ASSESSMENT OF CHRONIC PAIN

Abstract

By taking history from patient with persistent pain, this will usually give a clue to the initial triggering factor (injury, operation, medical illness) and site of nociception (distal - extremity, nerve root, visceral organ), which will invariably represent an acute etiology for the pain. Over its. course, however, the pain will change. With succeeding attempts at operative intervention or simply by alterations in normal posture or other factors, myofascial components may increase or spread to neighboring myotomes, with progressive complaints of stiffness, soreness, and sharp, aching, or burning and boring pain, increased by activity or cold. Deafferentation components (severe, burning pain) can evolve from initial neuritic dysfunction ( electrical, shooting pains), and there can be onset of facilitated autonomic discharges; with vasomotor instability and a causalgic overlay. Often these "new" pains are mistaken for new pathology, and unnecessary testing or operative procedures are performed. The patients should be asked to give a numerical value to the pain (on a scale ofzero to ten) or lo umrk on n ltlcm line (visual analog scale) the current severity of the pain, which can be reassessed at each succeeding visit. Physical examination should include a complete survey of baseline sensorirnotor, circulatory, and skeletal parameters. More detailed assessment of • focal dysfunction in the area of the pain should "start from the skin and go in" looking for trophic or vasomotor asymmetry, cutaneous hypersensitivity, tender scars or neuromas, regions of neuromuscular entrapment, and myofascial trigger points producing any or all of the pain, as well as differences in bone symmetry ( e.g., leg