Assessment of pain in patients with rheumatic diseases

Pain is the most prominent symptom in people with musculoskeletal disorders and the most common reason for patients to seek medical help. However, pain generally is not recorded quantitatively in usual medical care. A quantitative measure of pain is not needed in acute medical care but is essential over long periods as patients and health professionals cannot gauge accurately changes in levels of pain over years. The experience of pain is subjective, and early efforts by health professionals to estimate pain through an ‘objective’ measure of pain status were useful in clinical research but not in clinical care. Over the last three decades, self-report questionnaires have been developed in which a patient may record quantitatively a pain score, as well as other data concerning clinical status, which may be repeated over time to discern whether patients are improved, similar or worse. The most robust quantitative pain measure appears to be a simple 10-cm visual analogue scale (VAS) which can be completed by the patient and scored by a health professional in less than 30 s. These data cannot be obtained from any source other than the patient. Pain scores are correlated with ‘objective’ measures such as radiographs, laboratory tests and physical examination findings, but more strongly correlated with scores for functional status and psychological distress in patients with rheumatic diseases. It is recommended that quantitative assessment of pain be included at each visit in routine rheumatology care, along with assessment of functional disability, global status and other patient variables, using a patient self-report questionnaire to improve patient care.