neurologic disorders
Evaluation of Pain
Introduction
Clinicians should evaluate the cause, severity, and nature of the pain and its effect on activities, mood, cognition, and sleep. Evaluation of the cause of acute pain (eg, Evaluation of Neck and Back Pain , (See also Overview of Pain .) The history should include the following information about the pain: Timing (onset, persistence [whether constant or intermittent], pattern and degree of fluctuation and frequency of remissions, duration) Quality (eg, sharp, dull, crampy, burning, aching, shooting) Severity Location (localized, diffuse, deep, superficial) Radiation pattern Exacerbating and relieving factors Information from the history and physical examination help guide choice of laboratory and imaging tests to identify possible causes of pain. Clinicians should assess the patient’s level of function and the pain's effect on function, focusing on activities of daily living (eg, dressing, bathing), employment, avocations, and personal relationships (including sexual). A personal or family history of chronic pain can often illuminate the current problem. Whether family members perpetuate chronic pain (eg, by constantly asking about the patient's health) should be considered. The patient's perception of pain and other factors may influence the clinical presentation. What pain means to the patient should be determined, with emphasis on psychologic issues, depression, and anxiety. Reporting pain may be more socially acceptable than reporting anxiety or depression, and appropriate therapy often depends on identifying any additional issues. Pain and suffering should also be distinguished, especially Pain ; suffering may be due as much to loss of function and fear of impending death as to pain. In some patients, secondary gain (external, incidental benefits of a disorder—eg, time off, disability payments) may contribute to pain or pain-related disability. Patients and sometimes family members and caregivers should be asked about the use, efficacy, and adverse effects of prescription and over-the-counter drugs and other treatments. If Opioid Use Disorder and Rehabilitation or other substances is suspected, further evaluation is required. 