PAIN ASSESSMENT,

REASSESSMENT
& MANAGEMENT
Sumi Nath
Bsc. Nursing, MBA(HA), CCEPC
CONTENTS
01 DEFINATION OF PAIN

02 CLASSIFICATION OF
PAIN

03 ASSESSMENT METHOD

04 MANAGEMENT
Pain is broadly defined as the unpleasant sensations in the body resulting due to the complex
experience of various factors like physical, psychological and emotional. Pain is subjective as pain
tolerance differs from person to person. Pain cannot be quantified as it is associated with the
effective as well as sensory components.

Pain is classified into various categories depending upon the duration, location, intensity and
etiology of the pain. Pain can be acute or chronic depending on the duration of the pain. Acute
pain is not long-lasting as it gets resolved within a short duration whereas pain that cannot be
resolved within six months is considered chronic pain.
 PAIN
“An unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage. ”
ACUTE PAIN- PAIN DOESNOT
RESOLVE WITHIN 6 MONTHS

CHRONIC PAIN

MORE THAN 6 MONTHS

Acute Pain
Acute pain lasts for less than six months (i.e., minutes, hours, a few days, or months) and is often caused by a specific
injury or event, such as:

Surgery
Broken bones
Cuts or burns
Dental work
Labor and childbirth
Chronic Pain
Chronic pain is pain that has lasted for over six months and is frequently felt. It can also persist for years and ranges from
mild to severe on any particular day. Chronic pain is often a result of health conditions such as diabetes, cancer,
fibromyalgia, circulation problems, back pain, and headache.

Without proper medication, chronic pain can affect one’s quality of life, at times even leading to depression or anxiety
Neuropathic Pain
Neuropathic Pain is due to nerve damage or other parts of the nervous system. It’s usually described as stabbing, burning,
shooting, or sharp pain. Other people describe it as being like an electric shock. It can also affect sensitivity to touch and
cause someone to experience difficulty feeling cold or hot sensations.

Common causes of neuropathic pain include:

Cancer
Alcoholism
Stroke
Limb amputation
Chemotherapy drugs
Radiation
Diabetes
Nociceptive Pain
Nociceptive pain is pain due to damage of body tissues. People usually describe it as a throbbing, sharp, or achy pain. And
it is often caused by an external injury such as hitting your elbow, falling and scrapping up your knee, twisting your ankle,
or stubbing your toe. This type of pain is often felt in the bones, skin, joints, tendons, and muscles.
Chronic pain can feel like: Chronic pain may make you feel:

Sharpness Tired / Fatigued

Aching Irritable
Dullness Nauseous
Pins and needles Angry
Burning Frustrated
Shooting Depressed
Throbbing Anxious
Numbness Hopeless
Tenderness Mentally or physically exhausted
Tingling
Unbearable
 T TO O L S
N AS S E S S ME N
PAI
 ASSESSMENT
&
REASSESSMENT
Acute Pain: Any pain of less than 6 weeks duration.

Chronic Pain: Any pain of more than 6 weeks

duration
The patient’s report of pain shall be accepted as the key indicator of the amount of pain

experienced.While acknowledging all forms of pain cannot be controlled in all patients 100% of the

time, every effort shall be made by the interdisciplinary team to:

•The first Assessment of pain shall be done in OPD and in IPD on admission.

•Age specific pain scales are used for Pain assessmentfor different category of patient.

•All assessments and reassessments and interventions shall be documented in the Pain Assessment form.
PATIENT CATEGORY NAME OF FORMAT PAIN SCALES USED

ADULT SEDATED PATIENTS SEDATION & PAIN ASSESSMENT CRITICAL CARE PAIN OBSERVATION
AGE MORE THAN 7 YEARS TOOL (CPOT)

NEONATES SEDATED PATIENTS SEDATION & PAIN ASSESSMENT NEONATAL INFANT PAIN SCALE (NIPS)
AGE 0-1 YEAR

PAEDIATRIC SEDATED SEDATION & PAIN ASSESSMENT FACE, LEGS, ACTIVITY,

PATIENTD AGE 1-7 YEARS CRY,CONSOLABILITY SCALE (FLACC)

NEONATE CONSCIOUS PATIENT PAIN ASSESSMENT FORM-AGE NEONATAL INFANT PAIN SCALE (NIPS)
GROUP LESS THAN 1 YEAR OLD

PAEDIATRIC CONSCIOUS PAIN ASSESSMENT & FACE, LEGS, ACTIVITY,

PATIENT 1-7 YEARS OLD REASSESSMENT 1-7 YEARS CRY,CONSOLABILITY SCALE (FLACC)

