Comprehensive Pain Evaluations

Pain is an unpleasant sensory and emotional experience related to or described in terms of an actual or potential injury.

When we use this academic definition, many times, we are not aware of the true dimension of its terms. Pain is not a perception; that would be pure nociception. It would be limited to registering an unpleasant stimulus (many perceptions such as smells, tastes, sounds, etc… are unpleasant, and we would not define them as pain). At least, it is not a simple perception. 

Pain also has a cognitive-discriminative component that allows us to define the type of stimulus. This is the reason why we distinguish the passage of the knife through our finger from the door that closes on it, it helps us to integrate and relate the stimulus and its intensity (the pleasant heat of the fire when it is cold outside and the burning sensation if we bring our hand too close, which we also relate to our previous experience with that or another stimulus).

However, the truly differential fact of pain is the emotional elaboration. It is the one that makes the long-distance runners not stop despite the suffering, the one that keeps us clinging “to the burning nail” to avoid falling into the void, the one that encourages women to keep pushing in childbirth despite the fact that what they notice is progressively greater during childbirth.

Pain involves an elaboration related to our experience and our expectations that converts and modulates mere perception. Even more so when the pain is perpetuated over time. If an isolated perception can lead to multiple elaborations, a sustained perception adds continuity as the main variable to the equation.

For all the above, pain assessment is a complex process that depends, of course on the patient, his experience, his culture, his expressiveness, but also that of the therapist who must calibrate the message and catalog it.

Fortunately or unfortunately, our experiences and communication strategies are multiple and not always extrapolated.


How do we measure pain?


Adequate treatment depends on a correct assessment and measurement of pain.


In pain, we will measure:


  • Intensity
  • Duration
  • Companions and / or circumstance


There are several scales to measure pain


  • Visual Analog Scale (VAS)
  • Analog Numerical Scale (ENA)
  • Facial expression scale
  • McGuill questionnaire, among others …


To help speed recovery, it is important for doctors and nurses to know the intensity of your pain, your previous pain experiences, and your response to the treatment you received. We cannot measure pain with a laboratory test or with a machine; they do not exist yet. Self-report (what the patient expresses) is the best way to measure it; even when they cannot communicate, there are other ways to observe it, such as pain assessment scales for patients who cannot communicate.




For some people, it is easier to measure pain by choosing one of the following words:

None – Mild – Moderate – Severe (worst pain imaginable)




For other people, it is easier to tell the intensity of your pain. Using a scale of 0 to 10. On this scale, 0 means there is no pain at all, and 10 is the worst possible pain imaginable.

0 1 2 3 4 5 6 7 8 9 10




On this scale, the patient indicates the face that best represents the severity of his current pain. The neutral face has a value of 0 (no pain), and the most suffered face has a value of 10, being the greatest pain you can imagine. The doctor or nurse will ask you to choose the face that shows how you feel.


Routine evaluation


Routinely assessing the presence and intensity of pain as well as the response to analgesics is part of your comprehensive treatment.

It is extremely important to report on the intensity of pain, and the response to treatment on this depends on your analgesia plan.

Several times a day, the nurse or health worker may ask if you have pain and how bad it is. But you don’t have to wait to be asked. If you need help with pain, tell the nurse or your doctor right away.


Pain characteristics


If you have pain, you need to inform your doctor of the main characteristics, such as:


  • Where is the pain (s) located?
  • When did your pain (s) start?
  • If the pain is constant
  • If it is spontaneous
  • The intensity (see pain scale)
  • If it comes with movement
  • Some factors that make the pain worse
  • If it interferes with sleep
  • If accompanied by other symptoms (nausea, sweating, weakness, etc.)
  • If it has interfered with your quality of life





Some people feel like they should put up with pain. However, when the pain becomes severe, it is much more difficult to control. If you get pain relief before the pain reaches this point, you will take less medicine and feel better.


Dr. Munish Lal, Pain Control Specialist


Pain control specialists are primarily concerned with improving your quality of life. However, by working closely with other specialists who are following up, the physician in charge of pain management will coordinate your care, including diagnosing the causes of your chronic pain or back pain, as well as determining the correct treatment options. Call now to book an appointment with Dr. Munish Lal.


CALL 424-254-3592