Assessing your pain
Assessing or measuring pain is the first step in treating it. It is very important to tell the healthcare team if you have pain, to describe the pain clearly and to let them know how it affects your life. No one experiences pain in the same way, so it will be treated based on your specific needs. The healthcare team assesses pain in different ways to find out as much as possible about it.
Your healthcare team will ask many questions about your pain to gather the information they need to help you manage it. These questions may include:
- When did the pain begin? What were you doing when the pain began? Did it begin at a certain time of day or night? Is it worse at a certain time of the day or night? Does it keep you awake? Has it been getting worse over time or has it stayed about the same?
- Where is the pain? Is it in one part of the body? Do you feel it in more than one place? Does it start in one place and move? Does the pain feel like it is deep inside or close to the surface?
- What does your pain feel like? What words would you use to describe your pain? Is it sharp (stabbing) or dull (aching)? Does it spread (radiate) from a specific area?
- How bad is the pain? Does it come and go? How long does it last? How much does it hurt at its worst? How much does it hurt at its best? Does anything make the pain better or worse?
- What types of treatments have you tried to relieve your pain? Do they relieve the pain? If so, for how long?
- How does the pain affect your life? How do you cope with pain and stress? What does pain mean to you and your family? Have you had mood changes (such as depression or anxiety) as a result of your pain? Have you had pain in the past? If so, how has it affected you?
- How is your cancer diagnosis affecting your life? How is it affecting your family? How well do you understand your cancer diagnosis and treatment?
- How much do you know about pain management? Are you concerned about using pain medicines? Are you concerned about the cost of pain medicines or treatments? What are your goals for pain control?
A physical exam, including a neurological exam, is very important in assessing pain. Your healthcare team will look at the area where you feel pain to see if there are any signs of infection, injury (trauma), tissue breakdown or changes in bone structures. Depending on where your pain is, the healthcare team may examine your abdomen, hips, spine, hands or feet. They may also check for swollen (enlarged) lymph nodes under your arms, in your groin or at the base of your neck.
Your healthcare team may do different diagnostic tests to find the cause of your pain. These tests may include blood tests such as liver or kidney function and tumour marker tests. You may also have imaging tests such as x-ray, bone scan, CT or MRI.
Your healthcare team may ask you to rate your pain on a pain scale. They may consider how your pain affects your quality of life based on changes in your mood, appetite or sleep. They may also ask you to use a self-report scale to help them measure how bad the pain is. Self-report scales can include numerical rating scales, face scales and visual analogue scales.
Numerical rating scales use a number scale to describe pain intensity. These scales usually range from 0 (meaning no pain or hurt) to 10 (meaning the most intense pain or hurt).
Face scales use a series of cartoons or photographs of faces. At one end of the scale is a neutral or happy face that represents no pain. At the other end of the scale is a face that represents the worst pain. You will be asked to point to the face that shows how much pain you have.
Visual analogue scales use a line to help you describe pain intensity. You make a mark or move a slider on a plastic ruler to show how strong the pain is.
These scales, along with your own words, help the healthcare team assess your pain.
The more detail you can give your healthcare team about your pain, the better able they will be to help you. It might be helpful to create a pain journal or diary to keep track of your pain over time. A pain journal can help your healthcare team assess your pain and see how well pain medicines are working.
Your pain journal should be a daily record or report of your pain. Include words to describe the pain, such as sharp, dull, stabbing, radiating (spreading) and so on. Describe where the pain is and how bad it is at different times of the day. List any activities that seems to worsen or lessen the pain and any activities that you can’t do because of the pain.
Include the name, dose and schedule of your pain medicines, as well as when you use other ways to relieve pain. Describe how bad the pain is before you take pain medicines or use other ways to relieve it. Also include how bad the pain is a few hours after you take pain medicines or use other ways to relieve it.
Your healthcare team will continue to assess your pain and try to relieve your pain as quickly, effectively and consistently as possible. Regular and ongoing pain assessment is very important.
Once the healthcare team finds the cause of and assesses your pain, they will decide the best way to manage it. Be sure to tell the healthcare team what helps to relieve your pain and what doesn’t. Let them know about any changes in the pattern of your pain, such as if it comes back more often, if it becomes worse or if new pain develops. The plan for treating pain may need to change over time. It is very important to let the healthcare team know right away about new pain, especially lower back pain with leg weakness or loss of bowel or bladder control. This could be a sign that the cancer is putting pressure on the spinal cord.