The Stepwise Approach to Pain Evaluation.

Abstract

The investigator who would study pain is at the mercy of the patient, upon whose ability and willingness to communicate he is dependent.-L. Lasagna (1960) Before any attempt is made at pain management intervention, assessment is essential. As I have reviewed elsewhere , most health care professionals are under time constraints, as well as billing constraints imposed by third-party payers, when deciding the best method of evaluating patients with pain. Therefore, a frequently asked question is the following: "If I were to choose the most time-and cost-efficient assessment method, which one should I select?" Unfortunately, one needs to avoid the assumption that there is a single instrument that can serve as the best assessment. For many patients, several assessments will be needed. Rather than asking which instrument should be used, a better question is: "What sequence of testing should I consider to develop the best understanding of potential biopsychosocial problems that might be encountered with this patient?"Assessment should proceed from a global biopsychosocial diagnosis of pain to a more detailed evaluation of the most important interactive factors of this diagnosis. There are numerous biological measurement arid diagnosis methods that can be used (Woessner, 2003). Of course, it is initially important to provide patients with a brief overview of the concept of pain. Providing a brochure to patients is often helpful in reinforcing what is said face to face. Appendix 4.2 presents a brief brochure my colleagues and I often use when treating back pain patients in our interdisciplinary pain 91