Introduction

Pain is defined by the International Association for the Study of Pain (IASP) as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."1 Pain is an unpleasant subjective experience that is the net effect of a complex interaction of the ascending and descending neurons involving biochemical, physiologic, psychological, and neocortical processes. Pain can affect all areas of a person's life including sleep, thought, emotion, and activities of daily living. Because there are no reliable objective markers for pain, the patient is the only person who can describe the intensity and quality of their pain.

Pain is the most common symptom prompting patients to seek medical attention and is reported by more than 80% of individuals who visit their primary care provider.1 Despite the frequency of pain symptoms, individuals often do not obtain satisfactory relief of pain. This has led to recent initiatives in health care to make pain the fifth vital sign, thus making pain assessment equal in importance to obtaining a patient's temperature, pulse, blood pressure, and respiratory rate.

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