Pain: Diagnosis

> Pain
What is pain?

What are the symptoms of pain?

What causes pain?

How is pain diagnosed?

What treatments are available?

How does pain affect your life?

What to ask your doctor?


Pain severity is always subjective, even if the nociceptors register an objective “quantity” of pain in every single person. There is always an emotional component to a person’s perception of pain due to the interpretation of the pain signal in the central nervous system. Therefore it is helpful to evaluate the pain using a simple tool like an NRS or VAS, or to keep a “pain diary”:

  • NRS (numeric rating scale): Through a ‘pain rating’ the patient is asked to rate his or her pain on a “numbered” scale, ranging from “0” (no pain) to “10” (worst pain imaginable).
    Numeric rating scale
  • VAS (visual analogue scale): In a VAS, the numerical scale is absent and the patient indicates the severity of his or her pain with a cross on a line between “no pain” and “very severe pain”. This distance is measured and compared with the same parameter from the previous visit.
    Visual analogue scale
  • Keeping a daily ‘pain diary’ can also be a useful instrument in pain assessment. In this diary, the patient notes date and time when he feels pain, rates the severity of the pain (0-10) and mentions the pain medication he takes every day, other pain-relief methods and the side effects of the pain medicine. You can find different examples on the internet.

A pain scale helps not only to assess the pain, but also makes it possible to evaluate treatment success. The ‘pain scale’ has proven its benefit in pain treatment because it compels the patient to take sufficient pain medication. Most people tend to ‘under-report’ their pain: they already define it as “good” when the pain decreases a little, but it still makes them suffer considerably. In this case, the ‘pain scale’ will tell the attending doctor that a satisfactory painkilling level has not been reached. Conversley the painkillers can be adjusted when there are signs that the pain is diminishing.

How can you prepare for your doctor's visit?

Here are some details that your healthcare team will want to know about your pain:
  • Where is your pain located?
    Pay attention to where you feel pain. Is it located in your head, torso, arms or legs? Is it deep inside your body or nearer to the surface?
  • How would you describe your pain?
    Is it a sharp, shooting pain? Or is it dull and throbbing? Do you experience any burning, tingling or numbness as well as pain?
  • Is there a pattern to your pain?
    When does it start? When is it worst? When does it feel better? Is it provoked by anything you do or don't do? On a scale of "0" to "10" (with "0" being "no pain" and "10" being "the worst pain imaginable"), how bad is your pain? Would you describe it as mild, moderate or severe? Is it constant, or does it come and go? If you are taking medication, is it working? Give your doctor or nurse the names of pain medications you have already tried. Tell them which ones were most effective, and which ones failed.
  • Other important details
    Does the pain prevent you from carrying out your normal routine? Other than medication, what methods have you used to combat the pain you experience?

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Item code: NPR/08-0056
Date of Preparation: July 2009