Introduction to Patient Management
Patient and Family Education
Pain Assessment Strategies
Pain Interview
Pain Maps

Pain Assessment Strategies

• The patient's pain history
• The patient's pain type and pain pattern, including the intensity of pain, the location and onset of pain, and factors which ease or exacerbate pain
• Relevant psychosocial and quality-of-life factors to determine the patient's (and family's) ability to cope, as well as manage the responsibilities and costs associated with treatment
• The patient's response to a screening test

Various pain assessment tools are available for use by clinicians to help evaluate the patient's pain experience. Tools include the comprehensive McGill-Melzack Pain Questionnaire, pain assessment maps, and simple pain rating scales, such as the 5-Point Pain Scale or the visual analog scale shown in Figure 1.

Figure 1: Visual Analog Scale and 5-Point Pain Scale

When asking patients about their pain experience, many physicians begin with an open-ended question. They then move to close-ended questions requiring a yes/no response if the patient has difficulty with more general questions. Examples of questions typically used include:

• How would you describe your pain? (open-ended question)
• Is your pain throbbing? Is your pain burning? Is your pain a shooting pain? (close-ended questions using the following words:)

Throbbing	Shooting	Sharp
Cramping	Hot-burning	Aching
Heavy	Tender	Splitting
Tiring/Exhausting	Fearful	Punishing/Cruel

• How would you rate the intensity of your pain? (Use your institution's approved rating scale, if available, or one of the scales shown in this section (Figure 1)
• When did your pain start?
• Describe where in your body you experience pain. (Use the pain map found in the online Library titled Prestimulation Pain Assessmentor the Pain Inventory form available from Medtronic to help the patient identify the location of the pain.)
• What kinds of activities make your pain worse?
• What makes your pain better?
• Tell me how your pain affects the way you function.
• Tell me how your pain affects your life and family.

A simple pain rating scale can be easily modified for use by patients at home to help them log the relationship between their activity level, screener settings, and pain distribution and severity. This allows the treatment team to track the patient's response to intrathecal drug delivery during the screening test and over the long term.

Many pain management centers use pain maps as part of the pain assessment process. Consider giving the patient a blank pain map such as the one included in the Prestimulation Pain Assessment(available in the online Library) and asking the patient to sketch or identify areas of consistent pain and areas of intermittent chronic pain. During prescreening, many physicians find it advisable to obtain this information before the day of surgery. This will take advantage of the patient's more relaxed and unsedated state.

Pain maps are also used in some clinics to assess pain at the conclusion of the screening test, immediately after complete system implantation, and each time dosage adjustments are made. Because periodic dosage adjustments are typically required over the first 6 to 8 weeks following implantation, several pain maps and assessment forms may need to be completed. Together, these pain assessment forms may help provide the basis for evaluating treatment effectiveness.

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Introduction to Patient Management
Patient and Family Education
Pain Assessment Strategies
Pain Interview
Pain Maps