Pain Assessment

Key points

1. Pain as vital sign

   According to the American Pain Society, pain is the fifth vital sign (Department of Veterans Affairs, 2000).

2. Routine pain assessments

   Pain assessments should be performed routinely to allow for better pain management by developing a treatment plan that meets the individual needs of the patient.

3. Medication reassessment timing

   Prior to administering pain medication, nurses must perform a thorough pain assessment. They must then reassess the pain at least fifteen minutes after administering the medication to evaluate effectiveness.

4. Comprehensive assessment elements

   A thorough pain assessment identifies the patient’s risks for pain, assesses the pain using an approved pain scale, determines the classification of pain (nociceptive, neuropathic, referred, somatic, visceral, phantom), determines if the pain is acute or chronic, and assesses the patient’s previous response to pharmacological interventions and analgesics, noting any adverse reactions.

5. Behavioral pain cues

   During a pain assessment, the patient should also be assessed for physical, behavioral, and emotional signs of pain, such as confusion, diaphoresis, moaning, decreased activity, irritability, guarding, grimacing, clenched teeth, muscle tension, depression, and insomnia.

6. Culture and individualized planning

   Despite these examples, it is important not to generalize about someone’s pain based upon their culture alone. Instead, nurses must understand how a patient’s culture may affect pain and use this information to create an individualized plan to best meet their individual needs.

7. Assessment mnemonic purpose

   The letters in each mnemonic stand for important categories of information relevant to a patient’s pain experience.

8. Open-ended pain questions

   Regardless of the pain assessment framework used, it is important to use open-ended questions that allow the patient to describe the pain in their own words. Closed-ended questions result in “yes” or “no” responses and fail to capture a comprehensive description of the pain.

9. Clarifying responses and goals

   It is also important to follow up on the patient’s initial responses by asking clarifying questions and to continue asking questions until you have a clear enough understanding of the pain to develop and implement an individualized pain treatment plan. In doing so, the nurse should collaborate with the patient to establish reasonable pain goals that are fluid over time and reflective of the patient’s current condition.

10. Reason for pain scales

    Because nurses cannot test pain objectively to determine what someone is experiencing, providers use pain scales to gain a concrete understanding of a patient’s pain.

11. Numerical rating scale use

    When using this scale, patients are asked to rate their pain between 0 and 10, with 0 being no pain and 10 being the worst pain ever experienced. Typically, a pain score of 0 means no pain, a score of 1 to 3 is mild pain, a score of 4 to 6 is moderate pain, a score of 7 to 9 is severe pain, and a score of 10 is unbearable pain.

12. Older adult pain assessment

    It is therefore crucial that nurses adequately assess and treat pain to maintain the health, well-being, and functional status of older patients, who are more likely to experience pain yet less likely to report being in pain.

13. Post-intervention reassessment

    Pain should always be reassessed after implementing an intervention to determine the effectiveness of the intervention in reducing the pain. Typically, pain should be reassessed within one hour of administering oral medications and within fifteen to thirty minutes of administering intravenous medications, depending upon institutional policy.