Pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

is often regarded as the fifth

vital sign Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...

in regard to

healthcare Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

because it is accepted now in healthcare that

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

, like other vital signs, is an objective sensation rather than subjective. As a result

nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...

s are trained and expected to assess pain.

Regulation

Pain assessment and re-assessment after administration of

analgesic An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

s or

pain management Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute (medicine), acute and simple to chronic condition, chronic and challenging. Most physici ...

is regulated in healthcare facilities by

accreditation Accreditation is the independent, third-party evaluation of a conformity assessment body (such as certification body, inspection body or laboratory) against recognised standards, conveying formal demonstration of its impartiality and competence to ...

bodies, like the Joint Commission. The Joint Commission began setting standards for pain assessment in 2001 stating that the route of analgesic administration dictates the times for pain reassessment, as different routes require different amounts of time for the

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

to have a therapeutic effect. Oral: 45–69 minutes.

Intramuscular Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles hav ...

: 30 minutes.

Intravascular Blood vessels are the tubular structures of a circulatory system that transport blood throughout many animals’ bodies. Blood vessels transport blood cells, nutrients, and oxygen to most of the tissues of a body. They also take waste and c ...

: 15 minutes.

Types of assessment

Most pain assessments are done in the form of a scale. The scale is explained to the

patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ...

, who then chooses a score. A rating is taken before administering any medication and after the specified time frame to rate the

efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as '' effectiveness'', and it has often been used synonymously, although in pharmacology a distinction is now often made betwee ...

of treatment.

Number scale

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

Faces scale

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

Special considerations

Patients who cannot verbalize/comprehend

pain scale A pain scale measures a patient's pain intensity or other features. Pain scales are a common communication tool in medical contexts, and are used in a variety of medical settings. Pain scales are a necessity to assist with better assessment of pai ...

s are assessed with different types of scales.

FLACC

Used for neonates/infants: The scores are added together to achieve a 0-10 pain score.

Physiological measurement of pain

fMRI brain scanning has been used to measure pain, giving good correlations with self-reported pain.

Long-term pain

Hedonic adaptation The hedonic treadmill, also known as hedonic adaptation, is the observed tendency of humans to quickly return to a relatively stable level of happiness (or sadness) despite major positive or negative events or life changes. According to this the ...

means that actual long-term suffering due to physical illness is often much lower than expected.

Legal awards for pain and suffering

One area where assessments of

pain and suffering Pain and suffering is the legal term for the physical and emotional stress caused from an injury (see also pain and suffering). Some damages that might come under this category would be: aches, temporary and permanent limitations on activity, ...

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, UK,

Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...

and New Zealand.

Addiction

Many patients who use drugs and are on

opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...

stimulant Stimulants (also known as central nervous system stimulants, or psychostimulants, or colloquially as uppers) are a class of drugs that increase alertness. They are used for various purposes, such as enhancing attention, motivation, cognition, ...

barbiturate Barbiturates are a class of depressant, depressant drugs that are chemically derived from barbituric acid. They are effective when used medication, medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological a ...

s, and

sedative-hypnotic A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are central nervous system (CNS) depressants and interact with brain activity, causing its deceleration. Various kinds of sedatives ca ...

s have the potential to become addicted. Many people with

chronic illness A chronic condition (also known as chronic disease or chronic illness) is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the ...

es,

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

, and history of

mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

are prescribed these drugs. As a nurse it is difficult to assess whether the pain is real or whether the patient is seeking the

narcotic The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "I make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...

. Adult patients display pain and emotions differently. Many patients become dependent physically and mentally on these drugs. 1.name 2.age 3.sex 4.occupation 5.address 6.chief complaint of patient 7.history of patient:- present illness history past illness history medical history family history personal history 8.pain site of pain nature of pain quantity of pain on v.a.s scale type of pain 9.examination active movement passive movement 10.observation gait posture r.o.m palpation aggravating factor relieving factor tenderness 11.treatment

Nurse Pain assessment

*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 An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in so ...

sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are central nervous system (CNS) Depressant, depressants and interact with brain activity, causing its decelera ...

at the exact time it's due? *Does the patient continually ask for the medication? *Does the patient continually ask the

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

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?

Assessment findings

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 Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

and

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

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.

References

{{reflist Pain