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Pain As the Fifth Vital Sign – Pain Assessment & Management


Health professionals are all well versed in the importance of an accurate pain assessment. However, challenges can often be present when providing effective pain management to patients. It is important that we ask why this is and make changes to our own practice to improve our pain management tools and strategies.

Why is Pain Management Important?

One in five Australians live with chronic pain. In addition to this number, every day many people experience acute pain, occurring post-surgery or from accidents such as burns or fractures.

Effective pain assessments are crucial for patient care. Not only does controlled pain improve the patient’s comfort, it also improves other areas of their health, including their psychological and physical function. This is why it is important for all health professionals to be able to complete an accurate pain assessment and implement successful pain management strategies.

Pain as the Fifth Vital Sign

One particular initiative that was implemented to improve the pain management skills of nurses was the practice of performing a pain assessment when completing vital signs. Although this practice allows pain intensity to be monitored regularly, it may not necessarily improve the quality of the pain management delivered.

Health professionals, especially nurses, need to understand that pain management involves more than just knowing the patient’s pain intensity; it’s about how we collect more information and what we do with it.

Different Types of Pain = Different Assessment Tools

Pain Assessment Tool

Unidimensional tools are the most commonly used pain assessment tools and look at one area of pain, usually pain intensity.

Pain is a subjective experience and very individualised to the person experiencing it. There are many different types of pain, including neuropathic pain, somatic pain and visceral pain, which can then also be either acute or chronic depending on its duration. Pain assessment tools need to be chosen to reflect the type of pain the individual is experiencing. These assessment tools can use either a unidimensional or multi-dimensional approach.

Unidimensional tools are the most commonly used pain assessment tools and look at one area of pain, usually pain intensity. These tools include the visual analogue scales, verbal rating scales and verbal descriptor scales. These are generally used when performing a pain assessment on a patient with acute pain. We can also then evaluate any interventions by comparing the pain intensity scores of the individual at different times.

Multi-dimensional tools are more descriptive and provide more information about the pain then unidimensional tools. These tools include the McGill pain questionnaire and brief pain inventory, and are good to use in cases of neuropathic and chronic pain. In addition to pain intensity, they also describe other impacts the pain has on the individual’s physical, psychological, emotional and social health.

What Do We Need to Include in Our Assessment?

Completing a pain assessment must be a tailored process depending on the individual. There are certain aspects of the patient’s pain experience that we must know in order to effectively manage their pain. These include:

  • Pain intensity
  • Pain quality
  • Location of the pain and any radiating elements
  • Duration and onset
  • Aggravating and alleviating factors
  • The impact on the patient

If the patient is unable to verbalise their pain, we need to rely on our assumptions and also look at any behavioural and physical indicators, such as grimacing and groaning. It is then important to implement pain management strategies and evaluate the effectiveness of these strategies through reassessments.

Barriers to Effective Assessments

There are many obstacles to effective pain management, which can be attributed to both the health professional and the patient. The health professional may have inadequate skills and knowledge relating to pain management, and additionally there may be inadequate documentation of the pain, which makes treatment more difficult. The patient’s age, illness and communication skills can also interfere with accurate pain assessments.

Misconceptions and stereotypes surrounding pain and pain management can impact negatively on this process. The patient may fear addiction to medication and therefore may downplay their pain. Alternatively, if the health professional does not believe the patient really feels the level of pain they report, he or she may not manage it appropriately. These potential barriers must be recognised and eliminated.

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