TABLE 341 Psychological Characteristics of Chronic Pain Patients

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The following set of historical inquiries may prove helpful in the ED. The patients should be asked to describe the nature of the current pain, initiating and exacerbating or relieving factors. Other useful information includes determination of the chronic nature of their pain, quantification of similar episodes, and sources and modes of treatment, including medications and dosages for physician-prescribed, over-the-counter, or alternative medications. Outcomes of previous therapeutic efforts and the effect of the condition on the patient's functional status are also important. Addiction to drugs or alcohol or experience with detoxification programs should also be noted. Finally, a review of systems should be done to rule out any other conditions.

Substance abuse is a frequent problem in chronic pain patients. Patients referred to chronic pain clinics meet Diagnostic and Statistical Manual of Mental Disorders, third revised edition (DSM III-R) criteria for active substance abuse disorders in 12 to 24 percent of cases, while 9 percent meet criteria for remission diagnosis. 67 Drug detoxification is often the first step of the therapeutic plan for new patients referred to a pain clinic.

Objective findings of acute pain include tachycardia, hypertension, diaphoresis, and muscle spasms on stimulation. Objective evidence of chronic pain includes muscle atrophy in the distribution of pain due to disuse, skin temperature changes due to the effects of the sympathetic nervous system after disuse or secondary to nerve injury, and trigger points, which are focal points of muscle tenderness and tension. However, these findings do not have to be present for the pain to be factual.

Signs and symptoms of chronic pain syndromes are summarized in Tab.!®. , . .

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