Page 88 Guide to Pain Management in Low-Resource Settings

76 Richard A. Powell et al.

any other symptoms, whether he has a known medi- pain may be present and that cognitive restruc-
cal condition, when the pain started, and what makes turing will be indicated. Another example would
it worse or better? While it is possible that the under- be a decrease of pain with movement, when pos-
lying cause of the pain may be treatable (and it is im- sibly osteoarthritis might be present.
portant to ascertain what the underlying cause is), it is • Localization: probably the most important
critical to manage his pain quickly, which should also question. Localization of the pain may differen-
allow him to become more relaxed, making it easier to tiate between a radicular and nonradicular eti-
ascertain the cause. ology of pain.
• The items mentioned are only rough indicators
Pearls of wisdom of certain etiologies. Further questioning and
examination must to be undertaken to confirm
• An understanding of the need to undertake an as- suspicions.
sessment of pain that is sensitive to the individual
patient (e.g., age, regarding cognitive ability, and References
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• Pain decrease: positions or situations in which
National Institute of Health Pain Consortium: http://painconsortium.nih.
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e.g., if only rest—and no other coping strategies— Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials
(IMMPACT) www.immpact.org
is considered useful for the patient, this is impor-
tant information for the therapist that chronic