Communication is key in the interview process. Listen and pause to gain a sense of the context of the pain within the individual’s life. Check for understanding by summarizing the patient’s history of present illness. This offers opportunity for clarification, eliminating any impediment treatment progress. Essential elements of a pain interview will help create a comprehensive and individualized treatment plan. These include the following:

To determine the chief complaint, you may ask “What is the main problem for which you are seeking treatment here today?” Using a pain diagram that enables the patient to mark or shade the areas that are painful (see Fig. 3-1). Next ascertain the onset and duration of pain by asking the following questions: “When did your current pain start? Can you briefly describe how your current pain started?”

Verify current pain medications, dosages, and frequency to determine therapeutic benefit. Obtain a list of previous medications (including psychopharmacologic and over-the-counter drugs), dosages, and frequency including the reasons for discontinuation. This will help identify adequate trial of medications. Determine whether the patient had previous injection therapies, when the injections were performed, and whether any pain relief was attained. For instance, ask “What percentage of pain relief did you derive from the injection(s)?” “How long did your pain relief last following the injection?” Different types of injections may include cervical or lumbar epidural steroid injections, neural blockade procedures, facet (z-joint) blocks, radiofrequency ablations, and joint injections. Previous physical therapy (PT) participation, the specific type of PT, when treatments took place, duration, and whether benefit was derived should also be discussed. For instance, the patient may have participated in a PT program with a focus on acute pain therapeutic modalities rather than functional restoration therapies while concomitantly learning active self-management strategies for chronic pain. In this scenario, successful PT was limited based on approach.

Previous diagnostic studies including the approximated date and results if known are important. These may include X-rays, CT scans, or MRI imaging. These can be helpful to track changes or detect interval development of a new pain problem. Electromyography (EMG) and nerve conduction studies (NCSs) help to identify abnormalities of peripheral nerves, muscle, and neuromuscular junction (NMJ) function. They can provide information on location of pathology, chronicity, and severity. EMG and NCSs also help determine the progression of abnormalities or
recovery from abnormal function. Laboratory studies such as elevated sedimentation rate (ESR) and C-reactive protein (CRP) are helpful in determining associated inflammatory or infectious process requiring further workup. B₁₂, vitamin D, autoimmune-specific labs should be obtained if history and physical examination are concerning for rheumatologic disease.