Chapter 4 – Pain Assessment
Pain Assessment Tools
Pain assessment tools are used to explore the relevant dimensions of pain in an organized way. Many have been developed: you should choose one that has been validated (RNAO, 2013). The following sections explore a few different types of pain assessment tools and discuss which may be most appropriate in various contexts.
Choice of the correct tool is informed by several factors:
- The reason for assessing. For example, are you assessing the pain to obtain an overview or comprehensive perspective of the pain? Are you assessing the pain to determine the effectiveness of a treatment?
- The client’s developmental stage. There are validated tools based on a client’s capacity to cognitively appraise their pain and communicate it.
- The client’s health status. At times, you will need a quick assessment of pain because the client’s health status is critical, or the client is deteriorating. Other times, you will need a more comprehensive understanding of the pain.
- The institution and unit. Many units specify the pain assessment tools to be used so that consistency of assessment is maintained; they may also offer training for all healthcare providers in that specific tool.
- Culture. Some people from different cultural backgrounds in terms of ethnicity and language may not be able to cognitively appraise their pain using some of the common pain tools. Thus, it is important to recognize the limits of pain tools.
Contextualizing Inclusivity
Everyone experiences pain, but not everyone has the cognitive or language capacity to understand it and optimally communicate it (e.g., newborns, infants, toddlers). Children as young as four can self-report their pain using tools that are appropriate to their developmental stage (Freund & Bolick, 2019). Other pain assessment approaches involve observing behavioural cues (e.g., crying) and physiological measures (e.g., heart rate, blood pressure). When appropriate, a combination of self-report and observation is best (Parker & Brown, 2019). With all children, but particularly those who are cognitively or developmentally delayed, you should partner with their caregiver (e.g., parent) as they are familiar with the child’s baseline behavioural cues (Freund & Bolick, 2019).
References
Freund, D., & Bolick, B. (2019). Assessing a child’s pain. The American Journal of Nursing, 119(5), 34-41. https://doi.org/10.1097/01.NAJ.0000557888.65961.c6
Parker, M., & Brown, N. (2019). Pre-hospital pain assessment in paediatric patients. Emergency Nurse, 27(2), 16-20. https://doi.org/10.7748/en.2019.e1905
RNAO (2013). Assessment and management of pain. 3rd edition. https://rnao.ca/bpg/guidelines/assessment-and-management-pain
