan), Nerve conduction study, Radiography (X-ray)

http://www.paineurope.com/index.php?q=en/book_page/assessment_of_pain