Lange Anesthesiology > Section III. Regional Anesthesia & Pain Management > Chapter 18. Pain Management

Evaluating the Patient with Pain

"The physician must first distinguish between acute and chronic pain. The management of acute pain is primarily therapeutic, whereas that of chronic pain additionally involves investigative measures. Thus, the patient with postoperative pain requires significantly less evaluation than the patient with a 10-year history of chronic low back pain who has sought multiple medical opinions and treatments. The former requires only a pertinent history and examination, including quantitative evaluation of pain severity, whereas the latter requires a careful history and physical examination, a review of prior medical evaluations and treatments, and thorough psychological and sociological evaluations.Reliable quantitation of pain severity helps determine therapeutic interventions and evaluate the efficacy of treatments. This is a challenge, however, because pain is a subjective experience that is influenced by psychological, cultural, and other variables. Clear definitions are necessary, because pain may be described in terms of tissue destruction or bodily or emotional reaction. Descriptive scales such as mild, moderate, and severe pain or verbal numerical scales are noncontinuous and generally unsatisfactory...."