BOX 3-1Factors Affecting the Choice of Treatment for Pain

Pain-Related Factors

  • the known likely source of pain, such as an arthritic joint;
  • the location, intensity, frequency, duration, and recurrence pattern of the pain;
  • pain descriptors, such as cramping, burning, and aching;
  • situations that make the pain more or less intense; and
  • impact of the pain on daily life, including eating, sleeping, activities, relationships, recreation, and attendance and performance at school or work.

Individual-Related Factors

  • health status, other medical or neurological conditions, and psychological state (e.g., depression or anxiety);
  • genetic factors (sometimes referred to as bioindividuality), such as a predisposition to migraines or response to specific treatments;
  • age, gender, race, and ethnicity;
  • patient preferences, temperament, and personality, including readiness to engage in disciplined self-management;
  • history of pain, trauma, abuse, and other major life events and stressors (e.g., divorce, unemployment);
  • financial means, health insurance coverage, and other factors affecting access to care;
  • likely adherence to prescribed treatments, including medications, physical therapy, and diet;
  • health beliefs—for example, that drugs or doctors can solve even the most difficult health problems or, conversely, that medications often prescribed for persistent pain are too dangerous;
  • cultural, spiritual, and religious beliefs; and
  • level of health literacy or English proficiency and cognitive, speech, hearing, or visual impairments that can affect communication with care providers.

Environmental Factors

  • living and work situations and associated risks of injury and physical and emotional strain;
  • the context of pain, that is, where the person is and what he or she is doing when pain occurs;
  • family history and modeling of disease and wellness behavior and its reinforcement or suppression of pain behavior;
  • coping resources, including support from significant others and adequate financial support;
  • cultural background and involvement, community response, and support from other people;
  • information obtained from the Internet, other media, and other people; and
  • past experiences with health care providers.

From: 3, Care of People with Pain

Cover of Relieving Pain in America
Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education.
Washington (DC): National Academies Press (US); 2011.
Copyright © 2011, National Academy of Sciences.

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