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correlation between symptoms, mechanisms and response to therapy is not fully defined,
specific therapy targeted at, for example, neuropathic pain, may be of benefit (Gray, 2008).
Table 2.1 Fundamentals of a pain history
1 Site of pain
a primary location: description ± body map diagram
b radiation
2 Circumstances associated with pain onset
including details of trauma or surgical procedures
3 Character of pain
a sensory descriptors eg sharp, throbbing, aching (Victor et al, 2008)
b McGill Pain Questionnaire: includes sensory and affective descriptors (Melzack, 1987)
c neuropathic pain characteristics (eg Neuropathic Pain Questionnaire) (Backonja & Krause,
2003)
4 Intensity of pain
a at rest
b on movement CHAPTER 2
c temporal factors
i duration
ii current pain, during last week, highest level
iii continuous or intermittent
d aggravating or relieving factors
5 Associated symptoms (eg nausea)
6 Effect of pain on activities and sleep
7 Treatment
a current and previous medications — dose, frequency of use, efficacy, side effects
b other treatment eg transcutaneous electrical nerve stimulation
c health professionals consulted
8 Relevant medical history
a prior or coexisting pain conditions and treatment outcomes
b prior or coexisting medical conditions
9 Factors influencing the patient’s symptomatic treatment
a belief concerning the causes of pain
b knowledge, expectations and preferences for pain management
c expectations of outcome of pain treatment
d reduction in pain required for patient satisfaction or to resume ‘reasonable activities’
e typical coping response for stress or pain, including presence of anxiety or psychiatric
disorders (eg depression or psychosis)
f family expectations and beliefs about pain, stress and postoperative course
2.2 MEASUREMENT
The definition of pain underlies the complexity of its measurement. Pain is an individual and
subjective experience modulated by physiological, psychological and environmental factors
such as previous events, culture, prognosis, coping strategies, fear and anxiety. Therefore,
most measures of pain are based on self‐report. These measures lead to sensitive and
Acute pain management: scientific evidence 35
