Principles & Practice of Pain Medicine > Part II. Pain: General Principles and Evaluation > Chapter 6. Evaluating the Patient with Chronic Pain Jeremy Goodwin and Zahid H. Bajwa

Evaluating the Patient with Chronic Pain: Introduction

"Pain is a complex multidimensional symptom. It is determined not only by actual or potential tissue injury and normal and abnormal activity of the nervous system, but also by the patient's personal beliefs, mood, previous painful experiences, psychosocial stressors, coping mechanisms, and motivational factors. Evaluation of a patient with chronic pain should take into consideration all of these factors. Unfortunately, there is no single test or scale that can measure pain comprehensively, reliably, or objectively. Thus, assessment of pain requires a thorough history and physical examination in combination with other diagnostic tools. Several visits may be required to elucidate relevant medical and pyschosocial factors. The patient's motivation for the evaluation must be clarified early (i.e., whether there are issues of litigation or disability affecting the patient's pain, and whether he or she perceives the potential to control pain as coming from without or within). To do this, it is important to listen well and not overly structure the interview. Chronic pain patients need validation. Without it, they cannot offer their trust, and trust is vital for treatment compliance and a successful outcome...."