Table 2.

Eliciting a pain history

Recommendations to consider:

Inquire openly about a patient's past personal and family history of substance use

Include use of alcohol and over-the-counter preparations

Solicit every history to eliminate profiling any patient or missing patients who do not fit a “drug-abusing profile”

Complaints of chronic pelvic and rectal pain that may disguise a patient's history of sexual assault (Streltzer, 2001)

Suggested questions to put the patient at ease, based on Koo (2003):

Instead of asking “how many pain pills do you use?”, ask “how many pills does it take to relieve your pain?”

Instead of asking “how often do you take them?”, ask “how long do they really work for your pain?”

Instead of asking “do you use other drugs?”, ask “do you wake with pain; do you need more medication to get back to sleep?”

Examination, based on Prater et al. (2002):

Direct observation of the painful site

Assessment of the patient's range of motion at the site if relevant

During the examination, ask patients about their goals for therapy (providing a realistic view of the extent of pain and impairment)