Pain Assessment

Strategies to Use When the Patient's Report of Pain Is Not Accepted

Acknowledge that ppl can have personal opinions, but personal opinion does not form the basis for professional practice. ( should not be the focus of care) Clarify that the sensation of pain is subjective and cannot be proved or disproved. Ask, "Why is it so difficult to believe that this person hurts?"

Intensity how do we measure this? (5)

Ask patient to rate the severity of the pain using a reliable and valid pain assessment tool Numeric Rating Scale Wong-Baker FACES Pain Rating Scale Faces Pain Scale-Revised Verbal descriptor scale Visual Analog Scale

Quality of pain

Ask the patient to describe how the pain feels. ' Descriptors such as "sharp," "shooting," or "burning" may help identify the presence of neuropathic pain.

Aggravating and relieving factors

Ask the patient what makes the pain worse and what makes it better.

Onset and duration

Ask the patient when the pain started and whether it is constant or intermittent.

Location

Direct patient to state or point to where it hurts pain on the body. Sometimes allowing patients to make marks on a body diagram is helpful in gaining this information.

Critical Care Pain Observation

Indicated for use in patients in critical care units who cannot self-report pain, may or may not be intubated. It is also patterned after the FLACC.

Comprehensive Pain Assessment: Patient Interview

Location(s) of pain Intensity: Numeric Rating Scale (NRS): Wong-Baker FACES Pain Rating Scale Faces Pain Scale-Revised Verbal descriptor scale Visual Analog Scale

PAINAD

Pain Assessment IN Advanced Dementia indicated for use in adults with advanced dementia who are not able to verbalize their needs. Patterned after the FLACC, used for patients who have dementia.

Faces Pain Scale - Revised (FPS-R)

The faces range from a neutral facial expression to one of intense pain and are numbered 0, 2, 4, 6, 8, and 10. As with the Wong-Baker FACES scale, patients are asked to choose the face that best reflects their pain. Faces scales have been shown to be reliable and valid measures in children as young as 3 years of age;

Comfort-function (pain intensity) goal:

acute pain pt should identify short-term functional goals and reinforce to the patient that good pain control will more likely lead to successful achievement of the goals. For example, surgical patients are told that they will be expected to ambulate or participate in physical therapy postoperatively. Patients with chronic pain can be asked to identify their unique functional or quality-of-life goals, such as being able to work or walk the dog. Success is measured by progress toward meeting those functional goals

Wong-Baker FACES Pain Rating Scale (FACES scale)

consists of six cartoon faces with word descriptors, ranging from a smiling face on the left for "no pain (or hurt)" to a frowning, tearful face on the right for "worst pain (or hurt)." ask Patients to choose the face that best reflects their pain. The faces are most commonly numbered using a 0, 2, 4, 6, 8, 10 metric, . The FACES scale is used in adults and children as young as 3 years Patients may be able to understand the tool better if it is displayed vertically with no pain as the anchor at the bottom.

Verbal Descriptor Scale

different words or phrases to describe the intensity of pain, such as "no pain, mild pain, moderate pain, severe pain, very severe pain, and worst possible pain." The patient is asked to select the phrase that best describes pain intensity.

DO NOT's Wong Baker Faces Pain Rating Scale

faces scales are self-report tools; clinicians should NEVER attempt to match a face shown on a scale to the patient's facial expression to determine pain intensity.

Visual Analog Scale

horizontal (sometimes vertical) 10-cm line with word anchors at the extremes, such as "no pain" on one end and "pain as bad as it could be" or "worst possible pain" on the other end. Patients are asked to make a mark on the line to indicate intensity of pain the length of the mark from "no pain" is measured and recorded in centimeters or millimeters. impractical for use in daily clinical practice and rarely used in that setting.

Numeric Rating Scale

horizontal 0- to-10-point scale, "no pain" at one end of the scale, "moderate pain" in the middle of the scale, and "worst possible pain" at the end of the scale. also on vertical axis, which may be helpful for patients who read from right to left.

Effect of pain on function and quality of life

important to ask patients with persistent pain about how pain has affected their lives, what could they do before the pain began that they can no longer do, or what they would like to do but cannot do because of the pain.

Quality and Safety Nursing Alert

it's known that accepting and responding to the pt's complain of pain will undoubtedly result in administering pain meds to an occasional patient who does not have pain, REASON TO DO HOWEVER IS BECAUSE ... doing so ensures that everyone who does have pain receives attentive responses. Health care professionals do not have the right to deprive any patient of appropriate assessment and treatment simply because they believe a patient is not being truthful.

what to use when patients can't self report their pain?

observational tools may be used to help with clinical decision making. observational scores are not considered equivalent to a patient's self-reported pain intensity score, FLACC PAINAD CPOT

When to reassess for pain

pain is reassessed and documented on a regular basis to evaluate the effectiveness of treatment. At a minimum, pain should be reassessed with each new report of pain and before and after the administration of analgesic medication frequency of reassessment depends on the stability of the patient's pain and is guided by institutional policy ex. in the (PACU), reassessment may be necessary as often as every 10 minutes when pain is unstable during opioid titration but may be done every 4 to 8 hours in patients with satisfactory and stable pain 24 hours after surgery.

patient's self-report

undisputed standard for assessing the existence and intensity of pain

FLACC

used in young children Scores are assigned after assessing Facial expression Leg movement Activity, Crying Consolability each of these five categories assigned scores from 0 to 2, yielding a total composite score of 0 to 10. Scores of "0" are interpreted as the patient is relaxed and comfortable, scores of "1" to "3" are interpreted as mild discomfort, scores from "4" to "6" are considered moderate pain, scores from "7" to "10" are considered severe discomfort or pain.