Measuring cancer pain

• Assessing your pain
• Questions your doctor may ask
• Pain examinations and tests
• Pain scales and diaries

Before your doctor can manage your pain they will need to ask you a lot of questions about the history of your illness and pain. This is called a pain assessment. It may seem like a lot to deal with if you are in a lot of pain at the time. You probably just want your doctor to give you something to relieve the pain immediately and leave you alone. But it is extremely important that your doctor takes the time to assess all aspects of your pain so you get the right treatment. If you are in too much pain or feeling too tired, and you really don't feel up to answering questions, then your family and friends may be able to help.

Your doctor will examine you and possibly arrange some other tests and investigations.

The types of questions that your doctor is likely to ask about your pain may include

• Where is your pain?
• Is it in one place or all over your body?
• On a scale of 0 to 10, how much does your pain hurt?
• Do you have pain all the time?
• Does anything that you do help to lessen the pain? For example changing position, applying heat or cold?
• What does it feel like - stabbing, tingling, aching, burning, throbbing, cramping or shooting?
• When did it start?
• Has the pain got worse or better if you have had treatment such as chemotherapy or radiotherapy?
• Do you have any other medical conditions?
• Did you have the pain before your cancer was diagnosed?
• Do you take any drugs to help with your pain?
• Does eating make the pain worse?
• How long is it since you have opened your bowels?
• Are you having any problems passing urine?

Your doctor may not ask you all these questions because the cause of the pain may become clear after just a few.

Next, your doctor will examine you. Depending on where your pain is your doctor may

• Examine your abdominal area, hips, spine, hands and feet
• Feel for enlarged lymph nodes under your arms, in your groin or at the base of your neck

You may also have X-rays and blood tests to give your doctor more information. For example, cancer in the bones can cause a fracture. So if you have pain in your hip, your doctor may want you to have an X-ray to rule out cancer in the bones.

Another way of assessing your pain is to ask you to rate it on a scale. This may be on a scale of 0 to 10, where 0 means no pain at all and 10 means the worst pain you can ever imagine. Or your care team may use a “pain faces scale”. This is a well known series of diagrams ranging from very happy to very unhappy faces. It is called the Wong-Baker pain face scale. You are asked to pick a face that best describes your pain. This scale is most often used with children.

There are different pain scales. Some use a number scale from 1 to 5 or 1 to 10. They can be a very good way of helping people describe pain. Many hospitals and hospices keep these records to refer back to when you have another pain assessment or treatment changes. Some people find it hard to rate their pain on a pain scale. If you find it difficult, you can use words like mild, moderate or severe to describe your pain.

Some people keep what is called a pain diary. This is a daily record or report of your pain, describing things such as where your pain is, how strong it is, what activities you are doing and how many pain killers you need to take. This information can help you, and your doctor or nurse, assess your pain, and see how well pain killers are working.