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Lippincott Nursing Pocket Card - June 2025

Pain Assessment

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Introduction

Nurses have an ethical responsibility to manage pain and the suffering derived from it (Miller, 2024). To assess pain adequately and accurately, a multidisciplinary and measurement-based approach is best.

Types of Pain (Dydyk & Grandhe, 2023)

  • Nociceptive pain originates in the peripheral nervous system and then travels to the central nervous system, creating a pain sensation once the threshold has been achieved.
  • Chronic pain occurs when acute pain is present for three to six months and becomes centralized. Centralized pain occurs with a lower threshold, resulting in a maladaptive form of pain.
  • Neuropathic pain is the dysfunction of the somatosensory tract of the nervous system and can be both peripheral and centralized pain. Neuropathic pain can be a factor in the development of chronic pain.

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History

  • Elicit details about the history of the pain including location, timing (onset, duration, frequency), quality or severity, factors that worsen or alleviate the symptom, and associated manifestations.
  • Ask the patient to describe the pain and how it started.
  • Ask if the pain is acute or chronic.
  • Ask if the pain is related to an injury or if it’s associated with a certain movement.
  • Have the patient describe the quality of the pain. Is it sharp, dull, or burning?
  • Ask if the pain radiates or follows a certain pattern.
  • Ask what makes the pain better or worse.
  • Perform a comprehensive medication history. Ask about both prescribed medications and over-the-counter pain medications.
  • Inquire about any other treatments the patient has tried, such as medical marijuana, physical therapy or alternative therapies.
  • Ask about any co-existing conditions that may impact pain, such as arthritis or diabetes, and recent or past injuries.
  • Find out how the pain affects the patient’s daily activities, mood, sleep, work, and sexual activity.

Assess Pain Severity

  • Use a consistent method to assess severity of the pain.
  • Pain scales that are commonly used include:
    • Visual Analog Scale (VAS)
      • horizontal line with verbal description at each end
      • patient marks the point on the line that best describes their severity.
    • Numeric Rating Scale (NRS)
      • zero to ten scale (0 = no pain; 10 = worst pain imaginable)
      • patient indicates number that best correlates to their pain
    • Wong-Baker FACES® Pain Rating Scale
      • six faces with different facial expressions ranging from “no hurt” to “hurts worst”
      • patient can point to picture that represents their pain level
      • commonly used with children or patients with language barrier or cognitive impairment

Physical Examination

  • Ask the patient to point to the pain.
  • Be alert for changes in vital signs: elevated blood pressure, heart rate, or respiratory rate.  
  • Throughout the physical examination, look for signs of distress: increased respiratory rate, sweating, tearing, and changes in facial expression.
  • Tailor your assessment based on the location and severity of the pain.

Pediatric Considerations (Wrona & Czarnecki, 2021)

Choose the correct pain scale tool based on age/developmental stage.
  • Neonates and infants
    • Premature infant pain profile (PIPP) for less than or equal to 37 weeks gestation
    • Neonatal Infant Pain Scale
    • Face, Legs, Activity, Cry, Consolability (FLACC) scale
    • Child Facial Coding System
    • Crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness (CRIES) score
    • Children’s Hospital of Eastern Ontario Pain Scale
    • Riley Infant Pain Scale
    • Children and Infants Postoperative Pain Scale
  • Toddlers
    • Faces Pain Scale-Revised (FPS-R)
    • Wong-Baker FACES pain rating scale
  • School age and adolescent
    • Numeric rating scales are easy to use and may be verbal (Verbal Numerical Rating Scale) or written (Visual Analogue Scale)

PEARLS

  • Patients who are nonverbal or unresponsive can still experience pain. Note changes in vital signs, facial expression, level of agitation or withdrawal to guide pain assessment and management.
  • A pain diary can be used to complement the history and physical examination.
References: 
 
Dydyk A.& Grandhe S. Pain Assessment. (2023, January 29). Pain assessment. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556098/

Miller, P. H. (2024). Moral distress and pain management: Implications for critical care nurses. Critical Care Nursing Clinics of North America, 36(4), 567–574. https://doi.org/10.1016/j.cnc.2024.04.011
 
Wrona, S. & Czarnecki, M. (2021, March 5). Pediatric pain management. American Nurse. https://www.myamericannurse.com/pediatric-pain-management-individualized-approach/

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