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10.1 Pain assessment

Essential equipment

  • An appropriate assessment tool – e.g.:
    • in acute pain, consider the use of a verbal or numerical rating
    • in chronic pain, consider the use of the Brief Pain Inventory (BPI)
    • in adults with severe cognitive impairment, consider the use of the Abbey Pain Scale (see the section above on assessment in vulnerable and older adults)
    • in unconscious patients, consider the use of the Critical‐Care Pain Observational Tool (CPOT) (see the section above on assessment in unconscious patients)

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [129], C).

Procedure

  1. 2.
    Encourage the patient, where appropriate, to identify the pain themselves and to describe the character of the pain, if possible.
    The body outline (see Figure 10.4) is a tool that a patient can use to describe their own pain experience (Macintyre and Schug [99], E).
  2. 3.
    Ensure that the patient's own description of their pain is recorded.
    To reduce the risk of misinterpretation (Schug et al. [166], R).
  3. 4.
    1. Record any factors that influence the intensity of the pain, for example activities or interventions that reduce or increase the pain, such as distractions or a heat pad.
    2. Record whether or not the patient is pain free at night, at rest or on movement.
    3. Record the frequency of the pain, what helps to relieve the pain, what makes the pain worse and how the patient feels when they are in pain.
    4. Determine whether there are any associated symptoms when the pain is present (e.g. nausea and vomiting).
    Ascertaining how and when the patient experiences pain enables the nurse to plan realistic goals. For example, relieving the patient's pain during the night and while they are at rest is usually easier to achieve than relief from pain on movement. E
    To gain an understanding of the experience of pain for the patient (Schug et al. [166], R).
    To ensure all elements of a pain assessment are explored (Macintyre and Schug [99], E).
  4. 5.
    Index each site (see Figure 10.4) in whatever way seems most appropriate, for example shading or colouring areas, or using arrows to indicate shooting pains.
    To enable individual pain sites to be located (Dansie and Turk [44], E).
  5. 6.
    Give each pain site a value according to the pain intensity or the pain scale and note the time recorded where possible. If cognitive impairment is present, complete an appropriate tool so that the patient does not need to verbalize a pain score.
    To indicate the intensity of the pain at each site (Gordon [68], E).
    To ensure that the patient's pain is assessed as well as possible (Doody and Bailey [50], E; Schofield [165], E).
  6. 7.
    Record any analgesia given and note the route, dose and response.
    To monitor the efficacy of prescribed analgesia. E

Post‐procedure

  1. 8.
    Record any significant activities that are likely to influence the patient's pain.
    Because extra pharmacological or non‐pharmacological interventions might be indicated (Gordon [68], E).
  2. 9.
    Discuss with the patient an ongoing reassessment plan for their pain.
    To ensure that the patient is informed regarding ongoing pain assessment and understands when to alert the nurse if they need additional help (e.g. when there is a change in the nature of the pain, when the pain is not responding to the planned treatment or when activities of daily living are being inhibited that previously could be maintained) (Macintyre and Schug [99], E).
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