Initial Pain Assessment

Pain management depends on a comprehensive assessment. This is especially true for the patient with persistent pain. Pain assessment should be ongoing (occurring at regular intervals), individualized, and documented so that all involved in the patient’s care have a clear understanding of the pain problem. As a result of the pain assessment, the clinician should understand the nature of the pain in terms of its etiology, pathophysiology and syndrome; its impact on many domains of life; and relevant premorbid conditions and comorbidities that will influence treatment decisions. This understanding requires detailed questions about the pain characteristics, an assessment of the impact of the pain in multiple domains, and an evaluation of related concerns and comorbidities. Based on this information, the findings on a physical examination and review of records and existing laboratory and imaging data, a working diagnosis can be developed that includes an understanding of the pain’s etiology, pathophysiology and syndrome. From this formulation, a plan of care can be developed that may include the need for additional evaluation and an initial set of therapies to address the pain and other concerns.

This process of assessment can be straightforward and brief in the setting of acute pain related to trauma or surgery. It increases in complexity and the time required as the pain becomes persistent, fails to respond to conventional therapy, or is observed to be occurring in a biomedical or psychosocial context that complicates the understanding of the pain or poses challenges in management.