PAIN IS WHAT THE PATIENT SAYS IT IS !
Who doesn’t have pain these days…whether it be physical, psychological, mental, emotional, phantom pain…pain is pain and is a impacts people’s of lives, robbing them of happiness and JOY. Most days people just deal with pain, but as a nurse, it is our duty and responsibility to assess and treat a patient’s pain while they are in our care.
Pain is one of the most common complaints or ailments of a patient, and is usually what makes them seek medical attention. Think about it, if someone has no pain, there is no need to seek medical are, or answers for the pain. It is generally considered one of the vital signs.
There are 4 primary vital signs: BLOOD PRESSURE, PULSE/HEART RATE, TEMPERATURE and RESPIRATIONS.
Pain is so important that is considered as the 5th or 6th vital sign, depending on the organization where you work.
Although pain is subjective, there are objective findings that can be seen in the Vital signs due to stimulation of the sympathetic nervous system (increased heart rate, blood pressure), but also the Parasympathetic nervous system (Decreased heart rate, blood pressure), as in vaso-vagal stimulation, think of those who “pass out due to pain”.
WHAT IS PAIN???
Pain is a general sign that something in the body may not be working or functioning properly. It may present as a variety of types of pain, such as dull or throbbing, aching, stabbing, and many other descriptions. Pain can be described as acute, which is sudden in its onset, due to injury, or a blockage; or Chronic, a pain that has been present for years, and can result from acute pain.
So then, how do you measure pain?
Through scales… not weight scales, but subjective number scales.
Pain is usually measured on a “PAIN SCALE” such as :
The NUMERIC Scale: 1 TO 10, or zero to 10. Zero being no pain and 10 being the worst pain. Another common scale is the WONG-BAKER FACES PAIN SCALE.
Other pain scales may include:
FLACC SCALE; CRIES SCALE; COMFORT SCALE; MCGILL SCALE, COLOR-ANALOG SCALE; MANKOSKI SCALE; BRIEF PAIN INVERTORY SCALE; DESCRIPTOR DIFFERENTIAL SCALE OF PAIN INTENSITY.
Remember Pain is subjective, and every person can tolerate pain at different levels.
Some people have different GOALS OF PAIN relief. Some may have the expectation of being totally Pain free, and want a zero pain level; while those who live with chronic pain may only want relief from the intense, burning pain at that moment.
Pain is not always curable, or may not go away entirely, but there are ways to treat pain, such as Pain medication, rest, surgery, acupuncture, or even meditation.
It is always good to ask the patient what is a comfortable or tolerable pain level if ZERO cannot be achieved.
In the hospital, or whatever healthcare setting, if you have given a medication or performed a nursing intervention, such as positioning, or position changes, pillows, turned the lights on or off, or improve the quietness of the environment for the patient, always assess before and after the medication or intervention. As always, then document, so it can be qualitatively measured how well the intervention worked or didn’t work.
HOW DO YOU ASSESS FOR PAIN?
As I mentioned, Pain is subjective, and cannot be directly measured. There is no “Pain Meter” that exists to measure a patient’s actual pain, that would be awesome! Can you imagine…scanning a patient’s forehead like a thermometer gives a temperature, yet it gives a pain level! Also, every person tolerates Pain at different levels. However, there is the patient as a PAIN METER, who can give you a Pain level as I just mentioned, as well as location, and even describe the type.
One thing you must remember, Pain is what the patient says it is!
In addition to using a pain rating scale, or numerical scale, Pain can be assessed a little further using a different type of scale.
This scale is the PQRST scale, or as it is also referred the OPQRST scale. Both are very similar, and will give you a little more information about the patients pain.
So what does PQRST? Scale stand for, or what is it used for. These letters are popular in the medical / nursing field. PQRST is also used in the measurement of a cardiac rhythm…P wave, QST segment T wave, etc.
But this focus will be on the PQRST scale as it is used in assessing Pain!
P: What Provokes the pain… What causes the pain to start or increase, movement..?
P can also refer to Palliation or and does anything relieve the pain…whether it be position, medication, distraction.
Q: What is the Quality of the pain? Is it deep, radiating, sharp, dull, burning, throbbing, aching.
R: where is the pain, or the area, or Region? Location? How large is the area of pain? Does it radiate from one area to another, is it a referred pain?
S: Severity …Rate with pain scale, how intense is it?
T: / O: Some assessment types will have the “O” at the beginning for OPQRT
Some will combine it with the Time.
So Onset or time= When does it begin, how long does it last, how frequent is the pain. Does something make the pain start?
Is there a History of chronic pain?
It is also best to assess a patient’s pain level when they are at rest, and with movement.
Patients need to move, but usually will not move if they are in pain, which puts them at risk for other complicating factors such as pneumonia, and deep vein thromboses, and increase their length of stay in the hospital. That is easily preventable, but first pain has to be controlled so that the patient can get up and get moving.
When assessing and treating pain, be sure to document the pain level, the intervention or Medication used. If a medication was used, document the dose, route, and then follow up with how much of the pain was relieved and then document the new pain level.