From the Guidelines
Pain perception is documented in a neurological examination by assessing a patient's response to various sensory stimuli, including the use of standardized scales such as the visual analogue scale (VAS), verbal rating scale (VRS), and numerical rating scale (NRS) as recommended by recent guidelines 1. The examiner typically tests pain sensation using a sharp object like a safety pin or neurological pinwheel, applying it to different areas of the body and asking the patient to report when they feel the sharp sensation. The examination should systematically cover all dermatomes (areas of skin supplied by specific spinal nerves) on both sides of the body to identify any asymmetry or deficit. Documentation should include the specific areas tested, the patient's response (normal, diminished, absent, or heightened sensation), and any pattern of sensory loss that might correspond to peripheral nerve, nerve root, or central nervous system pathology. Other sensory modalities like temperature, light touch, vibration, and proprioception are also assessed to provide a complete picture of sensory function. This comprehensive approach helps localize lesions within the nervous system, as pain sensation travels via the spinothalamic tract, while other sensory modalities follow different pathways. When documenting findings, it's essential to use precise anatomical terms and to note the distribution of any abnormalities in relation to known neuroanatomical patterns, considering the type of pain, whether it is nociceptive or neuropathic, as this improves the choice of therapy 1. Key aspects of pain assessment also include evaluating the impact of pain on the patient's daily activities, sleep patterns, mood, and quality of life, as well as assessing for any comorbidities or misconceptions about pain treatment 1. A thorough initial and ongoing assessment of pain, as emphasized in guidelines from 2018 1, is crucial for effective and individualized treatment plans.
From the Research
Pain Perception Documentation in Neuro Exam
Pain perception is documented in a neuro exam using various tools and methods. The following are some of the commonly used methods:
- Visual Analogue Scale (VAS): a widely used tool to measure pain intensity 2, 3, 4, 5
- McGill Pain Questionnaire (MPQ): a comprehensive tool to assess pain quality and intensity 2, 3, 4, 5
- Short-Form McGill Pain Questionnaire (SF-MPQ): a shorter version of the MPQ, which includes a VAS 3
- Observational pain assessment tools: used to assess pain in patients who are unable to communicate their pain 6
- Dolorimetry: a method to measure pain threshold on tender points 5
Comparison of Pain Measurement Tools
Studies have compared the responsiveness and discriminative power of different pain measurement tools, including:
- VAS vs. MPQ: VAS was found to be more responsive to clinical change when used to rate pain over the last 24 hours 4
- VAS vs. Dolorimetry: VAS was found to have higher sensitivity, specificity, and area under the curve compared to Dolorimetry 5
- MPQ vs. SF-MPQ: SF-MPQ was developed to reduce the administration time of the MPQ, while maintaining its sensitivity and validity 3
Clinical Applications
These pain measurement tools are used in various clinical settings, including: