The first part of the pain assessment consists of detailed questions regarding the nature of the pain. The questions are designed to help the examiner gain information and assess the patient’s condition. The most common questions address:

• Date of onset of pain. When the pain was first noticed and what factors preceded the onset.
  
  
• Character and severity of pain. Some common words used to describe pain include aching, burning, sore, pounding, sharp, pulsing and dull.
  
  
• Location of pain. Sometimes pain is localized to one part of the body, but sometimes a patient experiences pain in multiple locations.
  
  
• Radiation of pain. Sometimes pain radiates, such as from the back to the leg or toes.
  
  
• Changes in daily activities that have resulted from pain. Many patients suffer sleep disturbances. Others experience changes in mood or appetite.
  
  
• Other symptoms experienced in addition to pain. Pain can be accompanied by other symptoms including fatigue, balance problems, or motor difficulties such as gait disturbances or tremors.
  
  
• Factors that alleviate or worsen pain. A certain physical activity may trigger pain.
  
  
• Past experiences of pain. Some patients experience chronic (long-term) pain. Others experience acute pain, which is sudden or short-term.
  
  
• Treatments received for pain (if any). A physician may ask whether a patient has tried remedies such as medications, relaxation, meditation, heat therapy, cold therapy, water therapy or exercise.
  
  

Physicians may use a pain diagram or pain scale to evaluate pain. A pain diagram is a picture of the human body. Patients mark the area(s) where pain is being experienced and describe the nature of the pain (e.g., shooting or throbbing).

Pain scales help quantify pain experienced. For example, the visual analog scale (VAS) asks patients to rate pain based on a scale of 1 to 10. The McGill Pain Questionnaire provides information about the quality of pain experienced. The Health Assessment Questionnaire (HAQ) has been validated in patients with rheumatic conditions including rheumatoid arthritis, osteoarthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus and fibromyalgia.

When a specific condition is suspected, patients may be asked to complete specialized forms, such as the Migraine Disability Assessment (MIDAS) Test for migraines or the American Urological Association’s BPH Symptom Index Questionnaire for benign prostatic hyperplasia.

An overall physical examination may be completed for a general health assessment. During the physical exam, the patient’s temperature, blood pressure, pulse, height and weight may be recorded.

A more detailed examination will then focus on the specific areas of complaint. Depending on the location and type of pain, the physician or other practitioner may examine:

• Joints for range of motion, by having the patient briefly perform functional movements such as reaching over the head and touching the floor, or by using a protractor-like device called a goniometer
  
  
• Muscles for strength and flexibility with techniques such as manual muscle testing (MMT), which involves placing body parts in various positions and applying resistance
  
  
• Hand and finger strength with a dynamometer (grip meter) and pinch meter
  
  
• Skin for signs of ulcers or infection
  
  
• Response to pressure or movement

A sensory examination may also be performed. This usually entails the use of light touch, pinprick or vibration to determine the level of pain being experienced.