Pain Assessment

Pain is defined as an unpleasant sensory or emotional experience associated with tissue damage.

To successfully relieve pain, accurate, continuous pain assessment and reassessment is necessary.

Percentage of patients in various stages of palliative care that have ineffectively treated pain

  • 25% of newly diagnosed cancer patients
  • 60% of patients undergoing cancer treatments
  • 75% of patients in end stage disease
Unrelieved pain is one of the most frequent reasons for palliative consultations
In long term care 45-80% of residents have substantial pain with poor pain management
1/3rd of long-term care residents do not receive a formal pain assessment.
In assessment: Pain should be taken at the word of the patient experiencing it.
Acute pain etiology
It may be associated with:
  • tissue damage
  • inflammation
  • a disease process of short duration
  • a surgical procedure
Acute pain, regardless of intensity, is of brief duration, hours, days, weeks, under 6 months.
Chronic pain
Is persistent and worsens or intensifies with time.
It lasts months, years, a lifetime
It adversely affects the patient’s ability to function and their well-being.
Two classes:
  1. Chronic malignant
  2. Chronic non-malignant
Cancer pain etiology:
  • nociceptive
  • neuropathic
  • sympathetically maintained
  • may be related to primary or metastasis in 2/3 of patients
  • may be resulting from treatment: surgery, chemo, radiation, procedures or causes such as side effects or infection
  • Chronic pain may accompany a disease process such as HIV, arthritis, degenerative joint disease, osteoporosis, COPD, heart failure, neurological disorders (MS), fibromyalgia, CF, diabetes.
Pain may also be the result of an injury which did not resolve within the expected period of time eg. low back pain, spinal cord injury, reflex sympathetic dystrophy or phantom limb pain.
Pain assessment
Accurate pain assessment is a continuous process that encompasses many factors.
A comprehensive assessment  addresses each type of  pain and includes:
  1. a detailed history
  2. an assessment of pain intensity
  3. characteristics of the pain
  4. the effects of pain on function
  5. a history of previous substance abuse
  6. a physical examination with pertinent neurological examination – particularly if nerve pain is suspected
  7. a psychosocial and cultural work-up as they may pertain to the pain
  8. ATTN: Special attention should be paid to discrepancies between patients’ verbal description of pain and their behavior and appearance. (this may reveal emotional components or drug seeking behaviors)
  9. Focus of the assessment should be to areas of pain as well as areas of referred pain
  10. In the frail or terminal patient assessments should be performed only if the findings will potentially change or facilitate the treatment plan.
  11. The burden or discomfort of any diagnostic test must be weighed against the potential benefit of the information obtained
  12. ongoing and subsequent evaluations are necessary to determine the effectiveness of pain management and identify new areas of pain.

Ferrel, B. R., & Coyle, N. (Eds.). (2010). Oxford textbook of palliative nursing (3rd ed.). New York: Oxford University Press.

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