Acute pain and chronic pain can be different – with acute pain typically related to injury or protection from injury, while chronic pain can have a less clear pathology.
Physicians need to be able to distinguish between nociceptive pain, pain related to inflammatory conditions, neuropathic pain and pain where there is no clear stimulus or damage associated with the experience of pain.
Assessment and evaluation of the character and type of pain experienced by patients is important both for reaching a definitive diagnosis and to choose appropriate treatment options based on patient expectations.
Different types of pain suggest different pathological and biopsychsocial mechanisms and respond differently to treatment options.
Importantly in diagnosis of chronic pain, the physician needs to be aware that pain can be multifactorial in nature – often involving nociceptive and neuropathic components. Typical examples are certain forms of back pain and cancer pain where a nerve injury is involved.
When assessing patients with chronic pain, the physician needs to consider at all times the interaction of physical, psychological and social factors.
Clinical assessment is a crucial first step in effective chronic pan management
The table highlights the key factors that should be considered, explored and evaluated with the patient experiencing chronic pain.1
At the end of a pain assessment and pain diagnosis, and before devising a management plan, it is important to establish the patient view on their pain by asking some key questions about what has to happen to make the patient more content with their treatment.
Since there are no practical objective methods of measuring pain, we must resort to scales and questionnaires to obtain information. Various tools can be used to assess pain intensity and the impact of pain on patient function, daily living and quality of life.
Since most of these scales are very much based on a subjective estimation of the severity of pain, the CHANGE PAIN Scale, a new user-friendly communication tool aimed at assessing pain via a more holitic approach, taking into account patients’ expectations on pain relief and quality of life.
Detailed questionnaires can be used to assess the impact on quality of life e.g. SF-36, WOMAC.