Understanding Pain Assessment Tools

Melissa Mills, BSN

Let's talk about pain assessments. Knowing how to assess pain is the first step in effectively treating it. Pain assessments are at the core of good nursing care. All hospitals and other nursing facilities have policies and procedures for pain assessment and management.

It's not just your hospital or other facilities that believes patients have the right to pain control. The Joint Commission implemented new and revised standards for pain assessment and management in January of this year. The new standards require established policies and procedures that address comprehensive clinical assessment of pain, treatment or referral for treatment and reassessment for patients who report having pain.

Changes made by accrediting bodies like The Joint Commission remind us that pain assessments are an important part of our nursing practice. Whether you work in bedside nursing, a clinic, or even telephonically, you must know and understand a variety of pain assessment tools and when to implement them.

Numerical Rating Scale

Most nurses and other healthcare staff are familiar with the Numerical Rating Scale (NRS). It can be administered visually or verbally.

When using the NRS verbally, you simply ask the patient to rate their pain on a 0-10 pain scale. You must educate the patient that 0 is no pain and 10 represents the worst pain imaginable. When using the NRS visually, the same ratings are used. The patient is shown a picture of the 0 to 10 pain scale. It can be vertically or horizontally placed on the paper. Ask the patient to point to the number that best represents their pain rating.

Visual Analogue Scale

The Visual Analogue Scale (VAS) is a unidimensional way to measure a patient's pain. VAS can be shown to the patient in several different ways:

Scales created on a piece of paper that is around 10cm in length with tick-marks placed across the length of the scale. The patient is then instructed to point to the tick-mark that best represents their pain. This is then converted to a 0-10 pain rating.
Box-Scales - Circles are placed equal distances apart from each other and the patient chooses the one best representing their pain.
Wong-Baker Faces - The Wong-Baker Faces scale is commonly used with pediatric patients. Created in 2009 by Dr. Donna Wong, the Faces scale provides a picture with 6 faces that are rated from 0 to 10 running left to right. The expressions on the faces illustrate 'no hurt' up to 'hurts worst' and also run left to right, correlating with the numeric ratings.

You explain to the patient that each face shows a person who has no pain, some pain, and a lot of pain. You then ask them to choose the face that best represents the pain they are experiencing.

Verbal Descriptor Scale

The use of verbal descriptions is the main idea behind the Verbal Descriptor Scale (VDS). It can be given verbally or visually. The scale has two endpoints, 'no pain' and 'very severe pain'. In between these two endpoints are 4-6 other ratings that increase in severity. Common VDS descriptions are similar to this pain scale below:

No pain
Mild pain
Moderate pain
Severe pain
Very severe pain

Pain Drawing

In the pain drawing assessment, the patient is given an outline of a human figure. You then ask them to mark the areas of pain in their body on the outline. You may ask them to circle the pain or shade the body part that is painful. Some pain drawings also ask the patient to use symbols to describe different types of pain, such as burning, stabbing, shooting, or electrifying.

Other Considerations During a Pain Assessment: Along with assessing the patient's severity of pain, you must take into consideration a few other factors contributing to their pain. These factors include:

Chronicity: Acute and chronic pain differ immensely. If a patient has lived with pain for many years, their tolerance to pain will be higher and this may affect their pain scale ratings.

Description

During a pain assessment, you must ask the patient to describe their pain. This could be sharp, shooting, electrical, or dull. These descriptors can help a physician when diagnosing the cause of pain. Try to report the pain descriptions in the patient's own words, even if it does not make sense to you.

Frequency

Find out if the patient's pain is constant or intermittent. You can also ask if anything makes the pain better or worse. For example, if the patient is suffering from an acute ankle sprain, they may report that ambulation makes the pain worse and rest, elevation, and the use of ice makes it better.

Age of the Patient

There are many special considerations related to the patient's age. A pediatric patient may be unable to tell you much about their pain. Older adults may have similar issues with describing the pain as well.

Objective Signs

During your pain assessment, look for any objective signs of pain the patient may be exhibiting. This includes facial grimacing, tachycardia, frowning, guarding, or crying out. A patient who is experiencing pain may be angry, depressed, or irritable.

Pain ratings are subjective. You must always trust what the patient is telling you about their pain and document it using their own words when possible. Pain is an important part of your nursing assessment and can help the patient receive the correct treatment.

What pain assessment do you use? Are there other ways that you assess pain that are helpful in your nursing practice? Comment below. We would love to hear more about your pain assessment practices.