Important Aspects of the History

1. Onset and characteristics of pain

2. Other symptoms

3. Effect of pain on quality of life (activities, sleep, etc.)

4. Past history—pain or other symptoms/illnesses

5. Family, emotional, and social circumstances

A thorough history is needed to ensure there is no other disease process occurring (Table 2). It is also important to gain insight into how the pain condition is affecting the young person's quality of life and the lives of family members (Fig. 1). The pain associated disability (from both young person and parent perspective) can be evaluated once the full medical evaluation has been completed.

Table 2 Assessment of the Adolescent with Chronic Pain: Important Aspects of the History

History

Onset of pain

When did the pain start?

Was there a preceding infection, trauma or operation? Did it start gradually or suddenly? Where did it start? Characteristics of the pain Has the pain spread from original place? How would you describe the pain?

How severe is the pain on a good day and on a bad day?

Do you suffer pins and needles?

Is the pain constant?

Has the pain gotten any better or worse?

Is there variation in the pain during the day?

Does the pain alter at night? Does it wake you up?

What makes it worse?

What makes it better?

Is it painful to lightly touch the area that is painful? Does that area look unusual? Other symptoms

Is there a fever, rash, or weight loss? Has menstruation altered? Is there altered bowel habit? Do you have nausea? Do you suffer abdominal pain? Is there any muscle weakness? Do you have any areas that are numb? Do you suffer dizziness?

Have you passed out or suddenly fallen to the floor?

Is fatigue a problem?

Do you suffer headaches/migraines?

Do you feel colder/warmer than previously?

Do you suffer from blurred vision?

Has your mood been affected?

(Continued)

Table 2 Assessment of the Adolescent with Chronic Pain: Important Aspects of the History (Continued)

Effect of pain on daily living How is your sleep?

Do you find it hard to get to sleep/stay asleep? Do you "catnap" in the day? What can you do on a "bad" day? What can you do on a "good" day?

How much school have you managed over the past 6 months?

How is your concentration/memory?

On "bad days" how is your mood?

On "good days" how is your mood?

How has the pain affected your fitness?

How has the pain affected your hobbies?

Do you need help in areas where you were previously independent? Where? How has this affected your family?

What do you think is causing this? Do you have fears about a particular illness? Do the parents have fears concerning the pain that they feel has not been addressed? Past and family history of illness

Have you suffered painful conditions previously? Have you suffered fatigue, sleeplessness, or anxiety previously? Any operations or illnesses as a younger child? Have any family members suffered illness? Is there a family history of painful conditions? Family, emotional, and social circumstances Who currently lives at home? What are the occupations of the main carers? Have one or both carers changed/stopped their job since the pain condition started?

Can you identify any stressors in school, family, or peer groups?

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