Thursday, March 30, 2023

Pain Assessment

Practice Essentials

Precise and systematic pain assessment is required to make the correct diagnosis and determine the most efficacious treatment plan for patients presenting with pain.


Pain must be assessed using a multidimensional approach, with determination of the following:

Onset: Mechanism of injury or etiology of pain, if identifiable



Course or Temporal Pattern

Character & Quality of the pain

Aggravating/Provoking factors

Alleviating factors

Associated symptoms

Severity: Intensity or impact on function, sleep, mood

Barriers to pain assessment

Pain scales

Pain measures may be categorized as either:

Single-dimensional scales – These scales assess a single dimension of pain, typically pain intensity, and through patient self-reporting. These scales are useful in acute pain when the etiology is clear; see the image below

Faces Pain Rating Scale.

Faces Pain Rating Scale.

Multidimensional scales – These measure the intensity, nature, and location of pain, as well as, in some cases, the impact that pain is having on a patient’s activity or mood; multidimensional scales are useful in complex or persistent acute or chronic pain

Pain assessment in the elderly

Pain assessment can be particularly difficult in elderly patients for the following reasons:

Underreporting of discomfort because the patient does not want to complain or due to communication or cognitive impairment

Other medical comorbidities may overshadow pain complaints

Decreases in hearing and visual acuity, so that pain assessment tools that require extensive explanation or visualization to perform will be more difficult and possibly less reliable

The verbal descriptor scale may be the easiest tool for the elderly to use. It allows patients to use common words to describe what they are feeling.

Pain assessment in infants

The following tools use a combination of behavioral and physiologic measurements to assess pain in infants:

CRIES – Uses 5 variables (ie, crying, requires oxygen, increased vital signs, expression, sleeplessness) on a scale of 0-2 points to assess neonatal postoperative pain

Modified Behavioral Pain Scale – Uses 3 factors (facial expression, cry, movements); has been validated for children aged 2-6 months

Pain assessment in young children

Limited cognitive or language skills may influence pain measures, as may the positive or negative consequences of a child’s behaviors associated with pain.

In children older than 3-4 years, self-report measures may be used. However, children may underreport their pain to avoid future injections or other procedures aimed at alleviating the pain.

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