The first step in diagnosing psychological consequences of pain is for a physician to review the patient’s medical history, including a list of medications, and to perform a physical examination. Patients may be asked to fully describe the pain, including location, severity and duration. Physiological causes of pain are sometimes identified during a physical examination.

In some cases, patients undergo a clinical interview to better understand the psychological components that may be contributing to their experience of pain. A psychologist, psychiatrist or clinical social worker may conduct this type of pain assessment.

The goal of the interview is to determine the impact the pain has had on the patient’s life, such as how it has affected work and family, financial status and personal goals. Patients may be interviewed using the Psychosocial Pain Inventory (PSPI), a questionnaire aimed at identifying psychosocial factors that may be contributing to a patient’s pain. The PSPI has 25 questions. Factors evaluated in the PSPI include life changes, use of medication and environmental stress.

Other information that may be obtained during a clinical interview includes:

• Mental status. Questions are aimed at patient’s attitude, mood, speech, perception, quality of thinking, judgment and cognitive and intellectual functioning. Patients may also be asked if they have ever had suicidal thoughts or wanted to commit acts of violence.
  
  
• Level of functioning. Patients will be asked to describe how the pain has impacted their lives, such as whether they have missed work because of pain or have difficulty completing daily activities, such as dressing or bathing.
  
  
• Identifiable stressors. Related or unrelated problems to the pain experienced, such as conflicts at home or work or litigation that is being considered as a result of injury.
  
  
• Psychiatric history. Past consultations with psychiatrists or psychologists. Patients may be asked about prior psychiatric treatment, including medications and hospitalizations.
  
  
• History of substance abuse. Any prior treatment for substance abuse, including participation in detox or 12-step programs. Patients may also be asked to describe current use of substances such as alcohol, nicotine and caffeine.
  
  
• Developmental and social history. The patient’s childhood, relationships with parents and siblings and current social network.

Sometimes patients are asked to fill out questionnaires about their experiences with pain rather than being interviewed. There have been several questionnaires developed for this purpose. Among the most frequently used is the McGill Pain Questionnaire (MPQ), which incorporates a series of adjectives to describe the characteristics and intensity of pain. For example, patients may be asked to describe pain using words, such as burning, throbbing, or tingling.

Symptoms of depression may include:

• Feelings of guilt, hopelessness or worthlessness
• Lack of interest in favorite activities
• Sleeplessness or excessive sleepiness
• Suicidal thoughts or recurrent thoughts of death
• Trouble concentrating
• Marked decrease or increase in appetite
• Significant weight loss or weight gain

For depression to be classified as major, five of these symptoms must persist for at least two weeks.