The history should include the following information about the pain:
The examiner should determine the cause, severity and type of pain and its impact on the activities, mood, thought, and sleep. The clarification of the cause of acute pain (such as lower back pain, chest pain;.. S inTheManual supra) differs from the chronic pain (chronic pain). The history should include the following information about the pain: Quality (. Eg burning, cramping, pain, deep, superficial, uniform, einschießend) Heavy place spread pattern duration Graphs (including patterns and range and frequency of remissions) Aggravating and relieving factors the patient’s level of functioning should be evaluated, with a focus on the everyday activities (eg. as dressing, grooming), the professional activities, hobbies, and personal relationships (including sexual). The patient’s perception of pain may account for more than the actual physiology of the disorder. It should be noted that the pain for the patient group, with emphasis on the psychological level, v. a. in terms of depression and anxiety. There is more social acceptance to complain of pain when to report anxiety or depression; Thus, appropriate therapy often depends on whether these divergent perceptions are correctly identified. Pain and suffering should also be distinguished, particularly in cancer patients (. S treatment of side effects of cancer therapy: pain); Suffering can be just as much caused by loss of function and fear of impending death as well as by pain. It should be appreciated, if a secondary gain contributes (coming from the outside favorable side effects due to a fault-z. B. incapacity, disability benefits) for pain or for pain-related restriction. The patient should be asked about any pending litigation or claims for damages for personal injury. A personal or family history of chronic pain can often illustrate the current problem. Whether family members maintain chronic pain (eg., By constant questions about the health of the patient) should be considered. Patients and sometimes family members and caregivers should be asked about: application, effectiveness and side effects of prescription drugs and over the counter drugs, other treatments, alcohol consumption and use of recreational substances or illegal drugs. Pain quantification should before and be judged for potentially painful procedures, pain intensity. In speaking competent patient’s own report of the gold standard, and external signs of pain or discomfort (z. B. crying, twitching, stumbling) are secondary. In patients with difficulties in communication and in infants it may be necessary to resort to non-verbal (and sometimes behave claim related physiological) indicators as a primary source of information. Formal measurement (scales for pain quantification) include scales with verbal categories (eg. As light, medium, heavy), numeric scales and visual analogue scale (VAS). In the numerical scale, patients are asked to classify their pain between 0 and 10 (0 = no pain; 10 = worst pain imaginable). Mark patients on a non-scaled 10-cm line that “no pain” and is labeled on the right with “unbearable pain” on the left with a cross their degree of pain in the VAS. The pain score is the distance from the left end of the line in millimeters. Children and patients who can not read or have common development problems can have their pain perception using facial images tell of smiling up tormented with pain, or with fruits of varying sizes. When pain measurement, the examiner should specify a time period (eg. As “on average during the past week”). Scales for pain quantification The functional pain scale, the investigators should explain to the patient clearly that functional limitations for the assessment is only relevant if the pain that is clarified, is responsible; the treatment aims to relieve the pain as much as possible, at least to an acceptable level (0-2). Adapted from American Geriatrics Society (AGS) Panel on Chronic Pain in Older Persons: Management of chronic pain in the elderly. Journal of the American Geriatrics Society 46: 635-651, 1998; Used with permission; from Gloth FM III, Scheve AA, Stober CV et al .: The functional pain scale (FPS): Reliability, validity and Resonsiveness in a senior population. Journal of the American Medical Directors Association 2 (3): 110-114, 2001; and from Gloth FM III: Assessment. In Handbook of Pain Relief in Older Adults: An Evidence-Based Approach, edited by FM Gloth III. Totowa (NJ), Humana Press, 2003, p 17; Used with permission; Copyright © FM Gloth, III, 2000. Patients with dementia and aphasia A pain assessment can be difficult in patients with disorders that affect cognition, speech or language (eg. as dementia, aphasia). Pain is expressed by grimacing, frown or repeatedly eye blinking. Sometimes caregivers can describe behaviors that suggest the presence of pain (eg. Sudden as social withdrawal, irritability, grimacing). Pain should be considered in patients considered to have the communication problems and show unexplained changes in behavior. Many patients who have difficulty communicating can communicate useful if an appropriate pain scale is used. The functional pain scale z. B. has been validated and can be used with ? 17 patients in nursing homes with Mini-Mental State test scores. Patients receiving neuromuscular blockade There are no validated instruments for pain assessment available when neuromuscular blockade to facilitate mechanical ventilation is used. the patient is given a sedative, the dose may be adjusted until no sign of awareness is present more. In such cases, specific analgesics are not required. If the patient but sedated, but continues to show signs of consciousness (z. B. blink, some eye movements react when prompted), should be a pain treatment will be considered, which is based on the degree of pain, which is usually by the state is caused (eg. as burns, trauma). If a potentially painful process (z. B. rotating a bedridden patients) required a pre-treatment with the selected analgesic or anesthetic should be made.