Pain physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

Pain assessment also uses the concepts of pain threshold, the least experience of pain which a subject can recognize, and pain tolerance, the greatest level of pain which a subject is prepared to tolerate. Among the most frequent technical terms for referring to abnormal perturbations in pain experience, there are:

  • allodynia, pain due to a stimulus which does not normally provoke pain,
  • hyperalgesia, an increased response to a stimulus which is normally painful,
  • hypoalgesia, diminished pain in response to a normally painful stimulus.[1]

Verbal Characterization

A key characteristic of pain is its quality. Typical descriptions of pain quality include sharp, stabbing, tearing, squeezing, cramping, burning, lancinating (electric-shock like), or heaviness. It may be experienced as throbbing, dull, nauseating, shooting or a combination of these. Indeed, individuals who are clearly in extreme distress such as from a myocardial infarction may not describe the sensation as pain, but instead as an extreme heaviness on the chest. Another individual with pain in the same region and with the same intensity may describe the pain as tearing which would lead the practitioner to consider aortic dissection. Inflammatory pain is commonly associated with some degree ofitch sensation, leading to a chronic urge to rub or otherwise stimulate the affected area. The difference between these diagnoses and many others rests on the quality of the pain.

Point to a number or face that shows intensity of pain.

Numeric Rating Scale

Pain may be quantified on a pain numeric rating scale (NRS) that ranges from 0-10 points (0 means no pain); however, the accuracy of such as scale (using a cut point of 4 or more) for predicting pain that interferes with functioning is:[2]

This score does not correlate with heart rate.[3]

Visual Analog Scale

Visual analog scales (VAS) have been used to measure pain. An observational study concluded "the minimum clinically significant change in patient pain severity measured with a 100-mm visual analog scale was 13 mm."[4]

The PEG is a 3 item scale that rates pain and its impact on the patient's life.[5]


  1. IASP Pain Terminology.
  2. Krebs, Carey, and Weinberger, “Accuracy of the Pain Numeric Rating Scale as a Screening Test in Primary Care,” Journal of General Internal Medicine 22, no. 10 (October 21, 2007): 1453-1458,doi:10.1007/s11606-007-0321-2 (accessed September 28, 2007)
  3. Lord B, Woollard M (2011). "The reliability of vital signs in estimating pain severity among adult patients treated by paramedics". Emerg Med J. 28 (2): 147–50. doi:10.1136/emj.2009.079384. PMID 20926627.
  4. Todd KH, Funk KG, Funk JP, Bonacci R (1996). "Clinical significance of reported changes in pain severity". Ann Emerg Med. 27 (4): 485–9. PMID 8604867. Unknown parameter |month= ignored (help)
  5. Krebs EE, Lorenz KA, Bair MJ, Damush TM, Wu J, Sutherland JM; et al. (2009). "Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference". J Gen Intern Med. 24 (6): 733–8. doi:10.1007/s11606-009-0981-1. PMC 2686775. PMID 19418100.

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