Lippincott Nursing Pocket Card - August 2023

Pain Assessment



To assess pain adequately and accurately, a multidisciplinary, measurement-based approach is best.




  • 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:
    • the Visual Analog Scale (VAS) – horizontal line with verbal description at each end; patient marks the point on the line that best describes their severity.
    • the Numeric Rating Scale (NRS) – zero to ten scale; patient indicates number that best correlates to their pain.
    • the 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.


  • 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.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.