Pain Assessment: A Comprehensive Approach

Acute vs. Chronic Pain

When assessing pain, it is crucial to distinguish between acute pain and persistent/chronic pain, as this has direct implications for both evaluation and treatment:

• Acute pain: During the acute phase, a thorough assessment with reliable and validated tools is essential to prevent the pain from developing into chronic pain.

• Persistent/chronic pain: When pain becomes long-lasting, it is vital to understand the factors contributing to its maintenance over time.

Pain Assessment

Pain assessment is often based on a biopsychosocial approach, as this framework recognizes pain as a multidimensional phenomenon and integrates biological, psychological, and social factors into clinical practice.

Biopsychosocial Assessment

A biopsychosocial evaluation should seek to identify the following dimensions:

• Biological (Bio): Identification of pathology and triage to rule out dangerous conditions (red flags).

• Psychological (Psycho): Mapping psychological burden, fear-avoidance, coping strategies, and the patient’s perception of the pain cause (yellow and orange flags).

• Social (Social): Work conditions, family support, and financial circumstances that may affect the pain experience (blue and black flags).

Multidimensional Pain Assessment

Pain evaluation should consider multiple domains:

• Sensory: Intensity, duration, location, and pattern of pain.

• Affective: Emotional responses such as anxiety, fear, or sadness.

• Cognitive: Patient’s understanding, beliefs, and expectations about their pain.

• Physiological: Body’s responses including muscle tension, pulse, and respiration.

• Behavioral: Impact of pain on daily activities, movement patterns, and functional ability.

Clinical Implications

Pain has complex effects across physical, psychological, and social domains. By integrating the biopsychosocial model, clinicians can better tailor treatment to individual needs. Structured documentation and validated tools increase both accuracy and effectiveness of management.

Pain Assessment Tools

Common Patient-Reported Measures

Despite the challenges of quantifying pain, several accepted tools exist to evaluate treatment outcomes.

• Pain intensity scales:

  • Numeric Pain Rating Scale (NPRS, 0–10)

  • Visual Analogue Scale (VAS)

  • Verbal Rating Scale (VRS: mild, moderate, severe)

• Pain interference:

  • Roland & Morris Disability Index

  • Oswestry Low Back Pain Disability Questionnaire

• Physical function:

  • Brief Pain Inventory (BPI)

• Quality of life:

  • EuroQol 5D (EQ-5D)

• Emotional distress:

  • Beck Depression Inventory (BDI-II)

  • Hospital Anxiety and Depression Scale (HADS)

  • Profile of Mood States (POMS)

Specific Pain Tools

Some instruments focus on particular pain aspects:

• Pain Self-Efficacy Questionnaire (PSEQ) – self-management capacity

• Short-Form McGill Pain Questionnaire (SF-MPQ) – sensory and affective qualities

• Neuropathic Pain Questionnaire (NPQ) – neuropathic symptoms

• Pain Catastrophizing Scale – cognitive patterns and catastrophizing

• STarT Back Screening Tool – risk stratification for chronic low back pain

Performance-Based Measures

Physical performance tests can indirectly reflect pain-related limitations:

• Loaded Forward Reach Test – used in chronic low back pain for mobility and stability [3].

• Timed Up & Go (TUG) – functional mobility assessment in osteoarthritis [4].

• Grip Strength – functional test for rheumatoid arthritis [5].

• Abbey Pain Scale – observational tool for non-verbal patients, such as those with dementia.

Although useful, these tests cannot replace patient-reported measures, as factors like fear of pain may bias outcomes.

Physiological/Autonomic Responses

Some research explores physiological markers as potential pain indicators:

• Skin conductance

• Heart rate

While these variables provide insights into autonomic arousal, they have limited correlation with actual pain intensity and are strongly influenced by stress and emotional states. Thus, they should not be considered reliable stand-alone pain measures.

Practical Considerations

• Self-report questionnaires should ideally take no longer than 25 minutes to complete.

• Combine longer scales with frequent, short assessments to balance depth with feasibility.

• Ensure the tools match the patient’s cognitive and communication abilities.

Fysiologiske/autonome responsmål

Individualized Pain Assessment

Pain evaluation must always be personalized:

• Individual factors: Age, sex, genetics.

• Social and cultural aspects: Spirituality, ethnicity, socio-economic status.

• Pain characteristics: Duration, location, type.

• Classification: Neuropathic pain, cancer-related pain, musculoskeletal pain.

• Vulnerable groups: Patients with cognitive impairment or communication difficulties.

Outcomes of Pain Assessment

A structured pain assessment provides the foundation for effective treatment:

• Monitor treatment effects continuously.

• Adjust strategies based on patient response.

• Refer to specialists when red flags or complex comorbidities are identified.

Conclusion

Accurate pain assessment requires a multidimensional approach, integrating self-reported measures, clinical tools, performance tests, and biopsychosocial factors. This allows healthcare providers to tailor interventions, improve patient outcomes, and reduce the risk of pain becoming chronic.

Sources:

1. Younger, Rebecca McCue and Sean Mackey. Pain Outcomes: A Brief Review of Instruments and Techniques. Curr Pain Headache Rep. 2009 February ; 13(1): 39–43.

2. Harding VR, Williams AC, Richardson PH, et al. The development of a battery of measures for assessing physical functioning of chronic pain patients. Pain 1994;58:367–375.

3.  Smeets RJ, Hijdra HJ, Kester AD, et al. The usability of six physical performance tasks in a rehabilitation population with chronic low back pain. Clin Rehabil 2006;20:989–998.

4.  Stratford PW, Kennedy DM, Woodhouse LJ. Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther 2006;86:1489–1496.

5.  Goodson A, McGregor AH, Douglas J, et al. Direct, quantitative clinical assessment of hand function: usefulness and reproducibility. Man Ther 2007;12:144–152