What is the appropriate management and diagnostic approach for a patient presenting with a history of body pains?

Associated History for Body Pains

Begin by screening all patients with two standardized questions: (1) "How much bodily pain have you had during the last week?" (none, very mild, mild, moderate, severe, very severe) and (2) "Do you have body pain that has lasted for more than 3 months?" A response of moderate pain or greater during the last week combined with bodily pain lasting more than 3 months constitutes a positive screen requiring comprehensive assessment 1.

Initial Screening Approach

• Use validated pain intensity scales at every clinical encounter: Visual Analog Scale (VAS), Verbal Rating Scale (VRS), or Numerical Rating Scale (NRS) 0-10 1.
• Screen systematically at initial evaluation, at regular follow-up intervals, and whenever new therapy is initiated 1.
• Document the pain rating - any score greater than 0 triggers comprehensive assessment 1.

Comprehensive Pain History (For Positive Screens)

When patients screen positive, obtain the following specific details using a biopsychosocial approach 1:

Pain Characteristics

• Onset and duration: When did it start? How long has it persisted? 1
• Intensity and character: Use pain scales; ask patients to describe quality (sharp, burning, aching, shooting, throbbing, cramping) 1
• Location and radiation: Identify all pain sites, as one-third of chronic pain patients have multiple locations 2. Ask about referral patterns and radiation 1.
• Temporal patterns: Does pain increase during the day? Is it constant or intermittent? 1, 3
• Trigger factors: What makes it worse? What provides relief? 1

Functional Impact Assessment

• Physical function interference: Specifically ask about inability to perform activities of daily living (e.g., "Can you walk a block?" "Can you dress yourself?") 1
• Psychological function: Document effects on mood, sleep patterns, appetite, and social life 1
• Work and employment: Assess impact on work capacity 1
• Quality of life: Use Brief Pain Inventory (BPI) or the 3-item PEG scale (Pain intensity, Enjoyment of life, General activity) for efficient multidimensional assessment 1

Treatment History

• Past treatments: Document all previous pain therapies and their efficacy 1
• Current medications: Ask about prescribed and over-the-counter analgesics, including homeopathic remedies; assess frequency of use and whether dosing is safe 1, 4
• Treatment response: Document what has worked and what has failed 1

Co-occurring Conditions

• Underlying disorders: Identify conditions that may cause or contribute to pain 1
• Psychosocial factors: Screen for anxiety, depression, catastrophizing, fear of movement, and suicidal ideation 1
• Substance use history: Document any co-occurring substance use disorders 1
• Sleep disturbance: Ask about causes (pain, worrying, poor sleep habits) 1
• Social support: Assess presence of caregivers and social environment 1

Red Flag Symptoms

• New pain in patients with controlled chronic pain: Carefully investigate and document, as this may require treatment adjustments or indicate new pathology 1
• Associated symptoms: Ask about fatigue, nausea, numbness, tingling, weakness 1
• Warning signs: Document any fever, unexplained weight loss, neurological deficits, or signs suggesting serious underlying pathology 1

Physical and Diagnostic Evaluation

• Focused physical examination: Perform examination relevant to pain location and suspected etiology 1
• Psychosocial evaluation: Assess psychological status, degree of disease awareness, and spiritual concerns 1
• Diagnostic workup: Order appropriate radiological and biochemical investigations to determine potential cause 1

Documentation Requirements

• Monitor regularly: Reassess at regular intervals and after each treatment change has had adequate time to take effect 1
• Document systematically: Record pain intensity, quality of life, adverse events, and treatment adherence 1
• Track functional goals: Document progress toward achieving functional objectives 1

Common Pitfalls to Avoid

• Do not rely on single-site descriptors when patients report pain in multiple locations, as 33% have pain at multiple sites with significant demographic differences between groups 2.
• Avoid using retrospective questionnaire assessment alone, as it yields significantly higher pain scores than real-time diary assessment 3.
• Do not assume pain stability - pain intensity fluctuates greatly during the day and over time, requiring repeated assessment 5, 3.
• Recognize that pain impact on function may matter more than severity when determining treatment priorities 1.