In the ED, which patient demonstrates the best candidate for evaluating pain tolerance?

• A. A 12-year-old with fever
• B. A 55-year-old woman who has had moderate low back pain for three months
• C. A 40-year-old with an ankle sprain
• D. A 70-year-old with severe chest pain

Answer: (B)

Pain tolerance is about how much pain a person can endure and how their response to pain and analgesia is shaped by their experience and ongoing condition. A patient who has had moderate low back pain for several months provides the most stable context for evaluating tolerance because their pain experience and baseline are established, making it possible to interpret responses to analgesia against that baseline. In contrast, acute, life-threatening chest pain demands immediate care and isn’t suitable for testing tolerance; a child with fever isn’t primarily about enduring pain in the same way, and an acute ankle sprain involves sudden distress that can complicate judgment of true tolerance. Thus, the patient with chronic, moderate back pain best demonstrates the capacity to evaluate pain tolerance.