HEALTH ASSESSMENT MODULE 5

Pain Assessment

Pain Assessment

includes a history and physical exam.

Self report

is the most accurate indicator of pain.

COLLECTING SUBJECTIVE DATA

1.) Biographical data

2.) Current/ Past Health Status

5 MNEMONIC OF PAST HEALTH STATUS

1. Precipitating/ Palliative

2. Quality/Quantity

3. Region/ Radiation/ Related symptoms

4. Severity

5. Timing

quality/ quantity : 4 PAIN

1. Superficial somatic pain

2. Deep Somatic pain

3. Visceral pain

4. Neuropathic pain

Superficial somatic pain

Sharp, pricking, burning

Deep somatic pain

Dull or aching

Visceral pain

Dull, aching, or cramping

Neuropathic pain

burning, shock like, lancing, jabbing , squeezing, aching

Localized Pain

confined to the site of origin, such as cutaneous pain.

Referred pain

referred to a distant structure, such as shoulder pain with acute cholecystitis or jaw pain associated with angina.

Projected ( transmitted pain )

transmitted along a nerve, such as with herpes zoster or trigeminal neuralgia.

Visceral Pain

related symptoms include sickening feeling, nausea, vomiting, and autonomic symptoms.

Neuropathic pain

related symptoms include hyperalgesia and allodynia.

Complex regional pain syndrome

related symptoms include hyperalgesia, hyperesthesia, allodynia, autonomic changes, and shin, hair, and nail changes.

Brief flash

Quick pain as with needle stick.

Rhythmic pulsation

Pulsating pain as with migraine or toothache.

Long duration rhythmic

As with intestinal colic.

plateau pain

Pain that rises then plateaus such as angina.

Paroxysmal

Such as neuropathic pain.

Continuous fluctuating pain

As with musculoskeletal pain

Initial pain history

focuses on an understanding of pain from the child’s and family’s perspective, the child uses for pain e.g. “sakit”, “yayay”, “hurt”.

Self report methods

such as pointing, verbal responses, use of a body map, use of crayons or colored markers to locate pain.

Physical examination

Objective data are collected by using one of the Pain Assessment Tool (Pain Scales).

Un dimensional scale

assesses one dimension, usually intensity of pain, and is often used to assess acute pain.

Multidimensional pain scales

provide additional information about pain, such as the pain’s characteristics and the effects on the patient’s daily life.

Numeric rating scale

rates pain on a scale of 0 (no pain) to either 5 or 10 (worst pain) by asking the patient to rate her or his current pain level.

Visual Analogue scale

utilizes a vertical or horizontal 10-cm line with anchors.

Categorical scales

use verbal or visual descriptors to identify pain intensity (FPS)

Initial Pain Assessment

is used for initial assessment of pain.

Brief Pain Inventory

is used to quantify pain intensity and associated disability.

McGill pain questionnaire

uses descriptive words to assess pain on three levels: sensory, affective, and evaluative.

Neuropathic pain scale

assesses the type and degree of sensations associated with neuropathic pain.

Pain Scales for children

1. FACES Pain Rating Scale (Wong-baker)

2. Oucher Pain Scale

3. Numeric Scale

4. Poker Chip Tool

5. Word-Graphic Rating Scale

6. Numeric Scale

7. Visual Analogue Scale

8. Color Tool

9. NIPS (Neonatal Infant Pain Scale)

10. BOPS (Behavioral Observational Pain Scale)

FACES pain rating scale

assesses pain for children ages 3 years and up.

OUCHER pain scale

assesses pain for children ages 3 to 13 years with photos or a numeric scale.

Numeric Scale

ranges vertically from 0 to 100, with 0 being “no hurt” and 100 being “biggest hurt” (Beyer, Denyes, & Villaruel, 1992):

Poker chip tool

assesses pain in children 4 years of age and up.

Word- graphic rating scale

assess pain in children ages 4 to 17 years.