Acute pain and chronic pain are fundamentally different
processes and must be evaluated differently. Acute pain
assessment seeks to identify its underlying injury or disease
and treat it, thereby eliminating both the pain and the need
for pain management. Pain intensity, quality and location
are core to acute pain assessment, and reduction of pain
intensity is the primary outcome measure of acute pain
interventions.
In contrast, chronic pain is the disease itself, and, in many cases will not resolve. Chronic pain evaluation thus focuses on assessing function and co-morbidities, rather than merely intensity, quality and location. Pain disability refers to the impact of chronic pain on function, and should be assessed as a basis for setting treatment goals. Pain beliefs are important to evaluate as well, particularly for patients who have had difficulty adjusting to living and with chronic pain. Additionally, a detailed pain and treatment history is necessary to identify potential problems and opportunities for success in ongoing management.
Pain intensity. Pain scores, though useful in assessing and treating acute pain, have a limited role in treating chronic pain. While chronic pain intensity is important to assess, patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires both a shift in expectations for many patients accustomed to an acute pain management model, as well as a direct, consistent approach from providers.
Common pain intensity assessment tools include the Numerical Pain Rating Scale (NPRS), where the patient rates pain on a numerical scale, and the Visual Analogue Scale (VAS), upon which the patient places a mark along a 10 cm horizontal line to reflect pain severity. Both scales require verbal anchors (typically “no pain at all” for the left anchor (or “0”) and “the most severe pain you can imagine” on the right (or “10”). For the NPRS, a 10-point rating scale is recommended. The health care provider may verbally provide the anchors and ask the patient to rate the level of pain on the 10–point scale. See examples below.
In contrast, chronic pain is the disease itself, and, in many cases will not resolve. Chronic pain evaluation thus focuses on assessing function and co-morbidities, rather than merely intensity, quality and location. Pain disability refers to the impact of chronic pain on function, and should be assessed as a basis for setting treatment goals. Pain beliefs are important to evaluate as well, particularly for patients who have had difficulty adjusting to living and with chronic pain. Additionally, a detailed pain and treatment history is necessary to identify potential problems and opportunities for success in ongoing management.
Pain intensity. Pain scores, though useful in assessing and treating acute pain, have a limited role in treating chronic pain. While chronic pain intensity is important to assess, patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires both a shift in expectations for many patients accustomed to an acute pain management model, as well as a direct, consistent approach from providers.
Common pain intensity assessment tools include the Numerical Pain Rating Scale (NPRS), where the patient rates pain on a numerical scale, and the Visual Analogue Scale (VAS), upon which the patient places a mark along a 10 cm horizontal line to reflect pain severity. Both scales require verbal anchors (typically “no pain at all” for the left anchor (or “0”) and “the most severe pain you can imagine” on the right (or “10”). For the NPRS, a 10-point rating scale is recommended. The health care provider may verbally provide the anchors and ask the patient to rate the level of pain on the 10–point scale. See examples below.