Before we can begin to discuss the treatment of pain, we must discuss the importance of a complete assessment of pain. Pain is always subjective, so we must rely on the patient's report of pain. Measures of pain intensity are not meant to compare one person's pain with another; rather, they compare the intensity of one patient's pain at any given time with its intensity at another given time.
An effective assessment employs careful listening and open-ended questioning to correctly identify the following characteristics of each pain:
Location
Radiation
Duration
Intensity
Quality
Aggravating and alleviating factors
In addition, assessments should include all of the basic history taking elements we learned in medical schools (past medical history, family history, psychosocial review). When evaluating pain in the dying patient, you must also determine what impact the pain is having on the patient's quality of life.
The history should also include current and previous therapies that have been tried, remembering to discuss alternative and non-pharmacological therapies the patient may be utilizing. The history-taking session should include family members and should focus on the patient and family member's goals of care and expectations. It should be followed with a complete physical examination and appropriate laboratory and imaging studies.