Examining a patient with pain

Physical examination is an essential component of pain assessment and can:

• yield information that aids diagnosis (eg a neurosensory examination helps to confirm neuropathic pain and identifies sensitisation)
• determine the impact of pain on current physical functioning
• identify signs and symptoms associated with the cause of pain (eg joint swelling), or that require urgent evaluation (eg malaise, weight loss, fever).

Physical examination should not cause unnecessary pain; however, some discomfort may be inevitable and gives a valuable guide to function. Examine the patient at presentation and, if pain persists (eg chronic pain), repeat the examination intermittently.