{"id":105,"date":"2018-06-05T11:34:16","date_gmt":"2018-06-05T15:34:16","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-2-pain-assessment\/"},"modified":"2022-06-08T11:36:36","modified_gmt":"2022-06-08T15:36:36","slug":"2-3-pain-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-3-pain-assessment\/","title":{"raw":"2.3 Pain Assessment","rendered":"2.3 Pain Assessment"},"content":{"raw":"\"Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does\" (McCaffery, 1968, as cited in Rosdahl & Kowalski, 2007, p. 704).\r\n\r\nPain is a subjective experience, and self-reporting pain is the most reliable indicator of a patient's experience (RNAO, 2013). Determining pain is an important\u00a0component of a\u00a0physical assessment, and pain is sometimes referred to as the \"fifth vital sign.\"\r\n\r\n\r\n\r\n
\r\n\r\n[caption id=\"attachment_6665\" align=\"alignleft\" width=\"300\"]\"Example<\/a> Figure 2.1 Example of a pain scale[\/caption]<\/td>\r\n\r\n\r\n[caption id=\"attachment_3572\" align=\"alignright\" width=\"300\"]\"\"<\/a> Figure 2.2 Wong-Baker assessment of pain in children scale[\/caption]<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nPain assessment is an ongoing process rather than a single event. A variety of pain assessment tools and visual analogues are available to help with pain assessment (see Figures 2.1 and 2.2). When someone's pain changes notably from previous findings, a\u00a0more comprehensive and focused assessment should be performed. Sudden changes may indicate an underlying pathological process (Jarvis, Browne, MacDonald-Jenkins, & Luctkar-Flude, 2014). It is important to\u00a0assess pain at the beginning of a physical health\u00a0assessment to determine the patient's comfort level and potential need for pain comfort measures. Any time you think your patient is in pain, the mnemonic\u00a0OPQRSTUV may help guide the questions to ask\u00a0your patient. See\u00a0Checklist 14 for more specificity regarding this approach.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

<\/a>Checklist 14<\/span>: Pain Assessment<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n

\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

O: Onset<\/td>\r\n\r\n
    \r\n \t
  • When did it begin?<\/li>\r\n \t
  • How long does it last?<\/li>\r\n \t
  • How often does it occur?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
P: Provoking, palliation<\/td>\r\n\r\n
    \r\n \t
  • What brings it on?<\/li>\r\n \t
  • What makes it better?<\/li>\r\n \t
  • What makes it worse?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Q: Quality<\/td>\r\n\r\n
    \r\n \t
  • What does it feel like?<\/li>\r\n \t
  • Can you describe it? (patient's own words)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
R: Region, radiating<\/td>\r\n\r\n
    \r\n \t
  • Where is it?<\/li>\r\n \t
  • Does it spread?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
S: Severity<\/td>\r\n\r\n
    \r\n \t
  • What is the intensity (0 to 10) right now, at best, on average, at worst?<\/li>\r\n \t
  • Are there other accompanying symptoms?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
T: Treatment<\/td>\r\n\r\n
    \r\n \t
  • What treatments are you currently using?<\/li>\r\n \t
  • How effective are they?<\/li>\r\n \t
  • Any side effects?<\/li>\r\n \t
  • What have you used in the past?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
U: Understanding<\/td>\r\n\r\n
    \r\n \t
  • What do you believe is causing this symptom?<\/li>\r\n \t
  • How is this symptom affecting you or your family?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
V: Values<\/td>\r\n\r\n
    \r\n \t
  • What is your comfort goal?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Data source:\u00a0 RNAO, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n\r\nIn their \"Clinical Best Practice Guidelines: Assessment and Management of Pain\" (2013), the Registered Nurses Association of Ontario (RNAO) has published a variety of pain assessment tools for different populations including children, non-verbal adults, adults with cancer, and neonates. Table 2.1 is an assessment tool that can be used in adults with cognitive impairment.\r\n\r\n<\/div>\r\n
\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n

