History of Pain
[The patient feels pain – the doctor elicits tenderness (Norman
Browse)]
1. Original
site of pain
2. Time
of onset & mode of onset
(acute/subacute/
chronic)
3. Severity
·
Individuals react differently to pain. What is a severe pain to
one person might be described as a dull ache by another (Browse).
·
Better indication of severity is the effect of the pain on the
patient’s life, Ask following to assess severity (Browse)
·
Did it stop the patient going to work?
·
Did it make the patient go to bed?
·
Did they try proprietary analgesics?
·
Did they have to call their doctor?
·
Did it wake the patient up at night, or stop them going to sleep?
·
Was the pain better lying still or did it make the patient roll
around?
4. Nature or Character of Pain
·
Vague aching
·
Burning
·
Throbbing
·
Scalding
·
Pins & needles
·
Shooting
·
Stabbing
§ Sudden,
severe, sharp, and short-lived pain
·
Constricting
§ Pain
that encircles the relevant part (chest, abdomen, head) e.g. Angina
·
Colic
Ø Two
features
§ comes
and goes in a sinusoidal way
§ Feels
like a migrating constriction in the wall of a hollow tube which is attempting
to force the contents of the tube forwards.
Ø A
recurring, intermittent pain is not necessarily colic; it must also have a gripping
nature.
·
Twisting
·
Just a pain
5. Progression
6. Duration
7. Radiation/Referred/Migration
o
Radiation -extension of the pain to another site whilst the
initial pain persists
o
Referred - pain is felt at a distance from its source e.g.
Inflammation of the diaphragm will cause a pain which is felt at the tip of the
shoulder.
o
Referred pain is caused by the inability of the central nervous
system to distinguish between visceral and somatic sensory impulses.
8. Special
time of occurrence
9. Periodicity(recurrence)
10. Precipitating/aggravating
factors
11. Relieving
factors
12. Associated
symptoms
·
sweating, vomiting,
·
cold extremities, aura, fever
·
hematuria, jaundice
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