Achieving adequate pain control depends on effectively assessing, treating, and monitoring pain. Pain is referred to as the fifth vital sign alongside temperature, pulse, blood pressure, and respiration. To provide the best care possible, work with physicians and other members of the health care team to develop an individualized pain management program for each patient.
Pain has a sensory component and a reaction component. The sensory component involves an electrical impulse that travels to the central nervous system, where it’s perceived as pain. The response to this perception is the reaction component.
Pain is highly subjective and unique to the person experiencing it. Any report of pain must be assessed and addressed.
Pain also manifests differently according to each patient’s beliefs, culture, and age.
An older adult may not report pain and may metabolize and experience the effects of analgesic drugs differently than a younger patient. To assess pain in an older patient with cognitive dysfunction, use such cues as behavior (motor responses, facial expressions, crying) and physiologic changes (increased blood pressure and heart rate) in addition to self-reporting.
Children metabolize drugs differently from adults and may experience the effects of analgesics differently. When assessing pain in a child, use verbal, numeric, or picture scales to help determine the child’s pain level in addition to direct questions. Also watch for behavioral cues (facial expressions, crying) and physiologic changes (increased blood pressure and heart rate) to help determine the child’s pain level.
During the course of an illness, a patient may experience acute pain, chronic pain, or both.
Acute pain is caused by tissue damage from injury or disease. It varies in intensity from mild to severe and lasts briefly. It’s considered a protective mechanism because it warns of current or potential damage or organ disease. It may result from a traumatic injury, from surgical or diagnostic procedures, or from a medical disorder.
Chronic pain is pain that has lasted 6 months or longer and is ongoing. Although it may be as intense as acute pain, it isn’t a warning of tissue damage. (See Differentiating acute and chronic pain.)
It’s important for the nurse to have good pain assessment skills. The most valid assessment of pain comes from the patient’s own reports of his pain. (See PQRST: The alphabet of pain assessment.)
Many pain assessment tools are available. Whichever you choose, make sure that it’s used consistently so that everyone on the health care team is speaking the same language when addressing the patient’s pain.
The three most common pain assessment tools used by clinicians are the visual analog scale (see Visual analog scale, page 438
), the numeric rating scale (see Numeric rating scale, page 438
), and the FACES scale (see Wong-Baker FACES pain rating scale, page 438
). The patient may exhibit many physiologic and psychological responses to pain, and the nurse should watch for these during a pain assessment. (See Pain behavior checklist, page 439