Pain Assessment

Tips for Recognizing and Assessing Pain

Rate pain on a scale of 0-10, zero being no pain and 10 being the worst pain you've ever felt.

Caring for someone with a life threatening illness requires careful and thorough evaluation, or assessment, of their pain and other symptoms. You are the eyes and ears for the doctor and nurses caring for your loved one. You will be relaying important information about the patients pain and symptoms back to the health care team. Assessing pain and communicating it to the health care team will be one of the most important things you can do while caring for a loved one.

What is Pain?

It is important when assessing pain to understand what it is. You can find detailed information about the different types of pain and it's origins here. The important thing to remember here is that pain is always what the person experiencing says it is, occurring when and where they describe it.

If a person can communicate their pain, it will be easy to record it and relay it back to their doctor. If they cannot communicate what they are feeling, it is can be more difficult to assess their pain but it is still possible. To do so, you must aware of physical signs and symptoms that convey what they are feeling, which we discuss more in detail below.

Assessing pain is something your healthcare provider will be doing at every visit or appointment but it will be up to you to assess their pain between professional visits. The following information will be helpful to you as you assess the pain yourself.

Severity of Pain

The first step in assessing pain is to find out how bad it is at the present moment. There are tools that can help someone who is able to communicate describe the severity of their pain. For adults, this is usually done with a numeric scale of 0-10. Zero would describe the absence of pain and ten would symbolize the worst pain imaginable.

Ask the patient to rate their pain somewhere on that scale.

When asking young children or non-verbal adults to describe their pain, the tool most often used by healthcare providers is the Wong-Baker FACES Pain Rating Scale. It is recommended for persons age 3 years and older. With this scale, you would point to each face using the words to describe the pain intensity. Ask the child to choose the face that best describes their pain.

Acceptable Level of Pain

Everyone will have their own acceptable level of pain. For some it may be no pain and others will tolerate a pain level of 3 on a scale of 0-10. It is important to find out what the acceptable level is for the individual you are caring for. If your loved one is happy at a pain level of 3, you wouldn’t want to medicate them to the point of sedation to get them at a zero level of pain.

Location of Pain

The location of pain may be the same every time you ask. Someone with end stage liver disease may always have pain in the upper right side of their abdomen.

It is important to ask, however, because new pain may develop. If the location differs or new pain emerges, be sure to record that information and pass it on to the patients healthcare provider.

Palliation and Provocation

Ask the patient what makes their pain better, or palliates it. This may only be pain medications. It may be changing positions or lying only on their left side. Finding this out will not only help you do things that aide in their comfort but may provide some clues to the physician on the cause of the pain if it isn’t already known.

Also ask what makes the pain worse, or provokes it. Again, it could be movement or lying on a particular side. It could also be eating or touch. This again will help you avoid things that cause discomfort and provide important clues to the physician.

Assessing Non-Verbal Signs of Pain

It was mentioned early that it can be difficult to assess someone’s pain if they are unable to verbalize it and/or unable to point to the FACES scale. There are some signs and symptoms that a patient may exhibit if they are in pain that can clue you in:

  • Facial grimacing
  • Writhing or constant shifting in bed
  • Moaning or groaning
  • Restlessness and agitation
  • Guarding the area of pain or withdrawing from touch to that area
The more symptoms a patient has and the more intense they are will give you a clue as to how much pain they may be in. You can then record their pain as "mild", "moderate", or "severe".

Keep a Record

One of the most important things you can do for the person you are caring for is to keep an accurate record of their pain and their pain treatments. Once you assess their pain, record the severity and location and any medications or treatments that you gave them. Take note whether the medications or treatments worked effectively. Also write down anything new they may have told you about what makes it feel better or worse. This is a great way to team up with your healthcare professionals to provide the best palliative care possible.

Example of a Pain Log

Pain Log
Date/TimeLevel of PainLocation of PainMedication/Treatment Given
11/26 9:00a5/10upper abdomenMorphine 10mg
11/26 1:00p3/10upper abdomenwarm compress to abdomen
11/26 5:00p4/10headache and upper abdomenMorhpine 10mg

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