Tools for pain assessment

An assessment of the utility of 10 indices. Clin J Pain. The chronic pain coping inventory: development and preliminary validation. Comparison of fixed interval and visual analogue scales for rating chronic pain.

Eur J Clin Pharmacol. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. Pain [ PubMed ]. Von Spine. Grading the severity of chronic pain. Assessing global pain severity by self-report in clinical and health services research.

Measurement of pain: patient preference does not confound pain measurement. Linton SJ. Memory for chronic pain intensity: correlates of accuracy. Percept Mot Skills. A clinical comparison of two pain scales: correlation, remembering chronic pain, and a measure of compliance. Linton SJ, Melin L. The accuracy of remembering chronic pain. McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain.

The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance.

Musculoskeletal complaints, functional capacity, personality and psychosocial factors. Int Arch Occup Environ Health. A rating system for use with patient pain drawings. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Melzack R, Katz J. The McGill Pain Questionnaire: appraisal and current status.

Handbook of pain assessment. New York: Guilford Press; Passive coping is a risk factor for disabling neck or low back pain. Morley S. Morley S, Pallin V. Scaling the affective domain of pain: a study of the dimensionality of verbal descriptors. Nachemson A, Bigos SJ. The low back. Adult orhopedics. New York: Churchill-Livingstone; What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain?

Z Orthop Ihre Grenzgeb. Ohnhaus EE, Adler R. Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Oron Y, Reichenberg A.

Personality traits predict self-referral of young male adults with musculoskeletal complaints to a general practitioner. J Psychosom Res. Pawl R. Chronic pain primer. Chicago: Yearbook; The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.

Sensory—affective relationships among different types of clinical and experimental pain. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Theories and models of chronicity: on the way to a broader definition of chronic back pain.

The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Scott J, Huskisson EC. Graphic representation of pain. An evaluation of length and end-phrase of visual analogue scales in dental pain.

Sherbourne CD. Pain measures. Measuring functioning and well-being: the medical outcomes study approach. Durham: Duke University Press; Epidemiological differences between back pain of sudden and gradual onset. J Rheumatol. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Validity of an illness severity measure for headache in a population sample of migraine sufferers. Psychosocial factors in chronic spinal cord injury pain.

Electronic diaries for asthma. Clinical significance of reported changes in pain severity. Truchon M, Cote D. Predictive validity of the Chronic Pain Coping Inventory in subacute low back pain.

A case-control study of psychological and psychosocial risk factors for shoulder and neck pain at the workplace. Coping strategy use: does it predict adjustment to chronic back pain after controlling for catastrophic thinking and self-efficacy for pain control?

J Rehabil Med. Opioids are the treatment of choice. However, caution should be taken when using this class of drugs with patients who have bowel obstructions. The ability to quantify the intensity of pain is essential when caring for persons with acute and chronic pain. Though no scale is suitable for all patients, Dalton and McNaull 18 advocate a universal adoption of a 0 to 10 scale for clinical assessment of pain intensity in adult patients.

Standardization may promote collaboration and consistency among caregivers in multiple settings—inpatient, outpatient, and home care environments.

Using a pain scale with 0 being no pain and 10 being the worst pain imaginable, a numerical value can be assigned to the patient's perceived intensity of pain.

Asking patients to rate their present pain, their pain after an intervention, and their pain over the past 24 hours will enable health care providers to see if the pain is worsening or improving. Also, inquiring about the pain level acceptable to the patient will help clinicians understand the patient's goal of therapy. Although the faces scale was developed for use in pediatric patients, it has also proven useful with elderly patients and patients with language barriers.

Most patients have 2 or more sites of pain. Having the patient point to the painful area can be more specific and help to determine interventions. Breakthrough pain refers to a transitory exacerbation or flare of pain occurring in an individual who is on a regimen of analgesics for continuous stable pain Asking the patient to describe the factors that aggravate or alleviate the pain will help plan interventions.

Other factors movement, physical therapy, activity, intravenous sticks or blood draws, mental anguish, depression, sadness, bad news may intensify the pain. Other things to include in the pain assessment are the presence of contributing symptoms or side effects associated with pain and its treatment.