PAEDIATRIC MORE THAN 7 PAIN ASSESSMENT & NUMERICAL RATING SCALE (NRS)/
YEARS OLD & ADULT REASSESSMENT MORE THAN 7 VISUAL ANALOUGE SCALE (VAS)
CONCIOUS YEARS & ADULT
1.The patient shall be assessed for pain at the time of initial assessment by nurse and doctors.
2.The scope and complexity of care shall be determined through the assessment and evaluation of patients
3.Assessment criteria used to establish the patient care needs may include, but are not limited to,
clinical presentation, diagnostic testing, patient interview, the patient’s experience with pain, and
information obtained from other sources of assessment.
Patient/Family Education
When appropriate, patients and families shall be educated by the medical/nursing staff about an
expected result of treatments, procedures, or examinations;
Risk factors for pain
The importance of effective pain management
Use of the appropriate pain assessment scale and process•Methods for pain management when identified as part of
treatment
Education shall be documented in the medical record (Patient and Family Education form-NH/PFE/001)
MANAGEMENT
In 1986, the World Health Organization (WHO) proposed the WHO analgesic ladder to provide adequate pain
relief for cancer patients. The analgesic ladder was part of a vast health program termed the WHO Cancer Pain
and Palliative Care Program, aimed at improving strategies for cancer pain management through educational
campaigns, creating shared strategies, and developing a global network of support.
The original ladder mainly consisted of three steps :
First Step - Mild pain: non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or
acetaminophen with or without adjuvants

Second Step - Moderate pain: weak opioids (hydrocodone, codeine, tramadol) with or without non-opioid
analgesics and with or without adjuvants

Third Step - Severe and persistent pain: potent opioids (morphine, methadone, fentanyl, oxycodone,
buprenorphine, tapentadol, hydromorphone, oxymorphone) with or without non-opioid analgesics, and with or
without adjuvants.
NURSING MANAGEMENT
Causes (Related to)
The most common cause of acute pain is damage to the body tissues. It can be related to three types of injury agents;
physical, biological, or chemical. Acute pain can also be related to psychological causes or exacerbations of existing
medical conditions.

Biological injury agents include bacteria, viruses, and fungi that harm the body and cause pain.
Chemical injury agents are typically caustic and can cause harm in various ways.
Physical injury causes pain normally thought of when someone is hurt, such as a broken bone, laceration, or following a
surgical procedure.
 ASSESSMENT- PQRST

Subjective (Patient reports)

Verbal reports from the patient
Expressions of pain, such as crying
Unpleasant feeling (such as a prick, burn, or ache)

Objective (Nurse assesses)

Significant changes in vital signs
Changes in appetite or eating patterns
Changes in sleep patterns
Guarding or protective behaviors
GOAL & EXPECTED OUTCOME

The following are the common nursing care planning goals and expected
outcomes for acute pain:

 Patient will report relief of pain.

 Patient will rate the pain scale lower than the initial rate at a level that is
acceptable to them or 0/10.
 Patient will manifest vital signs within normal limits.
 Patient will verbalize regaining appetite and sleep .
INTERVENTION
1. Administer the appropriately prescribed analgesic.
Analgesic drugs like NSAIDS, opioids, and local anesthetics pharmacologically reduce acute pain quickly and
effectively.

Painkillers available over the counter, such as acetaminophen, aspirin, or ibuprofen

Prescription pain relievers, such as corticosteroids or specific COX-2 inhibitors
Opioid drugs, which may be administered for severe pain after an operation or injury
Specific neuropathic pain or functional pain syndromes may be treated with antidepressant or seizure medicines.

2.Follow the pain ladder.

The pain ladder is crucial for assessing the patient’s pain level and prescribing the appropriate drugs. The pain
ladder comprises a three-step transition from non-opioids through mild opioids to potent opioids to provide
adequate pain relief. It consists of three steps:
Mild pain uses non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
Moderate pain utilizes weak opioids (such as hydrocodone, codeine, and tramadol) with or without non-opioid
pain relievers.
Severe and persistent pain uses potent opioids with or without non-opioid painkillers. Potent opioids are
morphine, methadone, fentanyl, oxycodone, buprenorphine, tapentadol, hydromorphone, and oxymorphone.
3. Assess the appropriateness of a patient controlled analgesia (PCA) pump.
Assess if the patient is a PCA candidate. PCA is the IV infusion of opioids through a pump controlled by the patient. If
the patient meets the criteria, this can be a more effective method of pain management. PCA enables patients to self-
administer analgesia and gives the patient some degree of control over the dosage they receive. It is important to assess if
the patient is both physically able and willing to hit the PCA button but also mentally competent to understand that doing
so will relieve their discomfort.
4. Evaluate pain after interventions.
Reassess pain level after 30 minutes of interventions. It is essential to reassess pain following interventions to determine
if those actions were practical and if the patient’s pain control goals have been met. Also take into consideration how long
it will take the medication administered to reach its maximal effectiveness. Some medications such as those administered
IV will take effect almost immediately, while others may not reach peak efficacy for hours.
5. Educate the patient about pain management.
Teach regarding effective timing of medication doses prior to activities that exacerbate pain and to avoid periods of
intense pain. Patients can help effectively manage their pain with additional knowledge of when to request pain
medication to maximize its effectiveness and prevent severe pain episodes.
If the patient is not able to verbally respond to questions, the nurse can request that the patient nod their head, squeeze
their hand, move their eyes up and down, or raise their fingers, hand, arm, or leg to indicate the presence of discomfort. If
applicable, provide the patient with writing materials, pain intensity charts, or numbers they can reference.
6.Encourage feedback from the patient.
Instruct the patient to assess the interventions’ effectiveness and report the effectiveness of different interventions to the
care team. Feedback can assist the care team in modifying and improving pain control strategies. Ask the patient how
much pain they were experiencing both before and after taking pain management. What were actions taken if the patient’s
pain level was intolerable?

