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Effective pain management begins with a comprehensive assessment. This assessment allows the health care provider to characterize the pain, clarify its impact, and evaluate other medical and psychosocial problems. The assessment determines whether additional evaluation is needed to understand the pain.

Because pain is subjective, only the patient can describe it adequately. The health care provider should ask about the duration and location of the pain, 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, and the nature of other medical and psychiatric problems, should be noted. This assessment requires a physical examination and a review of previous medical records.

As part of the assessment, it is important that all prior pain treatments be discussed. The health care professional should ask about 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 has pursued. These might include acupuncture, chiropractic care, massage or other manual therapies, yoga, herbal and nutritional therapies, or others. This information helps the health care provider understand the nature of the pain or the potential benefits of treatment.

The goals of the comprehensive pain assessment are:

  • Obtain a full description of the pain
  • Determine whether the description fits a well-known pain syndrome
  • Determine whether there is structural disease of the body that may help explain the pain
  • Try to understand the mechanisms (tissue damage, nerve injury, psychological processes) that maintain the pain
  • Describe the negative effects on physical and psychosocial functioning caused by the pain
  • Understand the medical and psychiatric problems that co-exist with the pain and might need treatment at the same time


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