PCL 2 : History taking for pain by Jinli

1. KEY SKILLS
-LISTENING
-OBSERVING
-patient's limited capacity to communicate

2. Non Verbal Communication
Vocal – crying, moaning
Physiological – sweating, muscle tension
Expressions- grimacing
Posture – rubbing area, guarding, withdrawal
Crying with or without tears
Screaming , yelling, groaning, moaning
Screwed up or distressed looking face
Body appears stiff or tense
Difficult to comfort or console
Flinches or moves away if touched


3. Advantages of non-verbal communication
-Reflective
-Audible and visible
-Specific information
-Encodes severity
-Able to differentiate emotions such as anger and fear

Pain is ALWAYS accompanied by an emotion

4. Taking a Pain History
1. Where : Location / radiation
2. When : Duration
3. Quality
4. Quantity
5. Aggravating / relieving factors
6. Associated factors
7. Beliefs

Where : Location / radiation
Main site of the pain
Where is the pain? Where does it hurt?

Radiation
Does the pain move or spread to anywhere?

When
When did the pain start ?
Is the pain continuous or does it come and go?
How often are the attacks?
Have you had this before?

Quality :How does it feel like
What kind of pain is it?
Can you describe the pain? Cramping, dull, aching , Sharp, Burning
Does it affect your sleep/work?

4.Quantity : How to measure Pain
Verbal descriptor rating scales
-Mild
-Moderate
-Severe
-Most severe
Numeric rating scale
Pain out of 10
Reliable in the elderly

What makes it better?
– What makes it worse?
– What has the patient done to try to feel better?
– What seems to bring the pain on?
– Does anything make it better / worse ?
– Is the pain relieved by drugs / rest / changing position?
– Have you taken any medicines for the pain?

Aggravating / Relieving factors
What makes it better?
– What makes it worse?
– What has the patient done to try to feel better?
– What seems to bring the pain on
Does anything make it better / worse ?
– Is the pain relieved by drugs / rest / changing position?
– Have you taken any medicine for the pain?

Associated symptoms & Beliefs
Do you have any other problems coming along with the pain?
What seems to cause the pain?
What do you think might have cause the pain?

Pain is a subjective phenomenon so perhaps it will never be possible for one person to understand another’s pain.