I. OVERVIEW

A. Core questions to be answered as part of a pain assessment:

B. The methodology of the pain assessment:

II. INTRODUCTION

III. CORE QUESTIONS TO BE ANSWERED AS PART OF A PAIN ASSESSMENT

A. What is the type or category of pain? 8

1. Nociceptive Pain --

2. Neuropathic Pain --

3. Psychogenic Pain--

4. Mixed Category Pain--

B. Is there a primary cause of the pain?

C. What additional factors are contributing to the pain?

1. Mood disorder--

2. Anxiety disorder--

3. Somatization and hypochondriasis³⁴--

4. Secondary gain¹⁵--

5. Other physical factors

D. Are treatments available for the primary cause of the pain? 28,36

E. Are treatments available for the additional factors which contribute to the pain?

F. Are there other medical or psychosocial conditions which should influence the choice of treatment? ³¹

IV. THE METHODOLOGY OF THE PAIN ASSESSMENT

A. History^{6, 12}

1. How the pain developed?

2. Description of the pain.

3. The location of the pain and any spread.

4. How does the pain fluctuate over time.

5. What is the overall level of patient function?

6. What treatments have been attempted?

B. Past Medical History

1. Do other medical problems relate to the patient's complaint of pain?

2. Do other medical problems potentially affect the choice of pain treatments?

3. Does the patient have any prior or current substance abuse history?

C. Current Medications

1. Dosage and pattern of use

2. Effectiveness

3. Drug tolerance

4. Potential for drug interactions and toxicity

D. Physical Examination ^{6, 12}

1. Mental status exam

2. Vital signs

3. Inspection

4. alpation & Musculoskeletal exam

5. Neurologic

E. Diagnostic Testing ³⁷

1. Radiographic

2. Diagnostic blocks ³

3. Electromyography & Nerve Conduction Studies (EMG / NCS)

4. Somatosensory evoked potential testing (SSEP)

5. Other Quantitative Sensory Testing (QST)

F. Psychological Evaluation

G. Differential Diagnosis

H. SUMMARY

REFERENCES