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When dealing with cancer pain, it is important to take a holistic approach to evaluating the pain. The main steps to evaluating pain are listed below (adapted from WHO guidelines).
- Believe the patient's report of pain - it forms the basis of the rest of your evaluation.
- Initiate discussions about the pain - as well as direct questioning, take account of non verbal indications of pain and reports from other team members.
- Take a detailed pain history - we will look at this in more detail later on
- Evaluate the psychological state of the patient - depression is common in cancer patients, and treating it can have an impact on pain.
- Perform a careful physical examination - a detailed history and examination may reveal all you need to know to start treating pain effectively.
- Perform any necessary investigations - only if there is doubt of the cause of pain, and if the results will affect your management.
- Monitor results of treatment - evaluation of pain is an ongoing process, and changes to the treatment may be needed as the disease or the pain progresses.
We will now look at pain history in more detail.
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