Evaluating Pain in Patient with Cancer

Do you accept the patient's complaint of pain (unless there is evidence not to)?

• established the type and severity of the pain?

• determined when the pain occurs, its intensity and its duration?

• tried to characterize the pain?

• identified factors that may trigger the pain?

• identified factors that make the pain better or worse?

• provided immediate pain control to facilitate the evaluation?

• obtained a complete history, including a history of drug or alcohol abuse?

• done a review of systems?

• reviewed current medications, diet and activity level?

• performed a physical examination?

• performed laboratory tests paying attention to renal and hepatic function?

• performed imaging studies as needed?

• determined the impact of pain on patient and family, especially psychological distress?

• identified coping strategies used by the patient and family?

• assessed compliance with instructions and adherence to medications?

• determined probable explanation(s) for the pain?

• determined the effectiveness of current pain management and any problems?

• identifeid factors that may affect the effectiveness of pain medication?

• identified adverse effects of pain medications?

• identified resources that might be needed to alleviate the pain?

• established reasonable treatment goals?

• discussed the pain and management plan with the patient, obtaining informed consent?

• provided disease-specific therapy whenever possible?

• adjusted dosages to take into account age, other medications and comorbid conditions?

• made plans to rotate analgesics to optimize analgesia and to minimize adverse effects?

• instituted strategies to minimize adverse effects (constipation, etc)?

• provided the patient and family with some sense of control?

• developed a plan to monitor the program for effectiveness?