Table 2.1 Pain Assessment Tools for Elders with Cognitive Impairment<\/h3>\r\n

Note: The screening tool is for the presence\/absence of pain but NOT pain intensity.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Measure<\/h4>\r\n<\/td>\r\n

\r\n

Characteristics<\/h4>\r\n<\/td>\r\n

\r\n

Considerations<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

Pain Assessment in Advanced Dementia (PAINAD) Scale<\/td>\r\n\r\n
    \r\n \t
  • Observational behavioural tool of five items: breathing, facial expression, body language, negative vocalizations, and consolability<\/li>\r\n \t
  • Each item rated on a scale of 0\u20132 for a total score from 0 (no pain) to 10 (severe pain); score 1 or 2 indicates some pain<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\r\n
Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)<\/td>\r\n\r\n
    \r\n \t
  • 60-item tool assessing four categories: facial expressions, activity\/body movements, social and personality changes, and other (appetite or sleeping changes)<\/li>\r\n \t
  • Items in each category are rated present or absent, for a total score of 60<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\r\n
DOLOPLUS-2 Scale<\/td>\r\n\r\n
    \r\n \t
  • Observations of somatic, psychomotor, and psychosocial behaviours<\/li>\r\n \t
  • Items scored on scale of 0\u20133, total score range from 0\u201330<\/li>\r\n \t
  • Score of 5 or more indicates pain, maximum score 30<\/li>\r\n<\/ul>\r\n<\/td>\r\n
\r\n
Data source: RNAO, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n
\r\n

Critical Thinking Exercises<\/h3>\r\n
    \r\n \t
  1. You are caring for a patient who has just returned from a surgical procedure. How might the assessment of acute pain differ from assessment of chronic pain?<\/li>\r\n \t
  2. What\u00a0is more important in pain assessment:\u00a0the subjective or the objective data?<\/li>\r\n<\/ol>\r\n<\/div>\r\n

    Attributions<\/h2>\r\nFigure 2.1\u00a0Children's pain scale<\/a> by\u00a0Robert Weis is used under a CC BY SA 4.0<\/a> licence.\r\n\r\nFigure 2.2 The Wong-Baker scale for assessment of pain in children<\/a> by Intermedichbo<\/a> is used under a\u00a0CC BY SA 4.0<\/a> licence.","rendered":"

    “Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery, 1968, as cited in Rosdahl & Kowalski, 2007, p. 704).<\/p>\n

    Pain is a subjective experience, and self-reporting pain is the most reliable indicator of a patient’s experience (RNAO, 2013). Determining pain is an important\u00a0component of a\u00a0physical assessment, and pain is sometimes referred to as the “fifth vital sign.”<\/p>\n\n\n\n
    \n
    \"Example<\/a>
    Figure 2.1 Example of a pain scale<\/figcaption><\/figure>\n<\/td>\n
    		\n
    \"\"<\/a>
    Figure 2.2 Wong-Baker assessment of pain in children scale<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Pain assessment is an ongoing process rather than a single event. A variety of pain assessment tools and visual analogues are available to help with pain assessment (see Figures 2.1 and 2.2). When someone’s pain changes notably from previous findings, a\u00a0more comprehensive and focused assessment should be performed. Sudden changes may indicate an underlying pathological process (Jarvis, Browne, MacDonald-Jenkins, & Luctkar-Flude, 2014). It is important to\u00a0assess pain at the beginning of a physical health\u00a0assessment to determine the patient’s comfort level and potential need for pain comfort measures. Any time you think your patient is in pain, the mnemonic\u00a0OPQRSTUV may help guide the questions to ask\u00a0your patient. See\u00a0Checklist 14 for more specificity regarding this approach.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    <\/a>Checklist 14<\/span>: Pain Assessment<\/h3>\n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n

