Chapter 4 – Pain Assessment
Pain Assessment
You have an important role to play in screening for and assessing pain (RNAO, 2013).
You will often be the first person to recognize that a client is in pain as a result of your assessment including observations. Nurses also spend sustained periods of time with clients, so clients are more likely to share this information with you than with other healthcare professionals. If they say they are in pain, believe them. Trust will disintegrate if clients feel you do not believe them.
Unassessed pain can lead to inadequate pain management and/or untreated pain. This is a serious problem because it can affect many body systems as well as a client’s cognitive capacity and quality of life, and even whether they live or die.
Pain can be difficult to assess because it is a personal experience that affects clients in different ways. Clients may also have difficulty articulating their pain and describing what it feels like. Sometimes pain is invisible, making it difficult to recognize, particularly in someone with chronic pain. The next sections explore the dimensions of pain so that you can develop an understanding of how pain may appear.
Dimensions of Pain Assessment
Pain has many dimensions in terms of how it affects a person (see Table 1). The various dimensions of pain can involve various descriptions and considerations (Cleeland, 2009). It is important to be aware that these dimensions are not necessarily separate; for example, the subjective dimension includes cognitive, psychological, and social features. Consider the many dimensions in terms of your pain assessment of the client and which pain assessment tools may be best in certain situations and populations (this will be discussed in more detail later).
Table 1: Dimensions of pain and related considerations.
Dimension |
Considerations |
Subjective A report of pain by the person who is experiencing it is important because they know their pain best and how to describe it. This is sometimes referred to as the sensory dimension of pain, which includes a client communicating the intensity of pain and other descriptors. |
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Physiological Common physiological responses from pain may include tensing of muscles, pupil dilation, dry mouth, and a change in vital signs. |
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Behavioural Behaviours associated with pain can include facial and bodily responses such as grimacing, moaning, crying, fidgeting, guarding, and laying still. Other behaviours associated with pain include change in sleep patterns and eating patterns. |
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Cognition Pain can affect a person’s cognitive functioning in terms of their ability to think, reason, acquire and remember knowledge, attention span, and learning. |
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Psychological and social Clients may become anxious, irritable and upset, or have a flat affect (lack of reaction on the face). Chronic pain can affect a client’s identity and social relationships and can lead to social withdrawal and depression. |
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Reactive This dimension refers to the ways that pain interferes with daily functioning (Cleeland, 2009). |
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Contextualizing Inclusivity
Activity: Check Your Understanding
References
Association for the Study of Pain (2020). IASP announces revised definition of pain. https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
Cleeland, C. (2009). The Brief Pain Inventory: User guide. https://www.mdanderson.org/content/dam/mdanderson/documents/Departments-and-Divisions/Symptom-Research/BPI_UserGuide.pdf
Laitner, M., Erikson, L., Society for Women’s Health Research Osteoarthritis and Chronic Pain Working Group, & Ortman, E. (2021). Understanding the impact of sex and gender in osteoarthritis: Assessing research gaps and unmet needs. Journal of Women’s Health, 30(5). https://doi.org/10.1089/jwh.2020.8828
RNAO (2013). Assessment and management of pain. 3rd edition. https://rnao.ca/bpg/guidelines/assessment-and-management-pain
Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research and Management, article ID 6358624. https://doi.org/10.1155/2018/6358624
Zhang, L., Losin, E., Ashar, Y., Koban, L., & Wager, T. (2021). Gender bias in estimation of others’ pain. The Journal of Pain, 22(9), 1048-1059. https://doi.org/10.1016/j.jpain.2021.03.001