Assessment of Chronic Pain: Domains, Methods, and Mechanisms

Abstract

Accurate classification of chronic pain conditions requires reliable and valid pain assessment. Moreover, pain assessment serves several additional functions, including documenting severity of the pain condition, tracking the longitudinal course of pain, and providing mechanistic information. Thorough pain assessment must address multiple domains of pain, including the sensory and affective qualities of pain, temporal dimensions of pain, and the location and bodily distribution of pain. Where possible, pain assessment should also incorporate methods to identify pathophysiological mechanisms underlying the pain. This article discusses assessment of chronic pain, including approaches available for assessing multiple pain domains and for addressing pathophysiological mechanisms. We conclude with recommendations for optimal pain assessment.

Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties

“…While QST provides important information about underlying pain mechanisms, these QST methods are commonly used in laboratories for research purposes . Therefore, there is a need for knowledge translation methods to ensure better clinical utilization of some bedside testing tools, such as pressure algometry and von Frey monofilaments, and that they are clinically feasible tools to identify underlying pain mechanisms . Furthermore, developing reliable and valid simple, low‐cost, less time‐consuming tools is needed for different joint pain populations.…”

“…PJP, considered among “other musculoskeletal (MSK) conditions,” represented the 10th ranked cause of years lived with disability according to the Global Burden of Disease study in 2013, with OA ranked 13th . While multiple factors (biological, psychological, and social) contribute to the persistence of PJP, central sensitization of the nervous system is a key factor in the development of PJP. Such sensitization occurs at multiple levels (nociceptors, dorsal horn, brainstem, cortical, and subcortical regions) due to neurobiological changes (neural plasticity) in response to sustained or repeated nociceptor inputs …”

The Potential Role of Sensory Testing, Skin Biopsy, and Functional Brain Imaging as Biomarkers in Chronic Pain Clinical Trials: IMMPACT Considerations

“…Consequently, classifying and treating pain on the basis of either its etiology or symptomatology alone may not be the optimal approach for chronic pain conditions. An alternative approach to classification – analyzing pain on the basis of the underlying mechanisms – may lead to improved treatment responses and outcomes [61]. Although the mechanisms of pain cannot be directly examined in humans, the expression of sensory abnormalities (i.e., the individual somatosensory phenotype or sensory profile) might provide insights into the pathophysiological dysfunctions of afferent processing.…”

Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review

“…Although one‐dimensional measures are used frequently to assess pain intensity, multidimensional tools are helpful to obtain further information (Fillingim et al., ). In general, long‐lasting pain has an impact on emotional and physical function and needs to be assessed by complex tools (Breivik et al., ).…”