Assessment of the health care system is often forgotten, but difficult pain problems cannot usually be resolved until this is explored. Such assessment involves a review of the entire network treating the patient, as well as specific groups and individuals such as nurses, physicians, and social workers. Strengths and problems are identified. Including the health care system in any assessment includes everyone involved in the process of care, beyond just patient and family, and reinforces the mutual responsibility inherent in therapeutic relationships. Cognitive and affective states and developmental level must be considered.
Frequent reassessment is essential to titrate treatment of pain that rapidly waxes and wanes.
Patients do not automatically trust health professionals, especially when they have encountered untrustworthiness. Patients whose pain has been managed inconsistently and inadequately by an ever-changing roster of health care professionals may, for example, always rate their pain as 10 out of 10 or exhibit unusual pain behavior in an attempt to obtain adequate analgesia. Consistent, marked differences between the verbal report and observed behavior warrant further investigation.