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Evaluation of Pain

By

James C. Watson

, MD, Mayo Clinic College of Medicine and Science

Last full review/revision Apr 2020| Content last modified Apr 2020
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Neither examinations nor tests can prove that a person is in pain (see also Overview of Pain Overview of Pain Pain is an unpleasant sensation signaling actual or possible injury. Pain is the most common reason people visit their doctor. Pain may be sharp or dull, intermittent or constant, or throbbing... read more ). Consequently, doctors ask the person about the history and characteristics of pain. The person’s answers help them identify the cause and develop a treatment strategy. Questions can include the following:

  • Where is the pain? What is the pain like?

  • When did the pain start? Was there any injury?

  • How did the pain start? Did it begin suddenly or gradually?

  • Is the pain always present, or does it come and go?

  • Does it occur predictably after certain activities (such as meals or physical exertion) or in certain body positions? What else makes the pain worse?

  • What, if anything, helps relieve the pain?

  • Does pain affect the ability to do daily activities or to interact with other people? Does it affect sleep, appetite, and bowel and bladder function? If so, how?

  • Does pain affect mood and sense of well-being? Is the pain accompanied by feelings of depression or anxiety?

To evaluate the severity of pain, doctors sometimes use a scale of 0 (none) to 10 (severe) or ask the person to describe the pain as mild, moderate, severe, or excruciating. For children or for people who have difficulty communicating (for example, because of a stroke), drawings of faces in a series—from smiling to frowning and crying—can be used to determine the severity of pain.

Pain Scales: How Bad Is the Pain?

Pain Scales: How Bad Is the Pain?

Doctors always try to determine whether a physical disorder is causing the pain. Many chronic disorders (such as cancer Overview of Cancer A cancer is an abnormal growth of cells (usually derived from a single abnormal cell). The cells have lost normal control mechanisms and thus are able to multiply continuously, invade nearby... read more , arthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) , sickle cell anemia Sickle Cell Disease Sickle cell disease is an inherited genetic abnormality of hemoglobin (the oxygen-carrying protein found in red blood cells) characterized by sickle (crescent)-shaped red blood cells and chronic... read more Sickle Cell Disease , and inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The two primary types of inflammatory bowel disease (IBD) are Crohn... read more ) cause pain, as do acute disorders (such as wounds, burns Burns Burns are injuries to tissue that result from heat, electricity, radiation, or chemicals. Burns cause varying degrees of pain, blisters, swelling, and skin loss. Small, shallow burns may need... read more Burns , torn muscles, broken bones Overview of Fractures A fracture is a crack or break in a bone. Most fractures result from force applied to a bone. Fractures usually result from injuries or overuse. The injured part hurts (especially when it is... read more Overview of Fractures , sprained ligaments Overview of Sprains and Other Soft-Tissue Injuries Sprains are tears in ligaments (tissues that connect one bone to another). Other soft-tissue injuries include tears in muscles (strains) and tears (ruptures) in tendons (tissues that connect... read more Overview of Sprains and Other Soft-Tissue Injuries , appendicitis Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more , kidney stones Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more Stones in the Urinary Tract , and a heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) ).

Doctors use specific techniques to check for sources of pain. Doctors move the person’s arms and legs through their normal range of motion to see if these motions cause pain. Injury, repetitive stress, chronic pain Chronic Pain Chronic pain is pain that lasts or recurs for months or years. Usually, pain is considered chronic if it does one of the following: Lasts for more than 3 months Lasts for more than 1 month after... read more , and other disorders can make certain areas of the body (called trigger points) become hypersensitive. Doctors touch various spots to see whether they are trigger points for pain. Different objects (such as a blunt key and a sharp pin) may be touched to the skin to check for loss of sensation or abnormal perceptions.

Doctors also consider psychologic causes. Psychologic factors Psychologic Factors That Contribute to Pain Psychologic factors that commonly contribute to pain, particularly chronic pain, may include anxiety, depression, and insomnia. (See also Overview of Pain.) Psychologic factors can strongly... read more (such as depression and anxiety) can worsen pain. Because depression and anxiety may result from chronic pain, distinguishing cause and effect may be difficult. Sometimes in people with pain, there is evidence of psychologic disturbances but no evidence of a disorder that could account for the pain or its severity. Such pain is called psychogenic or psychophysiologic pain.

Doctors ask about which drugs (including over-the-counter drugs) and other treatments the person has used to treat the pain and whether they are effective.

Few people exaggerate the pain they feel. Nonetheless, doctors usually also ask questions to make sure there are no ulterior motives for reporting pain, such as time off from work with pay or extra attention from family members. Such questions are routine.

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