    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    O: Onset<\/td>\n\n
      \n
    • When did it begin?<\/li>\n
    • How long does it last?<\/li>\n
    • How often does it occur?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    P: Provoking, palliation<\/td>\n\n
      \n
    • What brings it on?<\/li>\n
    • What makes it better?<\/li>\n
    • What makes it worse?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Q: Quality<\/td>\n\n
      \n
    • What does it feel like?<\/li>\n
    • Can you describe it? (patient’s own words)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    R: Region, radiating<\/td>\n\n
      \n
    • Where is it?<\/li>\n
    • Does it spread?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    S: Severity<\/td>\n\n
      \n
    • What is the intensity (0 to 10) right now, at best, on average, at worst?<\/li>\n
    • Are there other accompanying symptoms?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    T: Treatment<\/td>\n\n
      \n
    • What treatments are you currently using?<\/li>\n
    • How effective are they?<\/li>\n
    • Any side effects?<\/li>\n
    • What have you used in the past?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    U: Understanding<\/td>\n\n
      \n
    • What do you believe is causing this symptom?<\/li>\n
    • How is this symptom affecting you or your family?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    V: Values<\/td>\n\n
      \n
    • What is your comfort goal?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Data source:\u00a0 RNAO, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n

    In their “Clinical Best Practice Guidelines: Assessment and Management of Pain” (2013), the Registered Nurses Association of Ontario (RNAO) has published a variety of pain assessment tools for different populations including children, non-verbal adults, adults with cancer, and neonates. Table 2.1 is an assessment tool that can be used in adults with cognitive impairment.<\/p>\n<\/div>\n

    \n\n\n\n\n\n\n\n\n
    \n

    Table 2.1 Pain Assessment Tools for Elders with Cognitive Impairment<\/h3>\n

    Note: The screening tool is for the presence\/absence of pain but NOT pain intensity.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n

    Measure<\/h4>\n<\/td>\n

    		\n

    Characteristics<\/h4>\n<\/td>\n

    		\n

    Considerations<\/h4>\n<\/td>\n<\/tr>\n

    Pain Assessment in Advanced Dementia (PAINAD) Scale<\/td>\n\n
      \n
    • Observational behavioural tool of five items: breathing, facial expression, body language, negative vocalizations, and consolability<\/li>\n
    • Each item rated on a scale of 0\u20132 for a total score from 0 (no pain) to 10 (severe pain); score 1 or 2 indicates some pain<\/li>\n<\/ul>\n<\/td>\n
    		\n
    Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)<\/td>\n\n
      \n
    • 60-item tool assessing four categories: facial expressions, activity\/body movements, social and personality changes, and other (appetite or sleeping changes)<\/li>\n
    • Items in each category are rated present or absent, for a total score of 60<\/li>\n<\/ul>\n<\/td>\n
    		\n
    DOLOPLUS-2 Scale<\/td>\n\n
      \n
    • Observations of somatic, psychomotor, and psychosocial behaviours<\/li>\n
    • Items scored on scale of 0\u20133, total score range from 0\u201330<\/li>\n
    • Score of 5 or more indicates pain, maximum score 30<\/li>\n<\/ul>\n<\/td>\n
    		\n
    Data source: RNAO, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
    \n

    Critical Thinking Exercises<\/h3>\n
      \n
    1. You are caring for a patient who has just returned from a surgical procedure. How might the assessment of acute pain differ from assessment of chronic pain?<\/li>\n
    2. What\u00a0is more important in pain assessment:\u00a0the subjective or the objective data?<\/li>\n<\/ol>\n<\/div>\n

      Attributions<\/h2>\n

      Figure 2.1\u00a0Children’s pain scale<\/a> by\u00a0Robert Weis is used under a CC BY SA 4.0<\/a> licence.<\/p>\n

      Figure 2.2 The Wong-Baker scale for assessment of pain in children<\/a> by Intermedichbo<\/a> is used under a\u00a0CC BY SA 4.0<\/a> licence.<\/p>\n","protected":false},"author":397,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-105","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":26,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/105\/revisions"}],"predecessor-version":[{"id":5213,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/105\/revisions\/5213"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/105\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=105"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=105"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=105"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}