When someone tells you their pain is 6 out of 10, what do you ask next?

The score measures intensity, but not how pain affects daily life, what concerns the patient has or what activities they want to resume. Alongside clinical assessment, these insights guide care.

Start with the score — then ask about impact

Two people can have similar injuries, scan findings and pain scores, yet different experiences. One may stay active and working, while the other may sleep poorly, avoid movement and withdraw from valued activities.

Same score. Different person. Different impact.

Alongside history and examination, understanding these differences helps you identify what needs attention and what matters most to the patient.

The Pain Care Priorities framework encourages this person-centred approach.

Try asking: “What is your pain stopping you from doing?”

Explore what makes that activity difficult and what concerns the patient.

Explore what is influencing the pain

The International Association for the Study of Pain recognises pain as a personal experience influenced to varying degrees by biological, psychological and social factors.

Alongside clinical assessment, explore how pain may influence, and be influenced by:

• movement
• mood
• confidence
• participation
• expectations
• recovery behaviours

These factors interact.

Understanding these interactions helps explain differences in pain’s impact and the care each patient needs.

Try asking: “What makes your pain harder to manage, and what seems to help?”

Identify the factors most relevant to this patient. For example, poor sleep may affect mood and confidence, making everyday activities harder.

Identify what may be keeping the cycle going

A patient may reduce activity because they fear triggering a flare-up. Over time, reduced activity may affect their physical capacity and confidence. Poor sleep or increasing distress can add to these difficulties, making it harder to resume activities.

Explore this pattern without assuming that reduced activity is driven by fear or that the same explanation applies to everyone.

Try asking: “Is there anything you have stopped or changed because you are worried it might increase your pain?”

Follow with: “What tends to happen when your pain flares up?”

Clarify the patient’s expectations, responses and whether those responses help. Identify concerns needing further assessment, explanation or support, then agree on a practical next step.

Assess the whole person — in a structured way

A biopsychosocial assessment focuses on the factors relevant to this patient’s pain and daily life. Broader questions sit alongside your history, examination and assessment of underlying conditions or new and changing symptoms.

Organise the conversation around:

• Biological and physical Consider the clinical presentation, relevant pathology, sleep, physical capacity and current treatments, including their benefits and adverse effects.
• Psychological Explore the patient’s understanding of their pain, beliefs about injury or damage, expectations of recovery, mood, concerns about movement and confidence in managing symptoms.
• Social Ask about work demands, family responsibilities, relationships, support and cultural influences that may affect care.
• Function and participation Find out what the patient has stopped or changed, what they can still do and which activities matter most to them.

Try asking: “What has changed in your life since the pain started?” and “What matters most for you to get back to?”

Connect the findings: a patient who has stopped working may report pain during tasks, fear of further injury and limited support to modify duties. Each has implications for care.

Check your understanding with the patient and agree which concern or barrier to address first.

Watch the free masterclass and explore the practical resource guide.

Use what you learn to guide the care plan

Agree with the patient on a priority and a practical next step.

Consider:

• what you can address within your scope
• which concerns need further assessment or explanation
• what support the patient needs for self-management
• whether another discipline could contribute
• how you will review progress.

A patient may want to walk their child to school but fear further damage. Following appropriate clinical assessment, explore that concern, discuss support and agree on a manageable step.

Try asking: “Of the things we have discussed, what would make the biggest difference to your daily life?”

Clarify what the patient will try, what support you will arrange and when you will review progress together.

Review impact alongside intensity

A patient may still report pain at 6 out of 10 while sleeping better, walking further, returning to work or managing flare-ups more confidently. Track these changes alongside pain intensity.

At follow-up, return to the goal you agreed on.

Try asking: “Last time, you wanted to work towards walking your child to school. How is that going, and what is helping or getting in the way?”

You can also ask:

“What are you able to do now that you couldn’t do before?”

Explore improvements and continuing difficulties. Use this information, alongside symptoms and treatment effects, to decide whether to continue, adjust or reassess the plan.

Three questions to remember
Use these questions to focus assessment and further exploration:

• What is your pain stopping you from doing?
• What worries you most about it?
• What would you like to get back to doing?

Use the answers to agree on a practical next step and review outcomes that matter to the patient.

Take it further

This masterclass draws on OPEN’s Understanding Pain Severity and Impact Learning Hub topic.

Explore the supporting free resources, including:

• Watch the Masterclass: Beyond the pain score
• Read the clinical reflection by Dr Duncan Sanders
• Download the practical resource guide

The OPEN Clinical Pain Management Training Program offers practical, evidence-based training in person-centred pain care.

Explore the OPEN Clinical Pain Management Training Program