Community Coalition for End of Life Care

Articles

This is one of a series of articles from the Community Coalition on End of Life Care: a group of North Country individuals and organizations working to improve quality of life for those suffering from chronic, life limiting conditions.

Pain Assessment

In the last 2 articles we discussed definitions of pain and myths about pain. This article will review methods of pain assessment.

On patient surveys given to patients who had been cared for at Littleton Regional Hospital, patients state that their pain was managed well (scores on satisfaction surveys range from … 90-97% positive). One area that does not score as high as others was the question, “were you told about how your pain was going to be assessed….” which scored in the 85-90% range.

The Littleton Regional Hospital Palliative care team and the Community Coalition for End of Life Care therefore decided to work toward standardizing the way pain is assessed in our community, and work toward medical caregivers assessing pain in a similar way.

As discussed previously, pain is a subjective individual experience that is different for everyone. It is therefore hard to standardize. The most common scale to measure the severity of pain is a 0 to 10 scale, with 0 being no pain and 10 being the worst pain imaginable (see below). For most people “the worst imaginable” is worse than anything anyone can or has actually experienced. It is therefore important not to rate pain as 10 out of 10 unless it is clearly as bad as anything you can imagine (there are few people who experience pain worse than what they can imagine). Otherwise it may lead to caregivers over-treating your pain. You might be given too much medicine causing side effects or complications. Look at the scale attached carefully and read the words carefully aligned with each number. When you visit the hospital or your doctor’s office, you may be given this card to help you rate your pain. Use it thoughtfully. Being as accurate as possible will lead to getting your pain under better control sooner and with the least amount of side effects.

Severity is only one component of pain assessment. Quality is also important. What words you would give to describe your pain will help a provider understand what might be causing the pain. The pain could be a pressure, an ache, or a crampy pain often coming from organs such as the heart, gallbladder, or bowels; or it could be a shooting, burning pain or lancinating pain often coming from nerves.

How pain affects you is also important. This helps caregivers understand what impact the pain is having. Look at the pain card. There are words to show how pain affects you that help you rate the severity. Knowing the impact of pain helps providers choose treatments. For instance, we would use different treatments for those still working versus someone in bed at home.

Other important parts of pain assessment include where the pain is (the location), where it radiates to, when and how it started, how long it has been there and whether it is steady or comes and goes, and what makes it better or worse. What you think might be causing the pain or what you are scared about is also important.

Some people minimize their pain as they want to show they are strong or do not want to get medications with side effects. Others exaggerate their pain to be taken more seriously or because they are fearful it will not be treated aggressively. Minimizing or exaggerating pain is dangerous and most likely to lead to under or over treatment. In order to get the best care possible, be sure to explain your pain accurately and clearly to your caregivers.

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