The focus in chronic pain assessment differs from the evaluation of acute pain, which assumes a specific underlying injury or disease that treatment will cure. Begin chronic pain assessment with the history and physical examination. Important components of the initial evaluation are summarized in Table 3 and are detailed below.
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Many patient populations are unintentionally marginalized by both health care providers and health systems. This inequity is especially true with regard to pain management amongst non-white Hispanic, black, and other minority populations.33,34 Several factors should be considered when treating these vulnerable patients. It is the provider’s responsibility to recognize that inequity in this area is due in part, but not limited to, systemic barriers and complex influences such as implicit biases unbeknownst to providers.
Pain intensity. A patient’s report of pain intensity provides a subjective gauge of the distraction and interference pain causes in their daily life.
Sleep. For all patients recommend good sleep habits. Screen for sleep disturbance. Sleep complaints occur in 67–88% of individuals with chronic pain. Sleep and pain are often linked. Sleep disturbances may decrease pain thresholds and contribute to hypersensitivity of neural nociceptive pathways.
Evidence is limited regarding the long-term benefit of any single individual treatment modality. However, they may be used as part of a multimodal treatment program to improve function, quality of life, and alleviate pain.
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Pain diary: regular documentation of the pain intensity to identify peaks and triggers; enables treatment optimization
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Treatment. In the treatment plan, address both the underlying cause and the associated acute pain. In developing a treatment plan for the acute pain, consider the degree of tissue trauma, the patient’s situation, and any unique patient factors.