Effective pain management starts with a detailed and systematic assessment enabling your healthcare professional to characterize the pain, clarify its impact, whilst considering other medical and psychosocial problems.

Pain is very subjective so only you can adequately describe what it is like and the effects that it has on your life. To enable healthcare professionals to understand your pain better, they need to ask about the duration and location of the pain, its severity and quality, and what factors that make it better or worse. It also helps for them to understand what changes have occurred in your life as a result of the pain, what impact there has been on your family, social and working life. As part of the assessment a physical examination may be required as it is important to discuss and evaluate all the pain treatments that have been tried. This helps the doctor or other relevant healthcare professional to gain a clearer understanding of your pain or the potential benefits of treatment.

A detailed pain assessment will:

• Determine whether the description corresponds to a well-known pain syndrome;
• Establish whether there is structural disease of the body that may help explain the pain;
• Try to understand the mechanisms (tissue damage, nerve injury, psychological processes) that maintain the pain;
• Illustrate the negative effects on physical and psychosocial functioning resulting from the pain;
• Understand the medical and emotional problems that co-exist with the pain and might need treatment at the same time.

Pain Assessment Charts

Often there are few tangible or obvious indications which enable a health practitioner to judge the severity of pain. If you have no obvious disability you may feel that your problems are ill-understood or even that you are disbelieved. Pain Assessment Charts provide healthcare professionals with a structured and distinguishable way of gathering a clear history of your pain whilst appraising its nature and severity plus any impact on daily life for you, your family and friends.

You may find it useful to complete an assessment chart yourself before you see your doctor so that you can clearly explain your pain and the effects that it is having on you.

Healthcare providers can use assessment charts as a means of comparing your expereince of your pain over a period of time, and to determine how effective diferent treatment options areproving to be in modifying the symptoms and effects of the pain.

Pain Rating Charts

Pain scales can help your doctor analyse or measure your pain’s intensity and may provide insight into the treatment most likely to work. The most widely used scales fall into the following 3 categories:

Numerical Pain Scales: helps to quantify the intensity of your pain and discomfort using numbers ranging from 0 to 10. Numerical pain scales may include words or descriptions to better label your symptoms, from feeling no pain to experiencing excruciating pain.

Verbal Pain Scale: includes frequently used words such as “low,” “mild” or “excruciating” to help you describe the intensity or severity of your discomfort. The usefulness of verbal scales comes from the fact that the expressions are relative, so you focus on the most characteristic quality of your pain.

Visual Pain Scale: have pictures of human anatomy to help you explain where your pain is located. The Wong-Baker Faces Rating Scale help you show your doctor how the pain makes you feel. This scale is particularly useful for children, who sometimes don’t have the vocabulary to explain how they feel.

To provide a true interpretation, pain scales are best used as the pain is occurring. Over a period of treatment, the pain scales can be used to verify how your pain changes and to see if treatment is having the intended effect.

Pain Diaries

It is very common for people with chronic pain to feel tense and apprehensive when faced with trying to tell their doctor about the discomfort they feel and they can forget how hard some days can get. If you are one of these people it is useful to keep a diary to help you recall and describe what happened to you whilst the pain is so bad. When telling your doctor about times when the pain was really bad, it is very helpful for them to know how it started, how it made you feel, what made it better, what made it worse.

Tips of what to include in your diary

1. Where is the pain? · does the pain move? · does the pain vary in different places?
2. How does the pain feel? · e.g. stabbing, burning, tingling
3. When did the pain start? · when you woke up? · later in the day?
4. Does the pain change during the day? · becomes sharper, duller, piercing etc
5. Does anything make it better/ worse? · icepack, heat pad, tens machine.
6. What medications do you take? · do they help?
7. Do you use other non-drug based treatments? · e.g. acupuncture, massage, meditation
8. How well do you sleep? · wake in the night, can’t get off to sleep
9. Have you stopped spending time with family & friends?
10. Is you appetite affected?
11. How has the pain changed your life and what you enjoy?

Key points about Pain Diaries

• A pain diary only requires you to note down words that sum up the pain and how you felt at the time
• You do not need to complete the diary every day, as you will not want to be focusing on your discomfort all the time- go back when you feel ready and make brief notes.
• If you find it difficult ask a member of the family or a friend to make a record of what you want to say.
• You may like to keep a small notebook or tape recorder close at hand so that if necessary you can make notes about how you feel.
• You may like to use a specially design form which provides a guide as to what to record. changes and to see if treatment is having the intended effect.