Overview of assessing a patient with pain
Assessing a patient’s pain helps:
- identify the type of pain (nociceptive, neuropathic or nociplastic pain, alone or in combination), cause of pain (eg trauma, a medical procedure, central sensitisation), and the context in which the pain is experienced
- inform pain management strategies and the timeframe in which they should be implemented
- provide a baseline against which the findings of repeat assessment can be compared.
Comprehensive assessment of a patient with pain generally includes:
- establishing the history, characteristics and sociopsychobiomedical context of the pain (see #agg7-c02-s1__tagg7-c02-tbl2 for appropriate questions when taking a pain history). It is crucial to ascertain the patient’s experience of the pain and acknowledge the meaning they ascribe to it
- undertaking physical examination
- reviewing previous investigations and determining if any further investigations are warranted.
Importantly, there is often more than one major site of pain. Identify all painful sites and assess them separately—the type and cause of pain may vary between sites.
Tailor the assessment to the patient’s presentation. The timing of comprehensive assessment may be influenced by whether the pain is acute or chronic. For patients with acute pain it may be necessary to prioritise rapid assessment of pain, provision of initial analgesia, and treatment of acute medical problems (eg trauma). Comprehensive assessment may need to be postponed until distressing symptoms are controlled. For patients with chronic pain, however, a comprehensive pain assessment is needed before initiating management.
Repeated evaluation is often necessary, for both acute and chronic pain, because the patient’s condition may change.
Pain can be experienced from birth and the possibility that a child is experiencing pain should be considered during any medical assessment. Some people (eg children, people with impaired cognition) may be unable to give an accurate pain history; see Additional considerations when assessing pain in children and adolescents and Additional considerations when assessing pain in people with impaired cognition for advice. Collateral history about the impact of the pain should be sought from the patient’s family or carer(s). Older people may be reluctant to disclose the full extent of the pain and its effects; see Additional considerations when assessing pain in older people for advice.