When considering these difficulties, it should be remembered that social support is essential for people with chronic pain. The perception of social support and social participation has a protective effect upon the severity of chronic pain and the subsequent functional abilities (Musich, et al., 2019). The scientific literature indicates that the quality of social support from friends and family – even if that support is sometimes conflictual – is generally associated with positive outcomes in chronic pain and should be reinforced and encouraged (Cosio, 2019b).
A depressed person with chronic pain may isolate him- or herself or avoid social activities entirely. If either the pain or the condition that has caused it is significant enough to cause disability, the individual may be locked in a struggle with his or her employer to make accommodations for disability or strain to maintain his or her present employment against increasing discomfort and risk.
PAIN ASSESSMENT
this reason, virtually all pain assessment is based on subjective self-reporting. This section describes how clinicians should select measures and techniques to assess the various dimensions of pain and their impact. It includes a short discussion of key elements for assessment, suggestions for the clinical interview, and some commonly used self-report instruments. was involved. This trauma could be of a physical or psychological nature. Often, orofacial pain is precipitated by a stressful event. The provider should ask whether the pain came on suddenly or gradually and whether this is a new pain or a recurrence of a previously experienced pain. Diagnostic clues may also come from the age at which a certain pain condition began. The highest prevalence of migraines is between the ages of 18-44 with women affected with about twice the frequency compared to men (American Headache Society, 2016). Whereas tension-type headaches more commonly start in adolescence and peak when a person is in their 30’s but can also occur at any age (Cowen, 2019). Other types of headaches, such as those caused by giant cell arteritis, do not occur until the sixth decade of life (Starling, 2018). Conditions such as classical trigeminal neuralgia usually occur in people between the ages of 50-70 but can occur at a younger age (Khan, 2017). Temporomandibulardisorders occur mostly in females between ages 15 and 30 (Graff-Radford, 2016; Patton and Glick, 2016). Knowing the time of day that the pain occurs can also be helpful. For instance, a patient who wakes up with jaw or face pain may be grinding or clenching teeth while asleep or may be suffering from sleep apnea. Pain that occurs later in the day could mean that the patient is clenching her teeth during the day or that she is sitting at the computer all day in a posture that is creating neck pain and referred pain to the face. Pain location Pain location refers to the painful area or areas on the face, mouth, head, or neck. Individuals may have one or multiple pain locations, and the pain locations may be internal or external. The practitioner needs to ask the patient to point to or circumscribe with one finger where he or she feels the pain, keeping in mind that the site of the pain is not necessarily the source of the pain. A well-known example of this phenomenon is the referred pain experienced in the left arm caused by a myocardial infarction. Pain in the orofacial region (site) is often referred from the neck muscles (source). To better understand the location of the pain, it is helpful to have the patient draw areas of pain on a head/neck or full body mannequin. Pain intensity Pain intensity refers to how much a person hurts, on a continuum from no pain to the worst pain imaginable. The three most commonly used pain intensity scales are the visual analogue scale (VAS), numeric rating scale (NRS), and verbal rating scale (VRS; Appendix A): ● The VAS consists of a 100-millimeter line anchored at the low end by the words “No pain” and at the high end by the words “Pain as bad as it can be.” The patient marks the line to indicate pain intensity, and the placement of the mark is
Feelings of pain and pain-related suffering are personal, internal events. Although certain body systems may change in response to pain (e.g., increased blood pressure and heart rate), there is no biological marker for pain, and no blood test or other objective measurement exists to determine how much pain a person is in or how much the pain is affecting that person. For Key elements for history taking At least nine elements can be employed for assessment in cases of chronic pain. However, not every element requires assessment at every visit, and the elements to be assessed depend entirely on the treatment setting and treatment goals. A complete assessment of an individual with chronic pain is not required in all cases, and the assessor must be flexible in adapting the assessment to the individual. The nine key elements for assessment are: 1. Pain onset.
2. Pain location. 3. Pain intensity. 4. Pain quality. 5. Pain duration and frequency. 6. Pain modulating factors. 7. Associated symptoms. 8. Sleep quality. 9. Psychosocial factors.
The first seven elements are primarily biomedical. They are important to clinicians attempting to diagnose chronic pain conditions because in these conditions, as opposed to conditions causing acute dental pain, objective clinical signs may be absent and diagnoses may have to be based on a thorough medical history alone (as is the case for most neuropathic and headache conditions). Assessment of sleep quality and presence and influence of psychosocial factors as reflected by changes in energy level, mood, attitudes, behavior, activities of daily living, and lifestyle are also important in the assessment of the patient with chronic pain. In pain assessment, there is simply no substitute for a good clinical interview. Although a full review of basic clinical interviewing techniques is beyond the scope of this course, the interviewer must create the flexible structure necessary to collect all relevant information about the person’s pain. In a good interview, the interviewer builds rapport, works to understand the feelings and attitudes of the interviewee, conveys empathy, and uses the proper balance of open- and closed-ended questions. Clinical interviewing is a skill that develops with practice. In conducting a pain interview, it is essential to maintain an open-minded, nonjudgmental stance. Open-ended questions such as “Tell me how your pain has affected you” yield more information than questions that can be answered with a yes or no, such as, “Does your pain affect your eating?” or “Does it affect your sleep?” Chronic pain conditions are seldom diagnosed based on a single element of pain, but a combination of factors will guide and refine the diagnosis. A description of the usefulness of evaluating each element follows. Pain onset As with any bodily complaint, it is important to know how and when the pain started. The provider should ask questions about the historical and circumstantial aspects, such as whether trauma
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