7. Respond immediately to reports of pain.

If the patient is experiencing an altered passage of time due to pain, fear of delayed pain relief can exacerbate the pain
experience. Prompt responses to reports of pain reduce anxiety and promote trust.

8. Promote periods of rest for the patient.

Fatigue can contribute to pain. A quiet, darkened room with minimal noise and interruptions can promote rest and reduce
pain
9. Encourage the use of non-pharmacological therapy.
Use relaxation and breathing exercises and music therapy. These techniques help produce a sense of tranquility for the
patient. The goal is to reduce pain related to tension or stress. Complementary therapies are:

Biofeedback teaches the patient to control bodily functions like breathing actively.
Acupressure or acupuncture stimulates particular pressure spots on the body to relieve pain.
Massage relieves tension and pain by pressure and rubbing the muscles or other soft tissues.
Meditation releases tension and stress by concentrating on thoughts in specific ways during meditation.
Yoga or tai chi combines slow and intentional movements with deep breaths to relax the muscles.
Natural relaxation practices continuous muscle relaxation where the patient can contract and relax various muscles.
Guided imagery can picture something comforting for the patient, diverting them from pain.
10. Remove the stimuli.
Divert away the patient’s attention from the painful stimuli using effective distractors that can reduce the pain the patient
perceives. Provide appropriate and engaging distractions for the patient to redirect their attention. Diversional therapy
involves using the mind to redirect the attention to something else. The patient can put the pain on hold and concentrate
instead on things like playing games, counting, practicing breathing exercises, and many other things.

11. Monitor for side effects of medications.

Monitoring for side effects is also essential to maintain the patient’s comfort and safety. Drugs have varying effects based
on each person’s metabolism, and efficacy should be evaluated case by case. Sedation, mental fogginess, nausea, vomiting,
constipation, physical dependence, tolerance, and respiratory depression are typical adverse effects of opioid treatment.
Watch out for physical dependence that may put the patient at risk for overdosage and poor pain management.
12. Anticipate the need for pain relief.
Pain is most effectively managed by preventing it. Intervening as soon as possible can decrease the total amount of
analgesic needed to provide adequate pain control.

13. Refer to therapies.

Physical therapy could ease the pain brought on by illnesses like multiple sclerosis or arthritis, as well as injuries.
While occupational therapy may teach patients how to modify their routines and environments to minimize pain.

14. Apply a compress.

To relieve uncomfortable swelling and inflammation brought on by injuries or persistent illnesses like arthritis, apply
an ice pack or cold pack wrapped in a towel. While using heating pads or a warm bath relieves cramps, pain, or
muscle stiffness.
15. Follow RICE for minor injuries.
For minor injuries that do not require medical attention, follow RICE:

Rest the affected area.

Ice the affected area with a towel-wrapped cold pack for 10 to 20 minutes to reduce swelling.
Compress by wrapping the affected area with an elastic bandage to provide support. It should be applied tightly
enough to prevent numbness.
Elevate the affected area above the heart to encourage venous return.
NURSING DIAGNOSIS
1.Acute pain related to an orthopedic surgical procedure of the left lower extremity can be caused by a bone fracture
and inflammation, as evidenced by a heart rate of 112 bpm, guarding of the left lower extremity, reports of pain, and
pain scale of 8/10

2. Acute pain related to acute bronchitis can be caused by a viral infection, as evidenced by patient reports of chest and
throat soreness, a pain scale of 8/10, lack of appetite, and grimacing while coughing and speaking.

3.Acute pain related to psychological distress can be caused by anxiety and fear, as evidenced by the patient verbalizing
pain, moaning and crying, narrowed focus and altered passage of time, and pallor.

4.Acute pain related to skin and tissue damage caused by chemical burns, as evidenced by patient reports of burning
pain rated 6/10, restlessness when lying down, and antalgic positioning to avoid pressure on the back
THANKS