Pain assessment

Pain is often regarded as the fifth vital sign in regard to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective. As a result nurses are trained and expected to assess pain.

Pain assessment and re-assessment after administration of analgesics or pain management is regulated in healthcare facilities by accreditation 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 to have a therapeutic effect. Oral: 45–69 minutes. Intramuscular: 30 minutes. Intravascular: 15 minutes.

Most pain assessments are done in the form of a scale. The scale is explained to the patient, who then chooses a score. A rating is taken before administering any medication and after the specified time frame to rate the efficacy of treatment.

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

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

Patients who cannot verbalize/comprehend pain scales are assessed with different types of scales.

Used for neonates/infants:

The scores are added together to achieve a 0-10 pain score.

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

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

One area where assessments of pain and suffering 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 and New Zealand.

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