The Diagnosis of Pain: The Medical History

It is not hard for a doctor to diagnose pain. Every medical student is taught defining characteristics that are entered into the patient’s chart, substantiating the baseline pain: historic and physical data, patient self-assessment, numeric values, and physical exam findings.

The Waiting Room. Most doctors agree that personally calling the patient in from the waiting room allows a clinical assessment of the patient’s physical status: how does the patient get up from the waiting room chair? Does the patient move slowly? Limp? Favor one side over another? Or does the patient jump up and smile right away?

The diagnostic progression continues in the examination room:

Patient History. The Chief Complaint (CC) classically uses the patient’s own words to describe the reason for seeking medical care, in answer to, “What brings you here today?” It includes the length of time, such as

“I have a terrible headache” after a car accident yesterday.

The History of the Present Illness (HPI) includes answers to questions such as the classic, “How long have you had this problem?” The doctor must retrace the accident trajectory, inquire about the speed of impact, whether a seat belt was worn, whether the head was hit, along with question about associated symptoms indicative of major diagnoses like brain or spinal cord injury (e.g., neurologic system: nausea, vomiting, loss of consciousness, seizures, loss of bowel or bladder function, memory loss, confusion, loss of coordination, numbness).

To complete the clinical picture, review the Past Medical History (PMHx) and Past Surgical History (PSHx): allergies, medications, illnesses, hospitalizations, operations.

Then proceed with the Physical Exam. It is imperative to elicit enough historical information so the physical exam is directed.

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