Effective pain management begins with a comprehensive assessment of the patient and their pain. This assessment allows us to characterise the pain, clarify its impact on the patient, and to evaluate other medical and psychosocial problems. The assessment determines whether additional evaluation or investigations are needed to understand the pain.
Because pain is subjective, only the person feeling it can describe it adequately. Useful information that can help includes the pain's duration and location, its severity and quality, and factors that make it better or worse. The changes that have occurred in the person's life as a result of the pain should be noted. It is also important to find out details of other medical conditions that affect the pain and how the person is thinking about the pain, and how the pain is interacting with their mental state. One very important thing to clarify is that pain specialists would all agree that it is incredibly rare (if ever) for "the pain to be all in your head or mind" but equally patients often agree with us that "what is in your head can hugely affect how you feel your pain".
The patient's assessment normally requires a physical examination, and we review their previous medical records and investigation results.
As part of the assessment, it is important that we discuss what prior pain treatments and thir effects. This includes medicines and other conventional treatments that have been tried in the past. Equally important is a discussion of the complementary or alternative medical treatments that the patient may have tried. These might include acupuncture, chiropractic or osteopathic care, massage or other manual therapies, yoga, herbal and nutritional therapies, or others. This information helps us understand the nature of the pain or the potential benefits of treatment.
Further investigations may be necessary, and we will discuss these in linked pages from the menu on the right, to be added shortly. Unfortunately, though, there is no test or scan that shows where pain is felt, and many people have abnormalities on scans or other tests that are irrelevant to their pain and may be "red herrings": for instance, every 50 year old has abnormalities on imaging of their neck!
The British Pain Society and Map of Mediine have recently finalised and published a recommended pathway for the Initial Assessment and Early Management of Pain, which are highly recommended.
Further detail for professionals
We have put some further details of assessment tools and techniques which may be of further interest to professionals on a separate page which will be added shortly.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016