How can I effectively assess the impact of chronic pain on a patient's quality of life during a consultation?

To effectively assess the impact of chronic pain on a patient's quality of life during a consultation, adopt a comprehensive, person-centred approach that explores how pain affects multiple life domains and incorporates the patient's individual context and preferences. Begin by inviting the patient to describe how their chronic pain influences their daily activities, including work, sleep, physical and psychological wellbeing, social relationships, and any socioeconomic or cultural factors that may shape their experience and management choices NICE NG193.

Use open-ended questions to explore the broader effects of pain on the patient’s family, carers, and social interactions, as well as any stressful life events or history of substance misuse that might contribute to or exacerbate their pain experience NICE NG193. Recognise and acknowledge the distress and disability caused by chronic pain, fostering a collaborative and supportive relationship that encourages active patient participation and shared decision making NICE NG193.

Incorporate validated pain assessment tools such as numerical rating scales or visual analogue scales to quantify pain intensity and differentiate between usual pain levels, breakthrough pain, and flare-ups, which helps in understanding the pain’s variability and impact over time NICE CKS. Additionally, assess the quality, timing, and characteristics of pain to identify underlying mechanisms and potential causes, which can inform tailored management strategies NICE CKS.

Explore the patient’s strengths, coping skills, and views on living well despite pain, as well as their understanding and expectations regarding their condition and treatment outcomes, to personalise the care plan and support self-management NICE NG193. For younger adults (16–25 years), consider the impact of pain on education, social development, and family dynamics NICE NG193.

Be sensitive to cultural, ethnic, and socioeconomic backgrounds, as recent literature highlights that these factors significantly influence pain perception, reporting, and management preferences, necessitating culturally competent communication and assessment [1, Shah et al. 2024].

Finally, discuss the fluctuating nature of chronic pain, the possibility of flare-ups without identifiable causes, and the potential for quality of life improvements even if pain persists, ensuring that the patient feels validated and supported throughout the consultation NICE NG193. This holistic assessment should inform a shared care and support plan that aligns with the patient’s goals, abilities, and preferences, integrating both pharmacological and non-pharmacological management options as appropriate NICE NG193.