Pain Assessment and Associated Behaviors

Pain is a feeling of discomfort that ranges from mild to severe, usually caused by an underlying condition, and can be acute or chronic. Acute pain is typically short-term and resolves once the underlying cause is addressed, while chronic pain lasts for six months or more. To perform a pain assessment, you'll collect subjective and objective data about your patient's pain.

Pain is a subjective experience, meaning that it's based on a person's perceptions and feelings, which can differ depending on their pain threshold, or the point when they start noticing pain; and pain tolerance, which is the amount of pain someone can endure. So, your patient's report and description of pain is the most reliable source of information about their pain.

To obtain subjective data about your patient's pain, ask them a series of questions. Begin by asking them to rate their pain using a standard tool, like a numeric scale that uses zero to ten to indicate pain level, with zero meaning no pain and ten meaning the worst pain possible. Sometimes older adults might prefer a pain scale that uses words like no pain, mild pain, or severe pain. For pediatric patients, it's common to use the Faces Pain Scale where each face represents a different level of pain.

For a more detailed description of your patient's pain, use the mnemonic OPQRST. First, O stands for onset, or when the pain started, which can be sudden, gradual, or progressive. Then, P stands for provocation and palliation, meaning whether certain factors make the pain worse, like pressure or movement; or better, like ice or medication. Q is for quality of pain, such as sharp, dull, burning, or achy; and if it's intermittent or constant. R stands for region, which is the area of the body where the pain is felt; and radiation, or if the pain spreads to other areas of the body.

Next, S is for severity, which your patient can quantify using a standardized pain scale. The severity can also determine whether the pain impacts your patient's quality of life or ability to perform their daily activities. Then, T, which stands for treatment and timing, refers to any strategies or medications your patient has used to address their pain; and if the pain is constant or intermittent. For additional information, you may add U which stands for understanding pain, or what the patient believes is causing their pain; and V for values, or what your patient considers an acceptable level of pain.

In contrast to subjective data, objective data refers to information you observe during your pain assessment. Now, begin by checking your patient's vital signs, because pain can cause changes to pulse, blood pressure, and respiration. Keep in mind that changes in vital signs shouldn't be used exclusively to determine pain, since other conditions, like fever, can cause an increased pulse and respiration rate. In addition, pain might not cause vital signs to change at all, especially in patients with chronic pain.

You'll also want to perform a physical assessment to look for findings that could indicate your patient's pain is not well controlled. For example, hypoventilation may be present in patients with a chest injury if pain makes it difficult for them to breathe. Likewise, patients with joint pain may find it difficult to move in bed or might be reluctant to ambulate.

During your assessment, also be sure to note any nonverbal cues that indicate your patient is in pain, such as anxiety, irritability, restlessness, and grimacing, as well as rubbing or guarding a specific body part. Nonverbal cues are especially important for patients who are unable to self-report their pain, including preverbal children and unconscious patients. In these cases, you can use a facility-approved scale like the FLACC scale, which looks at nonverbal cues like facial expression, leg position and movement, activity, cry, and consolability.

Alright, as a quick recap… Pain is a feeling of discomfort that ranges from mild to severe, usually caused by an underlying condition, which can be acute or chronic. As the nurse, you'll perform a pain assessment that includes collecting subjective and objective data.