Assessment

To treat pain, it must be measured. The patient and the doctor should measure pain levels at regular intervals after starting cancer treatment. Checks should be done at each clinic visit, at each new report of pain, and after starting any type of treatment for pain. The cause of the pain must be identified and treated promptly.

Patient Self-Report

To help the health care provider determine the type and extent of the pain, cancer patients can describe the location and intensity of their pain, any aggravating or relieving factors, and their goals for pain control. The family/caregiver may be asked to report for a patient who has a communication problem involving speech, language, or a thinking impairment. The health care provider should help the patient describe the following:

• Pain: The patient describes the pain, when it started, how long it lasts, and whether it is worse during certain times of the day or night.
• Location: The patient shows exactly where the pain is on his or her body or on a drawing of a body and where the pain goes if it travels.
• Pattern: The patient describes if there have been changes in where the pain is, when the pain occurs, and how long it lasts, or if there is new pain.
• Intensity or severity: The patient keeps a diary of the degree or severity of pain.
• Aggravating and relieving factors: The patient identifies factors that increase or decrease the pain. The patient also identifies symptoms that are most troublesome, since they are not always the most serious or severe.
• Personal response to pain: Feelings of fear, confusion, or hopelessness about cancer, its prognosis, and the causes of pain can affect how a patient responds to and describes the pain. For example, a patient who thinks pain is caused by cancer spreading may report more severe pain or more disability from the pain.
• Behavioral response to pain: The health care provider and/or caregivers note behaviors that may suggest pain in patients who have communication problems.
• Goals for pain control: With the health care provider, the patient decides how much pain he or she can tolerate and how much improvement he or she may achieve. The patient uses a daily pain diary to increase awareness of pain, gain a sense of control of the pain, and receive guidance from health care providers on ways to manage the pain.

Physical Exam

The assessment will include an exam of the body to check general signs of health or anything that seems unusual, and to look for signs that the cancer has grown or spread. A history of the patient's health habits and past illnesses and treatments will also be taken. A neurological exam will be done. This is a series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks the patient's mental status, ability to move and walk normally, and how well the muscles, senses, and reflexes work. The patient's psychological and spiritual well-being are evaluated. A personal and family history of substance abuse is taken. All of this information is taken as a whole to diagnose and treat the pain effectively.

Assessment of the Outcomes of Pain Management

The results of pain management should be measured by monitoring for a decrease in the severity of pain and improvement in thinking ability, emotional well-being, and social functioning. The results of taking pain medication should also be monitored. Drugaddiction is rare in cancer patients. Developing a higher tolerance for a drug and becoming physically dependent on the drug for pain relief does not mean that the patient is addicted. Patients should take pain medication as prescribed by the doctor. Patients who have a history of drug abuse may tolerate higher doses of medication to control pain.