Assessment and Diagnosis of Pain Disorders. Pain Assessment: Goals. Characterize the pain Identify pain syndrome Infer pathophysiology Evaluate physical and psychosocial comorbidities Assess degree and nature of disability Develop a therapeutic strategy.
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Assessment and Diagnosisof Pain Disorders
Other physical symptoms
NeuropathicPsychologic Social isolation
Sense of loss or inadequacy
Adapted with permission from Portenoy RK. Lancet. 1992;339:1026.
Commensurate with identifiable tissue damage
May be abnormal, unfamiliar pain, probably caused by dysfunction in PNS or CNS
Pain, not attributable to identifiable organic or psychologic processes
Sustained by psychologic factors
Recent onset, transient, identifiable cause
Persistent or recurrent pain, beyond usual course of acute illness or injury
Transient pain, severe or excruciating, over baseline of moderate pain
Ask patient about complaints suggestive of
In patients with neuropathic pain, examination should focus on the anatomic pattern and localization of the abnormal sensory symptoms and neurologic deficits
EMG-NCV and QST
Infection (diskitis, epidural abscess)
MRI of the spine if patient demonstrates