Comprehensive clinical assessment is fundamental to successful treatment
☛ accept the patient’s description
↳ pain is always subjective and patients’ pain is what they say it is and not what others think it ought to be
☛ thorough assessment of the pain
☛ patients should be asked to describe their pain, in their own words
↳ their expression and any body language whilst describing their pain may provide useful information
☛ this information is supplemented by specific questions to define the exact nature of the pain
↳ the site and radiation of the pain
↳ the type of pain
↳ the duration of the pain and whether it has changed
↳ whether there are precipitating, aggravating or relieving factors
↳ its impact on functional ability, mood and sleep
↳ the effect of previous medications
☛ what the pain means to the patient
☛ physical examination, including neurological assessment, should be recorded both in writing and pictorially
☛ further investigations should be limited to those likely to have a significant bearing on treatment decisions
☛ assess each pain
↳ many patients have more than one pain and each pain requires assessment
☛ evaluate the extent of the patient’s disease
↳ the underlying disease is the most frequent cause of pain, new or worsening pain requires the extent of the patient’s disease be re-evaluated
☛ assess other factors that may influence the pain
↳ physical, psychological, social, cultural, spiritual/existential
☛ reassess
↳ repeated reviews are necessary to both assess the effect of treatment and because the underlying disease is usually progressive
Pain measurement
Pain is a subjective phenomenon for which objective measurement is not possible.
☛ A variety of pain intensity scales have been developed to measure pain.
☛ The instruments in common use are unidimensional and consist of a visual analogue scale, a numerical rating scale, or a verbal descriptor scale:
☛ Note: they are used to compare one patient’s pain at different times and are not intended to compare one patient’s pain with another’s.
↳ can be used to follow the course of a patient’s pain
↳ can be used to assess the effect of treatment
↳ may be seen by the patient as indicating concern about their pain
More complex multidimensional instruments are available
☛ e.g. the Brief Pain Inventory (BPI)
☛ includes affective and behavioural associations of pain and interference with function
☛ time consuming for both patients and staff and are best reserved for research projects
Pain in patients with cognitive impairment or dementia can be estimated using the Abbey Pain Scale (www.apsoc.org.au/PDF/Publications/). This is based on the score (0-3) given for six observations—vocalisation, facial expression, body language change, behavioural change, physiological change and physical changes.
↳
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
