How to Accurately Assess Pain

Transcript

Welcome to this video on Adult Pain Assessment. All adults should be assessed for pain at their initial visit or on admission to the hospital, regardless of their diagnosis, and periodically after that, depending on the results of the original assessment.

Key Steps

The first step in the assessment of pain is to ask if the person is experiencing pain or discomfort or has in the past, since pain may be intermittent, especially chronic pain. Assessment of pain should include the use of an assessment tool so that the pain assessment is consistent.

Try to pinpoint the site of the pain, including where the pain radiates. In some cases, people may have referred pain, such as pain in the left arm associated with a heart attack. Ask people to point to the site of pain because people often make general statements, such as saying, “My stomach hurts,” when, in fact, the pain may be localized to one area.

Next, ask if the person can describe the pain, such as “dull,” “sharp,” or “burning.” Then, ask the person to rate the degree of pain. Most adults are able to self-report their level of pain, and the most commonly used assessment tool is the 0 to 10 numeric scale.

A rating of 4 or greater is generally considered as indicating the need for pain control, but self-reported ratings alone are not always an accurate reflection of pain. Some may not fully understand the scale. In that case, a different tool, such as FACES, may be more appropriate.
For personal or cultural reasons, people may minimize or overstate the degree of pain, interfering with assessment. Some people may be concerned about addiction or the effects of drugs on cognition or other side effects. Some may be drug-seeking, and others may want to protect family from knowing the extent of their pain.

Next, note any associated symptoms. For example, sometimes people with pain may also feel dizzy or nauseated. Ask about the onset of the current episode of pain and the onset of this type of pain as well as the frequency, including any change in pattern. For example, an individual may have had episodes of pain every day for the previous week but only had episodes 2 or 3 times a week for the preceding 5 months, indicating a recent exacerbation of symptoms.

Next, ask the person about the duration of the current episode of pain, previous episodes, and the overall duration since the onset. Ask if the person knows what causes the pain, such as prolonged sitting, exercise, or drinking alcohol. Then try to find out if there are aggravating factors that worsen the pain or alleviating factors that reduce the pain.

Some adults, such as those with dementia, may be unable to verbalize their pain. For these adults, a different pain assessment tool is needed to guide an assessment based on behavioral observations.

One tool that is commonly used is the Pain Assessment in Advanced Dementia or PAINAD tool. PAINAD assesses breathing, vocalization, facial expression, body language, and consolability on a 0 to 2 scale.

Physical signs of pain may be present in both people who are verbal and who are nonverbal. These may include:

Changes in vital signs. The heart rate and blood pressure may increase, especially with acute pain. Breathing may be labored with short periods of hyperventilation or Cheyne-Stokes respirations when pain increases.
Additionally, vocalizations may change. People may remain quiet, may moan or groan, and may call out, groan more loudly, or cry as pain intensifies.
Facial expressions often show that people in pain are sad or frightened. They may frown or grimace with increased pain or hold their eyes tightly closed. Some may react with anger.
Body language can also reflect the discomfort people feel. They may be tense, fidgeting, or writhing. As pain intensifies, people often become more rigid, clenching their fists and lying in the fetal position with legs drawn up or kicking.

Some, especially those with confusion, become increasingly combative.

Factors Influencing Pain Perception

A number of factors can influence people’s perception and expression of pain.

First, people’s emotional status: People who are extremely upset, frightened, or anxious may be so overwhelmed that they don’t feel the pain intensely or at all. Some people who are tense and upset may feel pain more strongly than those who are calm and relaxed.
Additionally, if people expect to suffer from pain, they are also more likely to report severe pain than patients who expect that their pain will be controlled. Some people in pain become increasingly withdrawn. When pain is mild, patients may be easy to distract or console but this becomes more difficult as pain increases.
Next, cultural expectations play a part in the perception of pain. Some cultures, such as those of the Middle East, tend to openly express pain, while others, such as those of many Asian countries, tend to repress expressions of pain. However, it’s important to remember that cultural norms don’t always apply to the individual in that culture.
Another factor that can influence the experience of pain is the pain threshold. Some people have a higher threshold for pain and others a lower threshold.
Lastly, age also influences perception of pain. Older adults have some decreased sensitivity to low-intensity pain and thermal pain and may have increased pain thresholds. However, older adults also tend to develop an inflammatory response more quickly than younger adults, which may increase pain.

Acute pain affects about 25 million Americans because of injury, illness, or surgery, and about 50 million Americans suffer chronic pain, so accurately assessing pain is essential to patient care.

Choosing an appropriate pain assessment tool is an important aspect of pain assessment, as the result serves as the basis for the pain management plan.

Thanks for watching and happy studying.

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