Registered Nurses´ Association of Ontario
Page 7 of 17 Main Menu <<Back Next>>
Tools for Assessment of Pain in Adults Pain
SAMPLE 5 (cont'd)–Key for Pain Assessment Tool
- Location of Pain
- Intensity
- Quality
- Effects of pain on your quality of life
- Current Medications and Usage:
- Family Support
- Symptoms
- Behaviours
- Past pains
- Nursing pain diagnosis
- Pain Diagnosis
- Problem List
- Goals and Plans:
Location of Pain:
As indicated, have the resident, or if necessary, you can place the letter "A" on the part of the body where the resident reports feeling pain. If the pain starts at a certain point then travels, you can indicate the direction and extent of the travel with an arrow. If it seems that there could be a second or third pain, then use the letters "B" and "C".
Intesity
The resident will be requested to answer the questions in the table as they relate to each identified pain. The preferred pain tool is 0-10. If the resident is finding this confusing or is unable to comply, then use the facial grimace scale as an objective measure.
Quality:
Go over each pain location to identify the appropriate descriptors from the list or if the resident has a different descriptive word, record this beside "other". Indicate the letter that corresponds to the location of pain being described beside the descriptive words.
Effects of pain on activities of daily living (ADL's):
You want to find out if any of the pains identified in the "location of pain" and "intensity" section are affecting
any of the activities of daily living listed. Tick "yes" or "no".
If pain is causing a problem in any of the ADL's, indicate in the comments column which pain is causing the
problem and in what way.
If pain were not causing a problem in the activity but the resident expresses a difficulty because of some other problem
or symptom, you would tick no, but include a comment to elaborate.
It is also important to know if the resident feels that help is needed with any of the activities identified as a problem
or if they are content to live with it. If the resident wants help, this would then suggest a need to refer to the
appropriate person.
The following are some additional questions and/or points that you may find helpful when asking about the specific
ADL areas. Also, included are possible *referrals to the professional(s), who are experts in the different areas.
- Sleep and Rest:
Ask - How often do you wake in the night? How many nights of the week? What is a good or bad night? What position do you sleep in? Do you use any special positioning devices? Have you tried any in the past? Did they work?
*OT/PT/RN/DR/PC/SW - Social activities:
Includes leisure (hobbies), recreational activities, shopping.
*OT/SW/Volunteers. - Appetite:
Number and size of meals taken. Food preferences, snacks, an example of how each might help.
*Dietitian - Physical activity and mobility:
Moving in bed; transfers to bed, chair, toilet; stairs; walking; other exercise; sports; personal care; bathing, dressing, grooming, eating; medication management.
*OT/RN - Emotions:
Any change, as a result of the pain, and if so, is this significantly interfering with activities so that intervention would be helpful.
*SW/PC/Volunteer - Sexuality and intimacy:
Is the pain resulting in a significant reduction in desire for sexuality/intimacy or making the physical movement required too painful? In both cases, is this a concern for the resident?
*SW/PT/OT/RN/DR
Effects of pain on your quality of life:
This can be a very difficult subject to try to describe, which is why some descriptors have been included to
assist the resident: happiness, contentment and fulfillment. Have the resident indicate which activity can no
longer be done that is important to him/her. Ask how we can help.
Current Medications and Usage:
Include all medications and how ordered; dose, times, number of tablets, how effective
using 0-10 scale, regular or PRN, side effects.
Family Support:
This can be any person who is involved in the resident´s life and is recognized by the resident as a "significant
other".
Symptoms:
Have the resident identify from the listed symptoms which ones are affecting his/her quality of life.
Check appropriate ones.
Behaviours:
Have the resident identify disturbing behaviours if possible and/or the assessor will identify and check exhibited behaviour(s).
Past pains:
Have the resident describe the pain incident and his/her coping methods.
Nursing pain diagnosis:
Considering all the information from the assessment, identify one or more pains.
Assign the corresponding letter to relate them to the pains identified in the "Location of Pain" section.
Pain Diagnosis:
There are four classifications of pain; nociceptive pain, neuropathic pain, mixed pain and pain of unknown origin.
- Nociceptive:
Nociceptive pain is caused by tissue damage created by pressure, infiltration or destruction by an identifiable somatic or visceral lesion.- Visceral:
Constant, dull, aching, poorly localized pain that has a gradual onset often felt at a distance from the origin.
- Solid Viscera (eg: liver, pancreas)
- if intense, can be sharp and penetrating
- Hollow Viscera (eg: bowel, bladder)
- diffuse, or colicky pain
- feeling of pressure or fullness caused by blockage of previously open "tunnel"
- may have shortness of breath or cough with thoracic viscera; abdominal distention, nausea, vomiting with abdominal viscera.
- Somatic:
Constant gnawing or aching, usually well localized, worse on movement or weight-bearing if in pelvis, hips, femur, joints or spine.- bony metastases
- skin invasion or ulceration
- muscle invasion, soft tissue masses
- pathologic fractures
- osteo-arthritis and other bone destructive diseases
- may be present in back and shoulder if it involves T1
- Raised intracranial pressure:
- brain tumours
- meningeal carcinomatosis
- Visceral:
- Neuropathic:
Neuropathic pain is caused by pressure, invasion or destruction of peripheral or central nervous tissues, which leads to complex and abnormal spinal cord or thalamic neural processes that produce sustained pain.- invasion, destruction of lumbosacral or brachial plexus
- spinal cord compression
- pain often precedes sensory and motor loss
- constant ache to intermittent, sharp stabbing pain
- specific nerve root compression may cause dermatomal pain
- progressive damage may result in superficial burning pain
- can experience hyperaesthesia, dysaesthesia, progressive motor and sensory loss
- can have vasomotor changes
- Mixed:
Mixed pain in many instances is a combination of nociceptive and neuropathic pain.- tumour invasion of pancreas with spread to and destruction of vertebra including spinal cord compression.
- Unknown:
Persistent pain, the cause of which cannot be determined by history and investigations.- may be described with all the current word descriptors
- patient is often not believed if investigations are inconclusive
- is usually under treated
- can be debilitating
- lifelong suffering may lead to depression
Problem List:
Using the "Pain Assessment Tool" circle the pain diagnosis(es) and list them on the care plan. If you identify a problem
that the resident did not, it is important to ensure the resident agrees and understands why this is a problem. This
is an ongoing list. Please date each problem when identified and resolved.
Goals and Plans:
From the problem list, the resident creates goals and you work together to identify the interventions.
It is important to include who specifically will do what and to whom the resident has been referred.
Also, include what outcome measure you will be using to re-evaluate the goal i.e. analog scale of 0 -10
and what tool you will use if it is other than pain. i.e. 0 = no nausea, 10=worst nausea imaginable;
or scores from the behaviour checklist.
Include when you anticipate the plans to be carried out and when you will be re-evaluating the goal.
Make sure to sign and date each entry.
Originally adapted with permission from Grey Bruce Palliative Care/Hospice Association Manual. Reprinted with Permission. Brignell, A. (ed) (2000). Guideline for developing a pain management program. A resource guide for long-term care facilities, 3rd edition.
