According to the American Pain Foundation, more than 50 million Americans experience chronic pain. Back pain, headache, and joint pain caused by osteoarthritis are the most common chronic pain syndromes. The experience of chronic pain exacts a huge toll on the individual and the family. Pain may prevent a person from working, socializing, or enjoying a family life. It is associated with depressed mood and a poor quality of life. The consequences for society include lower productivity for businesses and a cost of billions of dollars each year.

The high prevalence of chronic pain, combined with its enormous cost, make unrelieved pain a huge public health problem. It is remarkable that so little attention has been focused on this problem in years past.

Fortunately, this is now changing. The U.S. government has designated the next ten years as the "Decade of Pain Control and Research." In the U.S., hospitals and nursing homes must meet new standards of pain management, and efforts are being made to educate professionals and the public at large about the nature of the problem and the potential for solutions. Similar things are happening in many other countries.

Many health care professionals are now recognizing that pain is complex and multidimensional. Patients with chronic pain require a careful evaluation and a treatment strategy that may incorporate a variety of distinct modalities.

Pain Assessment

Effective pain management begins with a comprehensive assessment. This assessment allows the health care provider to characterize the pain, clarify its impact, and evaluate other medical and psychosocial problems. The assessment determines whether additional evaluation is needed to understand the pain.

Because pain is subjective, only the patient can describe it adequately. The health care provider should ask about the duration and location of the pain, its severity and quality, and factors that make it better or worse. The changes that have occurred in the person's life as a result of the pain, and the nature of other medical and psychiatric problems, should be noted. This assessment requires a physical examination and a review of previous medical records.

As part of the assessment, it is important that all prior pain treatments be discussed. The health care professional should ask about medicines and other conventional treatments that have been tried in the past. Equally important is a discussion of the complementary or alternative medical treatments that the patient has pursued. These might include acupuncture, chiropractic care, massage or other manual therapies, yoga, herbal and nutritional therapies, or others. This information helps the health care provider understand the nature of the pain or the potential benefits of treatment.

The goals of the comprehensive pain assessment are:

• Obtain a full description of the pain
• Determine whether the description fits a well-known pain syndrome
• Determine whether there is structural disease of the body that may help explain the pain
• Try to understand the mechanisms (tissue damage, nerve injury, psychological processes) that maintain the pain
• Describe the negative effects on physical and psychosocial functioning caused by the pain
• Understand the medical and psychiatric problems that co-exist with the pain and might need treatment at the same time