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 Table of Contents  
LETTER TO THE EDITOR
Year : 2019  |  Volume : 33  |  Issue : 2  |  Page : 112-116

Comprehensive systematic pain assessment form: Patient's Visiting Pain Clinic


Department of Anesthesiology, Pain and Critical Care, AIIMS, Rishikesh, Uttrakahand, India

Date of Web Publication7-Aug-2019

Correspondence Address:
Dr. Azka Zuberi
Department of Anesthesiology, Pain and Critical Care, AIIMS, Rishikesh, Uttrakahand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_32_19

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How to cite this article:
Kathor N, Zuberi A, Gupta N, Kumar A. Comprehensive systematic pain assessment form: Patient's Visiting Pain Clinic. Indian J Pain 2019;33:112-6

How to cite this URL:
Kathor N, Zuberi A, Gupta N, Kumar A. Comprehensive systematic pain assessment form: Patient's Visiting Pain Clinic. Indian J Pain [serial online] 2019 [cited 2019 Aug 17];33:112-6. Available from: http://www.indianjpain.org/text.asp?2019/33/2/112/264077

Sir,

Pain is a wide spectrum of disorders including acute pain, chronic pain, and cancer pain and sometimes a combination of these. Pain can also arise for many different reasons, such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Chronic pain experience is shaped by a myriad of biomedical, psychological, and behavioral factors.[1]

As with other medical specialties, reaching correct diagnosis with comprehensive history and physical emanation is a most important part in the management of patients with pain. We cannot choose the correct treatment modality unless we identify the pain generator correctly and understand the pathophysiology behind it. In modern medicine with the advent of sophisticated imaging, there are tendencies of ignoring history part in clinical examination. Many a times, we jump directly into the magnetic resonance imaging (MRI) or other scans ignoring the importance of proper history in diagnosis of pain. However, we must remember that some abnormality in MRI may not be indicative of the source of pain.[2]

About 40%–80% of patients with chronic pain are misdiagnosed. The leading cause of misdiagnosis is (a) failure to spend enough time with patient to take careful history and in performing physical examination and (b) using wrong tests.[3]

For improving our diagnosis, we structured a pain assessment form compiling history, physical examination, special tests, and psychological examination in easily understandable, systematic, and step-wise approach.

We have designed the pro forma in two parts:

  • [Form 1]: History and General examination[4] – it should be the first pro forma to be used for any pain complaint as it has whole-body part/dermatological distribution diagram and helps us to assess the pain as a whole.


  • After reaching a differential diagnosis using Form 1, we should use pro forma designed for examination of specific body part or complaint to reach provisional diagnosis, i.e.,

  • [Form 1]A: Evaluation of low back/lower limb pain[4],[5],[6]
  • [Form 1]B: Evaluation of shoulder pain[8],[9]
  • [Form 1]C: Evaluation of knee pain[10],[11]
  • [Form 1]D: Evaluation of neck pain[12],[13]
  • [Form 1]E: Evaluation of hand pain.[14],[15]



Using these systematic pain assessment forms in our daily pain clinic helps us in decreasing the chances of missing important point in history and examination, decreases the time for assessing patients, and makes reassessing the patients in the next visit easier.

Most common complaints which we encounter in our pain clinic are chronic low back pain, neck pain, shoulder pain, knee pain, hand pain followed by multiple joint pain, cancer pain, and fibromyalgia; keeping that in mind so, we formulate this pro forma starting with general history and examination followed by evaluation for particular pain complaint or part involved (evaluation of low back ache, shoulder pain, neck pain, hand pain, and knee pain).

Formulating these forms helps us in evaluating pain patients visiting our pain clinic in a systematic manner, but we constantly review these forms according to our requirements and patient's compliance and complaints. According to institutional and pain physician preferences, these systematic pain assessment forms may require further validation and testing for their feasibility and user-friendliness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth 2013;111:19-25.  Back to cited text no. 1
    
2.
Gurumoorthi R, Das G, Gupta M, Patil V, Manoj Kumar S, Mehta P, et al. The art of history taking in patient with pain: An ignored but very important in making diagnosis. Indian J Pain 2013;27;59-66.  Back to cited text no. 2
    
3.
Nelson H. Why chronic pain patients are misdiagnosed 40 to 80% of the time? J Recent Adv Pain 2016;2:94-8.  Back to cited text no. 3
    
4.
Das G. Clinical Methods in Pain Medicine. 2nd ed. New Delhi, India: CBS Publishers; 2017. p. 113-26.  Back to cited text no. 4
    
5.
Biller J, Gregory G, Brazis PW. DeMeyer's the Neurological Examination. 6th ed. New York, NY: McGrawHill; 2011. p. 239-308.  Back to cited text no. 5
    
6.
Swartz HM. Textbook of Physical Diagnosis: History and Examination. 5th ed. Philadelphia: Saunders Elsevier; 2007. p. 593-710.  Back to cited text no. 6
    
7.
Gore S, Nadkarni S. Sciatica: Detection and confirmation by new method. Int J Spine Surg 2014;8:15.  Back to cited text no. 7
    
8.
Das G. Clinical Methods in Pain Medicine. 2nd ed. New Delhi, India: CBS Publishers; 2017. p. 50-61.  Back to cited text no. 8
    
9.
Moen MH, de Vos RJ, Ellenbecker TS, Weir A. Clinical tests in shoulder examination: How to perform them. Br J Sports Med 2010;44:370-5.  Back to cited text no. 9
    
10.
Hong E. An approach to knee pain. Patient Care 2003;37:42.  Back to cited text no. 10
    
11.
Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med 2003;139:575-88.  Back to cited text no. 11
    
12.
Fishman SM, Ballantyne JC, Rathmell JP. Bonica's Management of Pain. 4th ed.. Philadelphia: Lippincott Williams and Wilkins, Wolters Kluwer; 2010. p. 1020-8.  Back to cited text no. 12
    
13.
Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Del JR. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia: Elsevier; 2013. p. 628-37.  Back to cited text no. 13
    
14.
Gerriant F. Neurological Examination Made Easy. 2nd ed.. Philadelphia: Churchill Livingstone; 1999.  Back to cited text no. 14
    
15.
Raj PP. Practical Management of Pain. 3rd ed. Philadelphia: Elsevier; 2002.  Back to cited text no. 15
    




 

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