What is the most effective way to assess a patients pain?

Nurses can help patients more accurately report their pain by using these very specific PQRST assessment questions:

P = Provocation/Palliation

What were you doing when the pain started? What caused it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities?

What relieves it? Medications, massage, heat/cold, changing position, being active, resting?

What aggravates it? Movement, bending, lying down, walking, standing?

Q = Quality/Quantity

What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching.

R = Region/Radiation

Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around? Did it start elsewhere and is now localized to one spot?

S = Severity Scale

How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?

T = Timing

When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you first experienced it? When do you usually experience it: daytime? night? early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?

Documentation

In addition to facilitating accurate pain assessment, careful and complete documentation demonstrates that you are taking all the proper steps to ensure that your patients receive the highest quality pain management. It is important to document the following:

• Patient’s understanding of the pain scale. Describe the patient’s ability to assess pain level using the 0-10 pain scale.
• Patient satisfaction with pain level with current treatment modality. Ask the patient what his or her pain level was prior to taking pain medication and after taking pain medication. If the patient’s pain level is not acceptable, what interventions were taken?
• Timely re-assessment following any intervention and response to treatment. Quote the patient’s response.
• Communication with the physician. Always report any change in condition.
• Patient education provided and the patient’s response to learning. Don’t write “patient understands” without a supportive evaluation such as patient can verbalize, demonstrate, describe, etc.

• View PDF

Volume 101, Issue 1, July 2008, Pages 17-24

https://doi.org/10.1093/bja/aen103Get rights and content

Pain is a personal experience but may be difficult to communicate. It is vital that nurses know how best to assess it to ensure the optimal treatment is given

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Chapter 2. Patient Assessment

“Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery, 1968, cited in Rosdahl & Kowalski, 2007, p. 704). Pain is a subjective experience, and self-report of pain is the most reliable indicator of a patient’s experience. Determining pain is an important component of a physical assessment, and pain is sometimes referred to as the “fifth vital sign.”

Figure 2.1 Example of a pain scale

Pain assessment is an ongoing process rather than a single event (see Figure 2.1). A more comprehensive and focused assessment should be performed when someone’s pain changes notably from previous findings, because sudden changes may indicate an underlying pathological process (Jarvis, Browne, MacDonald-Jenkins, & Luctkar-Flude, 2014).

Always assess pain at the beginning of a physical health assessment to determine the patient’s comfort level and potential need for pain comfort measures. At any other time you think your patient is in pain, you can use the mnemonic LOTTAARP (location, onset, timing, type, associated symptoms, alleviating factors, radiation, precipitating event) to help you remember what questions to ask your patient. See Checklist 14 for the questions to ask and steps to take to assess pain.

Checklist 14: Pain Assessment

1. Start your assessments by asking patients to rate their pain on a scale from 0 to 10, with 10 being the worst possible pain and 0 being no pain.
L: Location	Where are you feeling pain?
O: Onset	When did the pain start? How long have you been in pain?
T: Timing	Is the pain constant or intermittent? Has the intensity changed over time?
T: Type	What does the pain feel like?
A: Associated symptoms	Do you have any associated symptoms such as nausea, vomiting, fever, etc.?
A: Alleviating factors	What makes the pain feel better? Do you take any medications for this pain? If so, are they effective?
R: Radiation	Does the pain move anywhere else?
P: Precipitating event	What was happening when the pain started? What has caused the pain to occur? Has this happened before?
2. Provide analgesia as prescribed and other comfort measures, such as distraction, massage, and the application of warmth or cold, as appropriate.
3. Report and document assessment findings and related health problems according to agency policy.
Data source: Assessment Skill Checklists, 2014

Read this section on vital signs to learn how to take a full set of vital signs.

1. You are caring for a patient who has just returned from a surgical procedure. The patient has a history of chronic pain. Would the patient’s assessment provide the same data as an assessment of a person who does not have a history of chronic pain?
2. What is more important: the subjective or the objective data in a pain assessment?

Attribution

Figure 2.1 
Children’s pain scale by Robert Weis is used under a CC BY SA 4.0 licence.