5.6 Pain Assessment

A report of pain by the person who is experiencing it is important because they know their pain best and how to describe it. This is sometimes referred to as the sensory dimension of pain, which includes a client communicating the intensity of pain and other descriptors.

• A subjective assessment of pain is often referred to as a self-report. This commonly includes a verbal self-report, but also can involve pointing or a written self-report.
• Subjective description of pain is only one way to express pain, and inability to communicate by no means indicates that a person is not experiencing pain (International Association for the Study of Pain, 2020).

Common physiological responses from pain may include tensing of muscles, pupil dilation, dry mouth, and a change in vital signs. 

• With acute pain, physiological responses can be important to consider, particularly with certain populations who are pre-verbal or nonverbal.
• Assess for changes in blood pressure, heart rate, and respiratory rate. Pain can cause increases in these vital signs due to the body’s stress response. However, it is important to note that vital signs cannot discriminate between pain and other states of distress such as fear. Additionally, underlying disease processes and medications such as sedation can affect vital signs.

Behaviors associated with pain can include facial and bodily responses such as grimacing, moaning, crying, fidgeting, guarding, and laying still. Other behaviors associated with pain include change in sleep patterns and eating patterns.

• Behavioral dimensions of pain vary widely among clients. Don’t assume someone isn’t in pain if they are not demonstrating any of these behaviors. The presence of these behaviors may be more apparent with acute versus chronic pain.
• Some responses are based on developmental stages and cultural influences. For example, a common behavioral response to pain among infants is grimacing and crying. Another consideration is related to culture and gender. For example, when young boys experience pain, parents often respond by saying “don’t cry, be a big boy.” Among individuals identifying as male, this can lead to more inhibited expressions of pain. Additionally, people with physical disabilities may exhibit pain behaviors in different ways. 

Pain can affect a person’s cognitive functioning in terms of their attention span and their ability to think, reason, acquire and remember knowledge, and learn. 

• Cognitive dimensions of pain will vary based on a client’s developmental stage.
• Effects of pain on cognition can be assessed based on self-reports and empirical tests.

Clients may become anxious, irritable and upset, or have a flat affect (lack of reaction on the face). Chronic pain can affect a client’s identity and social relationships and can lead to social withdrawal and depression.

• It is important to assess a client’s psychological and social response to pain. This can help you understand how pain affects them, their coping strategies, and priorities of care. For example, depression is a serious issue that can affect overall health and well-being.

This dimension refers to the ways that pain interferes with daily functioning (Cleeland, 2009). 

• Reactive dimensions are important to assess in order to understand interference with activities such as walking, sleep, relationships, and mood (Cleeland, 2009).