Biological, psychological and social factors

Effective pain management requires an accurate assessment of pain. As chronic pain is a complex phenomenon, evaluating it from a one-dimensional biological perspective is limiting, and often fails to fully explain the patient’s symptoms.

An appropriate diagnosis requires the examination of psychological and social factors in addition to biological causes. Key elements include:

• Performance of a full physical examination, including an evaluation of the patient’s medical history
• Assessment of pain location, severity, quality, onset and aggravating/relieving factors
• Utilisation of specific diagnostic procedures such as X-rays or bone scans may be required
• Evaluation of socio-psychological factors that may have contributed to the pain

Pain Assessment Tools

Various tools are available for identifying and measuring pain. For a rapid and simple assessment of pain severity, validated pain scales can be used. They are based on patient self-reports, thus giving physicians a good idea of patients’ pain perception. Very often used are the following scales in adults:

• Visual Analogue Scale: Patients are asked to rate the intensity of their pain on a scale with one end indicating “no pain” and the opposite end indicating “maximum imaginable pain”.
• Numeric rating scale: Patients are asked to identify how much pain they are having by choosing a number from 0 (“no pain”) to 10 (“worst pain”).