First you need to know exactly what you are dealing with. Take a careful case history, listening to what the patient is actually saying, rather than what you think they ought to be saying.
Pain is exhausting and demoralising, and the patient may be irritable, especially if they have not slept well for months. I find it is best to respect the patient, who knows far more about how they feel than I do. Its nice to have a feeling of working together to address the problem. Also, if you have an open and respectful attitude, you learn things from the patient that you can suggest to your other patients.
I find using a scale useful. The patient should be encouraged to put a tick at their pain level in the morning, afternoon and nightime. Although the patient finds it a nuisance, it helps you to see patterns and severity of symptoms and you can glean a lot of insight when you analyse the forms. Once you know what you are up against, you can bring hope in the form of effective treatment to the person, and that is a great feeling.
This is the form I use:
Very Important: This is the pain level that is experienced
AFTER taking the daily medication prescribed by your doctor.
1-Very minor annoyance -mild aches to some parts of the body. No pain medication needed.
2-Minor annoyance- dull aches to some parts of the body. No pain medication needed.
3-Annoying enough to be distracting. Over-the-Counter pain relievers (such as Naproxen Sodium, Paracetamol, or topical treatments such as Ibuleve or Arthritis Pain relieving rubs) take care of it.
4-Can be ignored if you are really involved in your work, but still distracting. Over-the-Counter pain relievers remove pain for 3-4
5-Can't be ignored for more than 30 minutes. Over-the-Counter pain relievers help somewhat (bring pain level from 5 to a 3 or 4) with pain for 3-4 hours.
6-Can't be ignored for any length of time, but you can still go to work & participate in social activities. Stronger painkillers (such as Tramadol) relieve pain for 3-4 hours.
7-Makes it difficult to concentrate, interferes with sleep. You can still function with effort. Stronger painkillers (such as Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to 4-6.)
8-Physical activity severely limited. You can read & converse with effort. Stronger pain killers (such as Tramadol) are not effective. (Narcotic pain killers do bring this pain down to a level 3 or lower.)
9-Non functional for all practical purposes. Cannot concentrate. Physical activity halted. Panic sets in.(Narcotic Pain killers bring the pain level from 9 to the 4-6 level.)
10-Totally non-functional. Unable to speak. Crying out or moaning uncontrollably - near delirium.