Assessing pain

The first step in treating your pain is to assess it. Your healthcare team can use the following ways to find out more about your pain.

Talking about your pain is the best way you can help your healthcare team understand it. The more information you can give them about your pain, the better able they will be to help relieve or control it. Some of the questions your healthcare team will ask you to better understand your pain include:

• When did the pain begin? What were you doing when the pain began? Did it begin at a certain time of day or night? Is it worse at a certain time of the day or night? Does it keep you awake? Has it been getting worse over time or has it stayed about the same?
• Where is the pain? Is it in one part of the body? Do you feel it in more than one place? Does it start in one place and move? Does the pain feel like it is deep inside or close to the surface?
• What does your pain feel like? What words would you use to describe your pain? Is it sharp (stabbing) or dull (aching)? Does it spread (radiate) from a specific area?
• How bad is the pain? Does it come and go? How long does it last? How much does it hurt at its worst? How much does it hurt at its best? Does anything make the pain better or worse?
• What types of treatments have you tried to relieve your pain? Do they relieve the pain? If so, for how long?
• How does the pain affect your life? How do you cope with pain and stress? What does pain mean to you and your family? Have you had mood changes (such as depression or anxiety) as a result of your pain? Have you had pain in the past? If so, how has it affected you?
• How is your cancer diagnosis affecting your life? How is it affecting your family? How well do you understand your cancer diagnosis and treatment?
• How much do you know about pain management? Are you concerned about using pain medicines? Are you concerned about the cost of pain medicines or treatments? What are your goals for pain control?
• What are your spiritual beliefs about pain and illness? Do you have religious or spiritual beliefs that affect how you cope with pain? Do you have beliefs about traditional medicine in healing?

A physical exam, including a neurological exam, is very important in assessing pain. Your healthcare team will look at the area where you feel pain to see if there are any signs of infection, injury (trauma), tissue breakdown or changes in bone structures. Depending on where your pain is, the healthcare team may examine your abdomen, hips, spine, hands or feet. They may also check for swollen (enlarged) lymph nodes under your arms, in your groin or at the base of your neck.

The healthcare team may do a neurological exam to check how the brain, spinal cord and nerves are working. It usually involves a series of questions and tests to measure mental status, cranial nerve function, coordination, movement and how the muscles, senses and reflexes work.

Your healthcare team may do different diagnostic tests to find the cause of your pain. These tests may include blood tests such as liver or kidney function and tumour marker tests. You may also have imaging tests such as x-ray, bone scan, CT or MRI.

Your healthcare team may ask you to rate your pain on a pain scale. They may consider how your pain affects your quality of life based on changes in your mood, appetite or sleep. They may also ask you to use one of the following self-report scales to help them measure how bad the pain is. These scales, along with your own words, help the healthcare team assess your pain.

Numerical rating scales use a number scale to describe pain intensity. These scales usually range from 0 (meaning no pain or hurt) to 10 (meaning the most intense pain or hurt).

Face scales use a series of cartoons or photographs of faces. At one end of the scale is a neutral or happy face that represents no pain. At the other end of the scale is a face that represents the worst pain. You will be asked to point to the face that shows how much pain you have.

Visual analogue scales use a line to help you describe pain intensity. You make a mark or move a slider on a plastic ruler to show how strong the pain is.

Assessing the pain of children or people with disabilities can be difficult. It is important to assess pain in children by age and developmental level. The healthcare team may use different techniques to assess people with learning or mental challenges, including observing changes in mood, behaviour, activities or other expressions.