Impact of pain on a patient’s function
Pain can affect multiple sociopsychobiomedical aspects of a patient’s life (eg sleep, self-care, mobility, school or work, leisure, emotions, relationships). c_agg7-c02-s1.html#agg7-c02-s1__tagg7-c02-tbl2 lists questions that can help establish the impact of a patient’s pain on their life. Assessing the impact of pain contextualises the pain experience.
In acute pain, pain intensity influences the impact of pain on a patient’s function. In chronic pain, however, impact of pain can be significant regardless of pain intensity.
Both acute and chronic pain can have a psychosocial impact. For patients with acute pain, brief assessment may be adequate. For patients with chronic pain, however, a comprehensive assessment of psychosocial impact is required. Determine the significance and meaning of the pain to the patient (their concerns, worries, and beliefs about the pain), and its impact on their emotions, relationships and other psychosocial factors. Establish relevant patient demographics (eg family, culture and language, work status, compensation status) and consider how these may affect or be affected by their pain. Effective assessment of psychosocial impacts of pain can help direct subsequent intervention. If a psychiatric disorder is suspected, see the Psychotropic Guidelines.
A key component of pain assessment is to measure how pain impacts physical function. Assessment of physical function determines whether a patient can undertake an activity at their current pain level. In acute pain, the functional activity scale (Functional activity scale) can determine whether a patient’s pain is affecting their physical function. It can also give an indication of pain intensity (eg significant functional limitation may indicate severe, acute pain).
|
Score |
Level of limitation |
Ability to undertake activity |
|---|---|---|
|
A |
no limitation |
the patient is able to undertake the activity without limitation due to pain |
|
B |
mild limitation |
the patient is able to undertake the activity but experiences moderate to severe pain |
|
C |
significant limitation |
the patient is unable to complete the activity due to pain |
Note:
From: Scott DA, McDonald WM. Assessment, measurement and history. In: Macintyre P, Rowbotham DJ, Walker S. Clinical pain management: Acute pain. 2nd ed. Boca Raton, FL: CRC Press; 2008. Reproduced by permission of Taylor & Francis Group. | ||
In chronic pain, functional impact of pain is often measured using multidimensional pain scales and is used to monitor a patient’s progress towards treatment goals. Multidimensional pain scales (eg the PEG scale1, the Brief Pain Inventory) provide information about the impact of pain and pain severity. They can be used to track the impact of pain over time and have a particular role in monitoring chronic pain. The Örebro Musculoskeletal Pain Questionnaire also provides information about the impact of pain but was developed to predict long-term disability and workers’ ability to return to work2.