By asking these seven assessment questions, you can better understand your patient’s pain in order to build a plan of care together.
Lifelong Learning in Clinical Excellence | August 24, 2018 | 1 min read
By Erica Leonard, MD, Johns Hopkins University School of Medicine
Pain is complex, multifactorial, and often presents a major treatment challenge. How can we help our patients navigate their pain to a more manageable place?
We can start with a pain assessment where we meaningfully explore each patient’s unique experience of their discomfort. In doing so, we can also begin to empower our patients to tap into their self-efficacy on their road to improved pain management.
I encourage you to approach the pain assessment as a chance to better understand how a patient perceives their pain. You will notice that the 0 to 10 pain scale is not included in the pain assessment recommendations below. Many of us have seen how one patient’s 4/10 may be another patient’s 10/10. While a number can be satisfying from an objective standpoint, it may not provide clarity to how pain is affecting a person’s day-to-day reality.
Here is what I ask to understand how my patient experiences their pain:
1.) When did you first become aware of the pain?
2.) Location of the pain, and does it radiate?
3.) Quality and severity of the pain? Is it nociceptive pain, either somatic (eg: sharp, aching, throbbing pain that is easy to localize) or visceral (eg: more difficult to describe and localize), or is it neuropathic pain (eg: burning, tingling, numbness, electrical, shooting, stabbing)? Note that nociceptive pain responds well to opioids and co-analgesics, while neuropathic pain responds better to a combination of opioids and adjuvant analgesics (eg: TCAs, anticonvulsants, antiarrhythmics).
4.) Exacerbating and relieving factors of the pain?
5.) Temporal nature of the pain? Is it constant, intermittent or breakthrough?
6.) How does the pain impact your life physically, emotionally and socially? What does your pain keep you from doing?
7.) What are your goals for what you would like to be able to do once your pain is under better control?
Piecing together the story of a patient’s pain with these assessment questions can help you build a plan of care with your patient.
Finally, by being curious about how pain affects a person’s functional status, and exploring a patient’s goals in the scenario of less pain, we can help our patients gain more insight into their pain. This enhanced perspective can allow them to see the potential for making progress against a formidable opponent.