Patient assessment

The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and if unresolved, can act as a barrier to treatment. A full pain history should therefore include:

• Description of pain
• Where is the pain?
• Does it radiate elsewhere?
• What does the pain feel like (eg, aching, burning, stabbing)?
• Does it vary in intensity?
• What makes it worse?
• What makes it better?
• What is the effect on sleep?
• What is the effect on mood?
• What is the effect on physical function?
• What is the effect on vocational/social function?
• Current medications and response to drugs (it may be appropriate to continue non-opioid therapies which have been previously effective)

• response to previous medications and other interventions including self-management strategies and alternative therapies (If opioids have previously been ineffective it is unlikely that offering an alternative opioid preparation will be helpful.)
• physical health including operations and illnesses. NB some comorbidities such as renal or hepatic impairment and sleep apnoea, will influence the choice of drug, dose and safety of therapy
• mental health including emotional trauma, previous and current mood, contact with mental health circumstances. Mental health comorbidities and a history of significant emotional trauma are not a contraindication to opioid therapy but: 

– are a risk factor for opioid therapy becoming prolonged and for high doses to be used
– patients may use opioids to blunt unpleasant thoughts and experiences: this may make opioids difficult to stop
– are a risk factor for addiction to prescribed opioids
– will be contributory to the current pain experience soneed to be identified and managed separately

• current or previous history of addiction to drugs or alcohol. Patients with a current or past history of addiction will need careful management and support in collaboration with specialists with expertise in addiction (for more information click here)
• patient circumstances and context (employment, family responsibilities, sources of support). Patients with a family/household member with addiction will need additional support and counselling about risks of diversion of controlled drugs
• patient’s understanding of pain and expectations of outcome
• pain assessment tools eg, VAS, Brief Pain Inventory, Leeds Neuropathic Pain Scale
• relevant physical examination including observation of patient mobility, distress
• imaging and other diagnostics (x-rays, scans, blood tests and electrophysiology)

Further Reading

• Faculty of Pain Medicine. Conducting Quality Consultations in Pain Medicine. 2015.