Pain assessment and documentation

Authors

Affiliations

Nate Yomogida, PT, DPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, PT, DPT

Doctor of Physical Therapy

B.A. in Neuroscience

Characteristics of pain

• Location¹
• Description of sensation
• Intensity¹
• Duration¹
• Frequency and duration¹
• Pattern¹

Location

Have the patient points to the location of pain¹.

Pain in a small localized area that does not spread is indicative of superficial lesion and is not severe¹.

Pain that in a small area that spreads is likely to be diffuse, segmental, or referred generally originating from a visceral or deep somatic structure¹.

Description

• Knifelike pain: potentially a systematic origin¹.
• Dull, somatic pain that is “aching” should be differentiated from aching pain from a muscular lesion by palpating the muscle where the pain is¹.

Intensity

Pain intensity is generally measured using a numeric or categorical scale. Each scale has its benefits and drawbacks but whichever scale you choose, make sure to use that same scale at follow-up¹.

• NPRS
• Visual analog scale (VAS)

VAS

The VAS consists of a horizontal bar with “No pain” on the far left and “Worst possible pain” on the right¹.

For patients who must remain supine, a vertical VAS scale is employed where “No pain” is at the bottom and “Worst possible pain” is at the top¹.

Frequency of pain

Frequency of pain refers to how often symptoms occur and whether the symptoms are constant or intermittent¹.

Useful follow-up questions:

• How long do symptoms last?
• Do you have this pain right now?
• Did you notice these symptoms this morning immediately when you woke up?

These follow-up questions are important in clarifying if the symptoms are truly contanst simply consistent¹. For example, if someone always has pain during activity but rest is alleviating, this would be consistent but not constant¹.

Duration

Pattern of pain

Pain patterns¹

Vascular	Neurogenic	Musculuskeletal	Emotional
Throbbing, pounding, pulsing, beating	Sharp, crushing, pinching, burning, hot, searing, itchy, stinging, pulling, jumping, shooting, electrical, gnawing, pricking	Aching, sore, heavy, hurting, deep, cramping, dull	Tiring, miserable, vicious, agonizing, nauseating, frightful, piercing, dreadful, punishing, exhausting, killing, unbearable, annoying, cruel, sickening, torturing.

Useful follow-up questions:

• Tell me about the pattern of your symptoms¹.
• When does the involved body part hurt?¹.
• Describe your symptoms from early morning until you fall asleep¹.
• Have you ever experienced similar symptoms before?¹.
• 24 hour pain pattern
• Monthly pain pattern (especially for women)

References

1.

Heick J, Lazaro RT. Goodman and Snyder’s Differential Diagnosis for Physical Therapists: Screening for Referral. 7th edition. Elsevier; 2023.