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5th November 2024
Assessing pain and its causes
Key steps when assessing pain, whether or not in a palliative care context, include the following:
- Characterise each individual pain (there may be more than one) to identify underlying causes
- Identify reversible causes
- Explore psychological, social, and spiritual factors
- Consider using a validated structured pain assessment tool
Characterise each individual pain to identify cause
This involves the usual, familiar steps for assessing pain, including history (SOCRATES) and examination.
Below are some examples of features of different types of pain:
| Type of pain | Features in the history |
|---|---|
| Nerve pain | Burning, shooting, tingling, hypersensitivity, changes in sensation |
| Increased intracranial pressure | Worse in the mornings and when lying down; nausea |
| Bone pain | Worse on weight bearing or with pressure on the bone |
| Intestinal colic | Wavy/crampy pain |
| Incident pain | For example, associated with moving |
| Muscle spasm | In a specific muscle or over a trigger point |
Identify reversible causes
Whilst there are many irreversible causes of pain related to a patient’s underlying conditions, palliative patients also get treatable illnesses that may cause pain. For example, nerve pain could be a manifestation of B12 deficiency and unilateral limb pain could be a deep vein thrombosis.
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