These include nausea, vomiting, constipation, sleepiness, confusion, urinary retention, and weakness. Some patients may tolerate these symptoms without aggressive treatment; others may choose to stop taking analgesics or adjuvant medications because of side effect intolerance.

Adjustments, alterations, or titration may be all that is necessary. Inquiring about the presence or absence of changes in appetite, activity, relationships, sexual functioning, irritability, sleep, anxiety, anger, and ability to concentrate will help the clinician understand the pain experience in each individual. Additionally, the clinician should discern how pain is perceived by the patient and his or her family or significant other and what works and doesn't work to help the pain.

Patients' knowledge and beliefs about pain are assumed to play a role in pain perception, function, and response to treatment Patients may be reluctant to tell their health care providers when they have pain, may attempt to minimize its severity, may not know they can expect pain relief, and may be concerned about taking pain medications for fear of deleterious effects.

A comprehensive approach to pain assessment includes evaluating patients' knowledge and beliefs about pain and its management and reviewing common misconceptions about analgesia. Several common myths need to be discussed openly:. I shouldn't take my pain medication until I really need it or else it won't work later. Discussing these myths during the assessment process not only legitimizes patients' concerns but provides an opportunity to educate patients and families about pain medications and how they work.

At times patients and family members believe that behavior such as complaining about pain or inadequate pain relief may result in substandard care Realizing that they have limited time with their health care providers, patients may prioritize the time available to them. This is another misconception to discuss with the patient. Patients' self-report is the gold standard of pain assessment. However, pain tools that rely on verbal self-report, such as the 0 to 10 numeric rating scale, may not be appropriate for use in nonverbal or cognitively impaired patients.

Additionally, reliance on nonverbal cues—e. Diverse responses to pain atypical of conventional pain behaviors have been noted in patients with Alzheimer's disease by Marzinski For example, a patient who normally rocked and moaned became quiet and withdrawn when experiencing pain. It is important to obtain feedback from the patient by asking the patient to nod his head, squeeze your hand, move his eyes up and down, or raise his fingers, hand, arm, or leg to signal the presence of pain.

If appropriate, offer writing materials, pain intensity charts, or figures that the patient can point to. The following questions can be used as a template for assessment of pain in the nonverbal patient:.

After reviewing the patient's history, is there a reason for this patient to be experiencing pain? When the patient experienced pain in the past, how did he or she usually act? Do they believe that the patient is having pain? Why do they feel this way? Has the patient been treated for pain previously?

What pharmacologic or nonpharmacologic interventions were used? If there is a reason for or a sign of acute pain, treatment with analgesics or nonpharmacologic measures may be helpful. If a modification of pain behavior occurs, pain treatment should be continued with an explanation to the patient and family. Multiple studies suggest that certain groups of patients who experience moderate to severe pain have been undermedicated and not adequately assessed 8 , 24 , Pain assessment tools are in the public domain and are available to all health care providers to assist them in better understanding the impact of pain on a person.

Single-dimensional scales only measure pain intensity and are useful in acute pain when the etiology is clear. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing.

Front Psychol. Acad Emerg Med. J Pain. Int J Pediatr. Eur J Pain. The McGill Pain Questionnaire as a multidimensional measure in people with cancer: an integrative review.

Pain Manag Nurs. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: visual analogue scale, faces pain scale-revised, and colour analogue scale.

George Francis McMahon, I. Comparison of a numeric and a descriptive pain scale in the Occupational Medicine Setting. MD Anderson Cancer Center. The brief pain inventory. A randomized controlled trial of gabapentin for chronic low back pain with and without a radiating component. Cleveland Clinic. Acute vs. Neuropathic pain. Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability.

Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth.

Minerva Stomatol. Actively scan device characteristics for identification. Use precise geolocation data. Select personalised content.

Create a personalised content profile. Measure ad performance. Select basic ads. Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. Types of Pain Scales There are at least 10 pain scales being used today. They generally fall into one of three categories: Numerical rating scales NRS use numbers to rate pain.

Visual analog scales VAS typically ask a patient to mark a place on a scale that matches their level of pain. Categorical scales use words as the primary communication tool and may also incorporate numbers, colors, or relative location to communicate pain.