Pain assessment

Patients rate pain on a scale from 0-10, 0 being no pain and 10 being the worst pain imaginable.

A scale with corresponding faces depicting various levels of pain is shown to the patient and they select one.

Patients who cannot verbalize/comprehend pain scales are assessed with different types of scales.

Used for neonates/infants:

The scores are added together to achieve a 0-10 pain score.

fMRI brain scanning has been used to measure pain, giving good correlations with self-reported pain.[1][2][3][4][5]

Hedonic adaptation means that actual long-term suffering due to physical illness is often much lower than expected.[6]

One area where assessments of pain and suffering are required to be made effectively is in legal awards. In the Western world these are typically discretionary awards made by juries and are regarded as difficult to predict, variable and subjective, for instance in the US,[7] UK, [8] Australia and New Zealand.[9]

• Does the patient show nonverbal signs of pain such as crying or grimacing?
• Does the patient watch the clock and ask for the pain medication or sedative at the exact time it's due?
• Does the patient continually ask for the medication?
• Does the patient continually ask the physician to increase pain medication?
• What is the dose of the medication and how often does the patient ask for it?
• How long has the patient been taking the drug?
• Does the patient have a change in mood and behavior if they don't receive the medication at the exact time?
• Have a conversation with the patient. Do they want the medication because they are in pain or because they can't sleep?
• Do they want the medication because they are anxious?
• What is going on in the patient's life?
• What are their social circumstances?
• Is the nursing staff performing three non-drug interventions before administering a sedative, hypnotic, or anti anxiety medication?
• How many different medications is the patient on?
• Is the patient gradually asking for less medication as time goes on or are they asking for more?

If the patient is continually asking for the physician to increase their pain medication or increase the frequency, they need further evaluation by both a nurse and a physician. There is a good possibility the patient is in pain. There is also a possibility that they are becoming addicted to prescribed medication. The patient's history must be taken into account as well. Medical conditions such as cancer and rheumatoid arthritis are chronic conditions and can be very painful.

In long-term care facilities, three non-drug interventions need to be attempted before administering anti-anxiety or anti-psychotic medications. These interventions can consist of giving the patient food, drinks, one on one care, back rub, changing the patient's position in bed, adjusting the temperature, and redirecting the patient's mental focus. Many times these interventions work, but many times the medication may still need to be administered.

The patient's history and diagnosis are helpful in deciding whether or not the patient is developing a substance abuse problem. A patient having social or relationship problems may need to meet with a crisis counselor.

During every shift that a nurse is on duty, they must do an assessment of the patient. If they suspect the patient is becoming addicted, they must notify the physician.