Approaches to Pain Assessment Flashcards
Pain Assessment
Is it acute or chronic?
● Temporal or causal relationships
● Loss of normal gated pain responses is highly suggestive of the
emergence of chronic dysfunctional pain
● allodynia, hyperalgesia indicative of chronic pain
Pain assessment is much more than a simple intensity score
6 months after - moving towards chronic pain
acute vs chronic pain
general and symptoms
● Obvious distress
● Attention to factors that alter pain threshold
vs.
● May have no noticeable suffering
● Attention to factors that alter pain threshold
Sharp, dull, shock-like, tingling, shooting,
radiating, fluctuating in intensity, and varying
in location
● Occur in a timely relationship with an obvious
noxious stimuli
vs.
● Sharp, dull, shock-like, tingling, shooting, radiating, fluctuating in
intensity, and varying in location
● Often occur without temporal relationship with an obvious noxious
stimuli
● Over time, pain stimulus may cause symptoms that completely
change (e.g., sharp to dull, obvious to vague)
● Hypertension, tachycardia, diaphoresis,
mydriasis, and pallor (not diagnostic)
● In some cases, no obvious signs
● Comorbid conditions usually not present
● Outcome of treatment generally predictable
describes
signs of acute pain
● Hypertension, tachycardia, diaphoresis, mydriasis, and pallor
seldom present
● In most cases, no obvious signs
● Comorbid conditions often present (e.g., insomnia, depression,
anxiety)
● Outcome of treatment often unpredictable
describes
signs of chronic pain
Lab and
Diagnostic
Imaging for acute pain
● No specific lab tests for pain
● Pain is best diagnosed based on patient
description and history
Lab and
Diagnostic
Imaging for chronic pain
● Pain is best diagnosed based on patient description and history
● No specific lab tests for pain; however, history and/or diagnostic
proof of past trauma may be helpful in diagnosing etiology
● Consider vitamin D, TSH (generalized or widespread pain) and
vitamin B12 (neuropathic pain)
how do we assess pain
PET scan
EEG
Pt with pain will have changes in PET and EEG
Doesn’t really correlate to how much pain they’re experiencing
Pain Assessment - Key Components
● Patient interview
● Pain assessment tools
● History - medical and medication
● Physical exam and diagnostic work-up findings
● Behavioural observations
SCHOLAR qs to ask
S Symptoms ● Chief complaint
● Any other relevant symptoms experienced
C Characteristics ● Describe the pain: sharp, dull, shock-like, burning, tingling, shooting,
stabbing, pressure, radiating, constant, intermittent
Rate the pain
Does it radiate elsewhere –> neuropathic pain
H History ● Has this happened before?
○ If so, what was done at that time?
O Onset ● How long have they been experiencing this?
● Any identifiable events that may have been causative?
L Location ● Where is the pain being felt?
● Can they put their finger on it? Does it radiate?
A Aggravating factors ● What makes it worse?
R Relieving (or Remitting) factors
● What makes it better
SOCRATES
S Site ● Where is the pain? Or the maximal site of pain
O Onset ● When did it start? Sudden or gradual? Progressive or regressive?
C Character ● Describe the pain (e.g., dull, sharp, burning, tingling, etc)
R Radiation ● Does it radiate anywhere?
A Associations ● Any other signs or symptoms associated with the pain? (e.g., nausea,
vomiting, dyspnea, etc.)
T Time course ● Does the pain follow any pattern?
E Exacerbating and
relieving factors
● Does anything change the pain (make it better or worse)?
S Severity ● How bad is the pain?
OLD CARTS
O Onset
L Location/radiation
D Duration
C Characteristics
A Aggravating factors
R Relieving (or remitting)
factors
T Timing
S Severity
OPQRST
O Onset
P Precipitating and Palliating
factors
Q Quality
R Region or Radiation
S Severity
T Timing
Dimensions of Pain Experience
what are 4 dimensions of pain experience that can be assessed for most pt
Pain intensity
● Quantitative pain intensity estimates usually can be provided relatively quickly
● Relatively easy for adults to identify
Pain affect
● More complex than intensity → degree of emotional arousal or changes in action readiness caused
by the sensory experience of pain
● Often felt as distressing or frightening; may interfere with daily activities, habitual modes of
response, and/or regulatory efficiency
● Affective component of pain consists of a variety of emotional reactions; complex and often
requires more than a single word or number to adequately describe
Pain quality
● Specific physical sensations associated with pain
Pain location
● Perceived location(s) of pain sensation
some other dimensions of pain experience
Functional dimension: how mch does pain affect ability to function
Econoomic domains
Sociocultural: dependent n others, family dynamics, quality ofl life overall
what are Single Dimension Tools
Rating from 0-10
Influenced by how bad they percieve wond to be
Anchor: 0-10
Diff interpretatio of scale
No pain at all
10 worst pain imagned
Worst paine xperienced for 10 could mean diff things
Verbal rating scale: no pain, mild, mod, or severe pain
Faces pain scale: aren’t as able to understand what you are asking them
