[Note — Always ask the person about frequency, intensity, and control of the pain. Observe the person and ask others who are in contact with the person.]
Intent:
To record the frequency and intensity of any pain the person may be experiencing. This item can be used to identify indicators of pain, as well as to monitor the person's response to pain management interventions. A substantial number of people with pain receive inadequate or no treatment. In particular, people with chronic, non-cancer related pain are often overlooked and not treated. One of the biggest reasons for this is that many people mistakenly believe that pain is to be expected as one ages, or that nothing can be done to relieve their pain.
Process:
Pain is highly subjective. It is what the person says it is. There are no objective markers or tests to indicate when someone is having pain, or to measure its severity. What a person experiences may not be proportional to the type or extent of the underlying tissue damage. Sometimes a specific cause for chronic pain cannot be identified. Regardless, unless the person refuses, pain must always be treated, even if its cause is unknown.
The most accurate and reliable evidence of the existence of pain and its intensity is what the person tells you. Even in cognitively impaired persons, self-reports of pain should be considered reliable.
However, you may not get an accurate answer if you simply ask “Are you in pain?” A person may think of "pain” as a more intense experience after an acute event -- such as what they may have experienced after surgery or spraining an ankle. For example, a woman may have a sore foot that “acts up” when she pivots to transfer to her wheelchair or the toilet but it does not bother her most of the time. So she might deny being "in pain.” People often use different words in describing pain, referring to what they’re feeling as "discomfort", “ burning”, “hurting”, “aching”, “tightness”, “heaviness”, “soreness”, or a “twinge” or “pang.”
If the person states he or she has pain, ask about the degree of control. If the person is unable to tell you if he or she is experiencing some type of painful sensation, observe the person for indicators of pain such as moaning, wincing, or guarding. In some people, the presence of pain can be hard to discern. For example, persons with dementia may not be able to verbalize that they are feeling pain, although they may manifest pain by particular behaviors such as calling out. Although such behaviors may not be indicative solely of pain, the assessor needs to make a determination (through assessment) if the behaviors are secondary to pain. If necessary, ask those who have had frequent contact with the person if he or she complained or showed evidence of pain in the last three days. [Note: The person must first be asked about frequency and intensity themselves.]
Definition:
Pain is defined as “an unpleasant sensory and emotional experience” that is generally associated with actual or potential tissue damage.
Frequency with which person complains or shows evidence of pain (including grimacing, teeth clenching, moaning, withdrawal when touched or other non-verbal signs suggesting pain)
Coding:
0. No pain
1. Present but not exhibited in last 3 days
2. Exhibited on 1-2 of last 3 days
3. Exhibited daily in last 3 days
Intensity of highest level of pain present —
The level of pain reported by or observed in the person.
Coding:
0. No pain
1. Mild
2. Moderate
3. Severe
4. Times when pain is horrible or excruciating
Consistency of pain —
Measures the frequency (i.e., ebb and flow) of pain from the person’s perspective.
Coding:
0. No pain
1. Single episode during last 3 days
2. Intermittent
3. Constant
Breakthrough pain —
The person experienced a sudden, acute flare-up(s) of pain one or more times in the last 3 days. Breakthrough pain might appear as a dramatic increase in the level of pain above that addressed by ongoing analgesics, or the recurrence of pain associated with end-of-dose failure.
Coding:
0. No
1. Yes
Pain Control —
The ability of the current therapeutic regime to control the person’s pain adequately (from the person’s point of view). This item describes the adequacy or inadequacy of pain control measures (e.g., medications, massage, TENS, or other therapeutic regime) instituted by the person, caregiver, or clinical staff caring for the person.
Coding:
0. No issue of pain
1. Pain intensity acceptable to person, no treatment regimen or change in regimen required
2. Controlled adequately by therapeutic regimen
3. Controlled when therapeutic regimen followed, but not always followed as ordered
4. Therapeutic regimen followed, but pain control not adequate
5. No therapeutic regimen being followed for pain, pain not adequately controlled