Evaluation of Pain

Doctors ask about the history and characteristics of pain, so that they can identify its cause and develop a treatment strategy. To evaluate the severity of pain, doctors sometimes use a scale of 0 (none) to 10 (severe) or ask the person to describe the pain as mild, moderate, severe, or excruciating. For children, drawings of faces in a series--from smiling to frowning and crying--can be used to determine the severity of pain. No laboratory test can document the presence or the severity of pain.

Doctors always try to determine whether a bodily injury or disease is causing the pain; they also consider psychologic causes. Many chronic disorders (such as cancer, arthritis, sickle cell anemia, and inflammatory bowel disease) cause pain, as do acute disorders (such as wounds, burns, torn muscles, broken bones, sprained ligaments, appendicitis, kidney stones, and a heart attack). Psychologic disorders (such as depression and anxiety) can worsen pain. Sometimes pain is determined to be caused mostly or completely by psychologic disorders; such pain is called psychogenic pain.

Doctors also consider whether pain is acute or chronic. Acute pain begins suddenly and usually does not last long. When severe, it may cause anxiety, a rapid heartbeat, an increased breathing rate, elevated blood pressure, sweating, and dilated pupils. Chronic pain persists for weeks or months. The term usually describes pain that persists for more than 1 month beyond the usual course of an illness or injury, pain that recurs off and on for months or years, or pain that is associated with a chronic disorder such as cancer. Usually, chronic pain does not affect the heartbeat, breathing rate, blood pressure, or pupils, but it may result in other problems, such as depression, disturbed sleep, decreased energy, loss of appetite, weight loss, and loss of interest in sexual activity.

Many people who are being treated for chronic pain may experience a brief, often severe flare-up of pain. It is called breakthrough pain because it breaks through the regularly scheduled pain treatment. Typically, breakthrough pain begins suddenly, lasts up to 1 hour, and feels much like the person's chronic pain except it is more severe. Breakthrough pain may differ from person to person and is often unpredictable.