Approach to Pain Treatment

How is pain assessed?

When pain is the presenting complaint, the assessment begins with the cause before the pain itself. Questions cover the site, character, duration and radiation of the pain and any accompanying symptoms; an examination follows and, where necessary, investigations are requested. The plan is drawn up after this assessment; not every case of pain follows the same path.

Pain is one of the most common reasons for seeking outpatient care. The World Health Organization (opens in a new tab) reports that approximately 1.71 billion people worldwide have a musculoskeletal condition and that these conditions are the group contributing most to disability. The same source states that low back pain is the single leading cause of disability in 160 countries.

Headache is similarly common: the World Health Organization (opens in a new tab) reports that, as of 2021, headache disorders affected approximately 3.1 billion people (40% of the population).

Pain is a symptom. Understanding its cause and addressing the factors that make recurrence more likely are as much a part of the assessment as reducing the pain itself.

What is asked about during the examination?

• The site of the pain and its radiation (radiation into the arm or leg is assessed separately)
• Its character (throbbing, stabbing, burning, pressure-like)
• Its duration and course (when it began, whether it is continuous or intermittent, whether it is getting worse)
• What makes it worse and what eases it (movement, rest, night-time, morning stiffness)
• Accompanying symptoms (numbness, tingling, loss of strength, swelling, fever, weight loss)
• Its effect on daily life (sleep, work, movement)
• Warning signs (fever, unintentional weight loss, a history of cancer, pain that does not ease with rest at night, a change in bladder or bowel control)
• The painkillers being used (which medicine, how often and for how long)
• Co-existing conditions (thyroid, diabetes, anaemia, vitamin D status)
• Sleep routine and stress levels (these are part of the assessment in long-standing pain)

How does the assessment proceed?

1. Detailed medical history and physical examination. The painful area and the surrounding areas are examined; restriction of movement and neurological findings are assessed.
2. Screening for warning signs. This first stage establishes whether anything needs priority assessment.
3. Laboratory tests and imaging, if considered necessary. Not every case of pain calls for investigations; the examination findings determine whether they are needed.
4. Assessment of the accompanying metabolic factors. Thyroid function, anaemia, vitamin D status and the course of blood sugar may be accompanying the clinical picture.
5. Drawing up the plan. Changes to movement and daily life, medication adjustments where necessary and, where considered suitable, procedures performed at the practice are planned together.
6. Referral to the relevant specialty. A referral is made in clinical pictures that require surgery or further assessment.

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In which patients is it assessed differently?

• In patients with fever, unintentional weight loss, pain that does not ease with rest at night, a history of cancer, loss of bladder or bowel control, or loss of strength in a limb (the assessment takes priority and is not postponed)
• In patients whose pain began after trauma (the priority is to assess for fracture and injury)
• In patients who are pregnant or breastfeeding (the medicines and procedures that may be used are limited)
• In patients taking blood thinners or with a bleeding disorder (needle-based procedures are assessed separately)
• In patients with a diagnosis of osteoporosis and in patients over 65 years of age (a fracture may develop with minor strains)
• In patients receiving treatment that suppresses the immune system and in patients undergoing active oncology treatment (follow-up lies with the relevant specialty)
• In patients whose condition requires surgery (follow-up lies within the field of the relevant surgical specialty; this assessment does not replace it)
• In patients under 18 years of age (assessment lies within the field of paediatrics; this page has been prepared for adults)

How long does it take, and how many appointments are needed?

The number of appointments and the time required vary with the cause and duration of the pain and any accompanying conditions. A definite timescale cannot be given in advance. In short-lived pain a single assessment may be enough, whereas long-standing pain may require follow-up at certain intervals.

If a procedure is planned, the number of sessions and the interval between them are determined at the end of the examination.

What should you do before and after the consultation?

When you come to your appointment, bring:

• A list of all the medicines and supplements you use (including how often you use painkillers)
• Your imaging reports, if you have them, and your most recent test results
• A few days’ notes on the course of the pain (date, duration, severity, trigger)

After the appointment, you are given a written plan. Apply the movement advice gradually. How long it takes for an effect to appear varies from person to person.

Risks and points to be aware of

A reduction in pain does not mean that the cause has gone away. For this reason, in recurring pain the triggering factors are addressed separately.

Frequent and long-term use of painkillers may cause problems. When painkillers are used frequently for headache, over time the original pain may be replaced by a headache caused by the medication itself. The World Health Organization describes this as the most common secondary headache disorder. Some painkillers also call for care with the stomach, the kidneys and blood pressure.

Do not start a medicine, increase its dose or extend its duration on your own initiative.

Imaging is not needed in every case of pain. Early imaging that is not needed may reveal findings that have nothing to do with the pain and may cause needless anxiety.

Interventional procedures carry risks of their own. Pain at the site of the procedure, bruising, bleeding and, rarely, infection may occur. The suitability criteria and possible side effects of each procedure are set out separately on its own page; you are advised to read these before the procedure.

In long-standing pain, inactivity may help sustain the clinical picture. The World Health Organization highlights physical approaches that increase muscle strength and the ability to move.

Results vary from person to person.

When should you see a physician without delay?

If you notice these symptoms, consult a physician without delay:

• Pain accompanied by fever
• Newly started pain in a person with a history of cancer
• Unintentional weight loss accompanying the pain
• Pain that began after trauma
• Pain that does not ease with rest at night and wakes you from sleep

In the event of loss of bladder or bowel control, loss of strength in an arm or leg or foot drop, numbness in the inner thighs and around the anus, or a sudden, very severe headache, go directly to the emergency department.

Frequently asked questions

Which department should I go to for my pain?

If the cause of the pain is not clear, an internal medicine assessment may be the starting point; the metabolic factors that accompany pain (thyroid, anaemia, vitamin D, blood sugar) are addressed together here. Where further surgical, rheumatological or neurological assessment is needed, a referral is made to the relevant specialty.

Should I have an X-ray straight away for my pain?

Imaging is not needed in every case of pain. The examination findings, and whether warning signs are present, determine whether it is needed. Early and unnecessary imaging may reveal findings that have nothing to do with the pain.

Can I carry on using painkillers?

Tell your physician how often and for how long you use them. Regular and frequent use may cause certain problems; which medicine is suitable, and for how long, is assessed together with your current medication.

Which procedures may be planned after a pain assessment?

If considered suitable following the assessment, procedures such as hijama and major ozone therapy may be added to the plan. Each of these has its own suitability criteria, course and possible side effects; these are described separately on the relevant pages. The decision on suitability is made at the end of the examination.

How many sessions are needed for pain procedures?

A definite number of sessions cannot be given in advance. The number of sessions and the interval between them are determined at the end of the examination, according to the cause and duration of the pain and the result of the assessment.

Should I exercise while I am in pain?

Keeping up movement is generally advised, but which exercise suits you is determined after the examination. Any movement that increases the pain or brings on numbness is discontinued. There is no single list of exercises suitable for everyone.

Sources

1. World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
2. World Health Organization, Headache disorders fact sheet, 24 October 2025. https://www.who.int/news-room/fact-sheets/detail/headache-disorders (opens in a new tab)