From the Guidelines
A comprehensive pain assessment should include an in-depth interview that explores the multidimensional nature of pain, as recommended by the American Society of Clinical Oncology clinical practice guideline 1. To conduct a thorough pain assessment, several key dimensions of a patient's pain experience should be evaluated.
- Begin by asking the patient to rate their pain intensity on a scale of 0-10 (with 0 being no pain and 10 being the worst pain imaginable) as suggested by the ESMO clinical practice guidelines 1.
- Determine the pain's location, quality (sharp, dull, burning, etc.), timing (constant, intermittent), aggravating and alleviating factors, and impact on daily functioning.
- Use validated tools like the PQRST method (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing) or specific instruments such as the Brief Pain Inventory or McGill Pain Questionnaire for more detailed assessment.
- For non-verbal patients or those with cognitive impairments, rely on behavioral observation scales like the FLACC (Face, Legs, Activity, Cry, Consolability) or PAINAD (Pain Assessment in Advanced Dementia) scales. The assessment should also characterize the pain, clarify its cause, and make inferences about pathophysiology, accompanied by a physical examination and diagnostic testing when warranted 1. Regular reassessment is crucial, especially after interventions, to ensure effective pain management and improve the patient's quality of life 1.
From the Research
Pain Assessment Methods
To conduct a pain assessment, the following methods can be used:
- A holistic, person-centred approach should be used when assessing someone living with chronic pain 2
- A comprehensive assessment should include a detailed investigation of a patient's pain and medical history, a physical examination, and diagnostic testing, if needed 3
- Self-report is the gold standard for assessing pain; however, in many clinical circumstances with older adults, the patient's verbal report is unobtainable 3
- Tools for pain assessment should be tested in older adult populations to establish reliability, validity, and sensitivity to changes from treatment 3
Pain Assessment Tools
The following tools can be used for pain assessment:
- Numerical Rating Scale (NRS) 4, 5
- Verbal Rating Scale (VRS) 4
- Visual Analogue Scale (VAS) 4
- Pain behavior tools can also provide useful information suggesting the presence of pain 3
Considerations for Pain Assessment
The following considerations should be taken into account when conducting a pain assessment:
- The use of unidimensional pain scales such as the NRS, VRS, or VAS is recommended for assessment of pain intensity 4
- NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS 4
- A pain assessment should capture the individual's experience of their pain 2
- The assessment of pain should be comprehensive and include the impact of pain and its severity 3