pain assesment

Pain Assessment Principle

Pain is subjective; pain is what the patient says it is and where the patient says it is.

Basic Pain Pathway

Pain stimulus activates nerve endings → signal travels through spinal cord → thalamus/cerebral cortex → pain is perceived.

Descending Pain Control

Descending nerve pathways can decrease pain transmission; substances involved include opiates, endorphins, and enkephalins.

Endorphins and Enkephalins

Natural substances that help reduce or block pain transmission.

Acute Pain

Recent or short-term pain.

Chronic Pain

Long-term or persistent pain.

Visceral Pain

Pain originating from internal thoracic, abdominal, or pelvic organs.

Somatic Pain

Pain originating from muscles, bones, joints, or connective tissues.

Cutaneous Pain

Pain caused by injury to the skin or superficial tissues.

Referred Pain

Pain caused by a problem in one area but felt somewhere else in the body.

Phantom Pain

Painful sensation perceived in a body part that is no longer present after surgical or traumatic removal.

Neuropathic Pain

More constant pain associated with abnormal nerve activity or sensitization.

Peripheral Sensitization

Increased sensitivity caused by inflammation in which normally nonpainful touch or pressure may become painful.

Nociplastic Pain

Pain with no identifiable cause; examples include fibromyalgia, CRPS, chronic low-back pain, IBS, headaches, restless leg syndrome, and TMJ.

Older Adults and Chronic Pain

Chronic pain occurs in about 25–40% of adults age 65 and older.

Pain and Cultural Considerations

Bias can contribute to differences in pain assessment and treatment among racial and ethnic minority patients.

Urgent Pain Findings

Chest pain may indicate myocardial infarction; “worst headache of my life” may indicate cerebral hemorrhage and requires immediate assessment.

Signs of Acute Pain

High BP, tachycardia, diaphoresis, shallow respirations, restlessness, facial grimacing, guarding, pallor, and pupil dilation.

OLDCARTS

Onset, Location, Duration, Character, Alleviating/Aggravating factors, Radiation, Timing, Severity.

Onset

When did the pain begin?

Location

Where is the pain?

Duration

How long does the pain last?

Character

What does the pain feel like, such as sharp, aching, burning, or stabbing?

Alleviating/Aggravating Factors

What makes the pain better or worse?

Radiation

Does the pain travel to another area?

Timing

Is the pain constant, intermittent, or associated with a certain time or activity?

Severity

How intense is the pain, often measured using a 0–10 scale.

Objective Pain Cues

Physiological and behavioral signs that may accompany pain, such as grimacing, restlessness, guarding, or vocalization.

Pain Assessment in Nonverbal Patients

Observe behaviors such as grimacing, bracing, rubbing painful areas, restlessness, and vocalizations.

Numeric Pain Scale

Usually ranges from 0 = no pain to 10 = worst pain possible.

Faces Pain Scale

Uses facial expressions to help a patient communicate the severity of pain.

FLACC Scale

Behavioral pain scale that assesses Face, Legs, Activity, Cry, and Consolability.

FLACC Scoring

Each FLACC category is scored 0–2, for a maximum total score of 10.

Reassessing Pain

After a pain intervention, reassess the patient to determine whether treatment was effective.

Pain Management Sequence

Assess pain → provide intervention → reassess → document.

Pain Assessment Bias

Prejudice, cultural beliefs, family values, educational values, or assumptions about age can interfere with accurate pain assessment.

Effect of Poor Pain Assessment

Inaccurate assessment may lead to incorrect medication or treatment choices.

Nociception

The clinical concept describing pain perception through sensory receptors called nociceptors.

Nociceptors

Sensory receptors located throughout the body that detect painful stimuli.

Patient Reports Severe Pain but Looks Comfortable

Believe and assess the patient’s report; body language should not be used to decide whether the patient is telling the truth.

When Behavioral Pain Signs Are Most Important

When the patient cannot verbally communicate, such as some infants or older adults with cognitive impairment.