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.
Other physical symptoms
Neuropathic Psychologic Social isolation
mechanisms processes Family distress
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 factorsPathophysiology
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)
Compression FxAssessment of Acute Back Painand Sciatica: “Red Flags”
MRI of the spine if patient demonstrates