Patient’s self-report is the “gold” standard, alternative methods/observations if patient unable to report

Pain Experience and Context

• Location, referral, radiation
• Intensity
  • Last 24 hours and current, rest/movement
• Interference with activities
  • General, mood, relationships, sleep, appetite
• Timing
  • Onset, duration course; persistent/intermittent
• Quality
  • Aching, stabbing throbbing, pressure (somatic)
  • Gnawing, cramping, aching, sharp (visceral)
  • Sharp, tingling, shooting (neuropathic)
• Aggravating/Alleviating factors
• Other symptoms
• Current pain management
  • Meds, how much/often, prescriber
  • Response, relief, compliance, side effects
• Prior pain therapies
  • Reason, length of use, response,?discontinued
• Special issues
  • Meaning/consequence for patient/family
  • Knowledge/beliefs regarding pain medications
  • Cultural, religious, spiritual, existential beliefs
  • Goals and expectations
• Psychosocial/psychiatric
  • Prior/current substance abuse
  • Risk factors for aberrant use/diversion (environmental, social)
  • Risk factors for undertreatment
    • Peds, geriatric, minorities, female
    • History abuse, history neuropathic pain
    • Cultural factors
• Medical history – current/prior
  • Oncologic treatment, chemotherapy, radiation, surgery
  • Other significant illnesses. Pre-existing chronic pain
  • Physical exam, labs, imaging
• Pain diagnosis and individualized pain treatment plan based on mutually developed goals
  • Pain diagnosis includes etiology (disease process, treatment implication) and pathophysiology (somatic/visceral, neuropathic)

Pain Assessment Mnemonics

“WILDA”

• Words
• Intensity
• Location
• Duration
• Aggravating/Alleviating

4 A’s of pain management outcome

• Analgesia
• Activities
• Adverse effects
• Aberrant behavior