PAIN ASSESSMENT
DEFINITION:
One of the most common symptoms that prompts a person to seek health care.
An unpleasant sensory and emotional experience associated with actual or potential
tissue damage (International Association for the Study of Pain).
Complex and multifactorial. It involves sensory, emotional, and cognitive processing
but may lack a specific physical etiology.
Pain is a very personal experience that varies from person to person. What feels very
painful to one person may only feel like mild pain to another. Factors, such as
emotional state and overall physical health, can play a big role in how a person feel
pain.
ASSESSING PAIN:
1. Acute pain
associated with a physical cause and is triggered in the nervous system to alert the
body to injury, disease or inflammation.
Arises quickly and is short lived
This aids in preventing additional injury and resolves after treatment and healing
takes place.
2. Chronic pain – has several definitions:
Pain that lasts more than one month beyond the course of an acute illness or injury
Pain recurring at intervals of months or years
This is also a pain that is not associated with cancer or medical conditions that
persists for more than 3-6 months.
3. Visceral pain
Occurs when hollow abdominal organs such as intestines or biliary tree contract
unusually forcefully or are distended or stretched.
Visceral pain may be difficult to locate. It is usually palpable at the midline at levels
that vary according to the structure involved
4. Parietal pain – originates from inflammation in the parietal peritoneum, usually more
severe than visceral pain and more precisely localized over the involved structure
5. Referred pain – felt in the more distant sites, which are innervated at approximately the
same spinal levels as the inflamed structure.
Since pain is subjective and only the patient can tell you how severe the pain is, you
should carefully listen to the patient’s description of the many features of pain and all
contributing factors.
The following may guide you in the assessment of pain:
OLD CART
ONSET: when did the pain begin? How? Does it occur at a specific time of day?
LOCATION: ask patient to point to the pain in order to localize the site of origin. Ask
also if there is radiation of pain.
DURATION: is it constant? Or does it come and go?
CHARACTERISTICS OF SYMPTOMS: assess the severity of symptoms. There are
several scales that can be used : examples are: visual analog scale, numeric rating
scale, verbal pain rating scale, faces pain scale, defense and veterans pain rating scale,
brief pain inventory, McGill pain Questionnaire.
ASSOCIATED MANIFESTATIONS: Does anything occur when you experience the
pain? Nausea? Headache? Burning? Itching? Etc.
RELIEVING FACTORS: WHAT Makes the pain better? What makes it worse?
TREATMENTS: all interventions done to relieve symptoms. ( medications, physical
therapy, alternative medications)
PQRST characteristics of pain:
P – PALLIATIVE, PROVOCATIVE - what makes the pain better or worse
Q – QUALITY – how is the pain described
R – RADIATION – does the pain travel or spread to anywhere else? If so, where?
S- SEVERITY – what is the intensity of the pain? ( on 0-10 scale)
T – TEMPORAL – is the pain constant or does it come and go?
TYPES OF PAIN:
1. Nociceptive or somatic pain – pain related to tissue damage. It can be either acute and
remitting or chronic and persistent. Modulating neurotransmitters include endorphins
histamines, acetylcholine and monoamines. These different nociceptors can be sensitized
by inflammatory mediators.
2. Neuropathic pain – pain resulting from direct injury to the peripheral or central nervous
system. Over time, neuropathic pain may become independent of the inciting injury
become burning, persisting beyond healing from the initial injury.
3. Psychogenic and idiopathic pain – psychogenic pain relates to the many factors that
influence the patient’s report of pain – psychiatric conditions like anxiety or depression,
personality and coping style, cultural norms, and social support systems. Idiopathic pain
is pain without an identifiable etiology.
