The focus in chronic pain assessment differs from the evaluation of acute pain, which assumes a specific underlying injury or disease that treatment will cure. Begin chronic pain assessment with the history and physical examination. Important components of the initial evaluation are summarized in Table 3 and are detailed below.
Since chronic pain is a disease entity rather than a symptom of an underlying disease, a new strategy is needed to assess patients with chronic pain. Assessment should result in the diagnosis of a chronic pain syndrome and determine the underlying neurobiologic mechanism to help direct specific treatment strategies.
If you're taking sleeping pills for more than a few weeks, talk to your provider about an appropriate follow-up schedule to discuss your medicines.
Although not completely understood, the pathophysiology is thought to involve the following two mechanisms:
A chronic secondary pain syndrome initially manifests as a symptom of another disease and then continues after successful treatment of the disease.15
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Neonatal pain assessment Scoring systems for acute and postoperative pain in infants evaluate physiological parameters , behavioral changes , and/or contextual factors.
Assess the degree of functional impairment to help determine the urgency for addressing the acute pain issue.
Fentanyl testing. Fentanyl is a synthetic opioid and its metabolites are often missed in urine drug screens. GC/MS or LCMS are relatively good at detecting it and are reasonable confirmatory tests.
Response to these results may include counseling, shortened follow-up intervals and urine testing, pill counts, referral for treatment of substance use disorder, or discontinuation of opioid therapy. See Appendix D for a guide to ordering and interpreting urine drug tests.
Self-regulatory and psychophysiological approaches. The experience of chronic pain elicits strong physiological reactions that are often accompanied by cognitive thoughts Shop Now and processes.
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Definition: pain that is perceived at a location other than that of the causative stimulus; projection of pain usually onto a specific dermatome or myotome of the corresponding segment of the spinal cord
While multidisciplinary subspecialty pain services are increasingly available, primary care clinicians will continue to manage the majority of patients with chronic pain. This care can be challenging and resource-intensive, and many clinicians are reluctant or ill-equipped to provide it.