Pain Assessment and Pain Scores

Overview: 

Pain is a highly prevalent symptom for all patient populations, regardless of age or level of cognitive impairment. Pain control is a high priority and can be achieved in most patients. All patients deserve a treatment plan for pain, emphasizing pain prevention, improved function, and realistic goals. All patients deserve to have their pain report accepted by members of the healthcare team. 

Special Considerations: 

Pain assessments must be tailored to the needs of patients age, physiologic condition, medical history, preferences, and cognitive/developmental status.

  • Clinicians should provide patient and family-centered pain management education, including pain treatment options 
  • Clinicians will adjust the pain management plan based on the adequacy of pain relief and presence of adverse effects
  • Pain assessments must consider a patient’s culture and beliefs, underlying meaning of the pain, and associated spiritual and psychological issues or stressors related to pain

Clinical Recommendations​

Pain is inherently subjective, so a patient’s self-report remains the gold standard

  • Clinicians may use behavioral assessment tools when patients cannot report pain due to cognitive deficits, sedation, developmental stage, or other factors
  • Analgesia is provided to help patients achieve their unique functional goals 
  • Clinicians should not rely solely on “objective” measures such as vital signs, as these are neither valid nor reliable 
  • UCSF endorses the following adult and pediatric scales to capture patients’ experience of pain:

 

References: 

Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., Carter, T., Cassidy, C. L., Chittenden, E. H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M. F., Suresh, S., Sluka, K., Strassels, S., … Wu, C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2), 131–157. https://doi.org/10.1016/j.jpain.2015.12.008

Scher, C., Petti, E., Meador, L., Van Cleave, J. H., Liang, E., & Reid, M. C. (2020). Multidimensional pain assessment tools for ambulatory and inpatient nursing practice. Pain Management Nursing, 21(5), 416–422. https://doi.org/10.1016/j.pmn.2020.03.007

UCSF Pain Assessment and Management Nursing Procedure

Author: 
Marilyn A Bazinski
Lena Ngo