Comprehensive Pain Assessment
Pain is a universal human experience. Millions of people experience pain because of surgical procedures, injuries, cancer, and other diseases. A certain percentage of people experience chronic pain without a known cause. Since assessing pain is the first step toward effective pain management, doctors need to have organized methods of evaluating pain in all of their patients, even if those patients are too young to have mastered spoken language, are uncommunicative, speakers of others languages, or hearing or cognitively impaired.
The doctor's attitude is important in pain assessment and treatment. Empathic listening goes a long way to relieving patient anxiety, providing patient support, validating the patient's personal experience, and finding appropriate pain treatments.
Types of Pain
Pain is generally divided into two basic categories: acute and chronic. Acute pain may last for hours, days, or weeks, while chronic pain, which may vary in intensity over time, can persist for months, years, or even throughout a lifetime. Acute pain is typically associated with inflammation, injury, infection, surgery, or a brief disease. Blockages, such as kidney stones or gallstones, can also result in acute pain.
Chronic pain, on the other hand, accompanies disease processes such as cancer, rheumatoid arthritis, osteoarthritis, HIV/AIDS, fibromyalgia, and diabetes. It can also be the result of an injury that has not healed properly, nerve impingement (commonly a cause of back pain), unsuccessful surgery, or phantom limb pain. It has been estimated that nearly 10 percent of the population of the United States lives with moderate to severe nonmalignant chronic pain.
It is possible, of course, for acute pain to become a chronic problem, or for a patient with chronic pain to have acute episodes of greater intensity.
The WILDA® Pain Assessment Guide
The WILDA® Pain Assessment Guide is a condensed approach to assessing pain. It attempts to quantify the subjective pain experience. There are five elements to the WILDA approach.
Words
Patients are asked to describe their pain in words so that the doctor understands the nature of the pain and is better able to address it. The types of pain differentiated by the WILDA guide are:
- Neuropathic (nerve) pain, described as burning, shooting, radiating, tingling, electric
- Somatic (orthopedic) pain, described as aching, throbbing or dull
- Visceral (abdominal or bowel) pain, described as pressure, cramping, distention
The medication administered to relieve pain depends on the the patient's description the pain's known, or suspected, source.
Intensity
Patients are asked to rate their pain on a scale from 0 to 10, with 0 representing a total absence of pain and 10 representing the worst pain possible. This scale is used to rate pain in the present, and after medication or other intervention. This scale helps the doctor to determine whether pain is improving, worsening, or remaining at a constant level.
The Wong/Baker faces rating scale represents each number on the pain scale with a facial expression. This scale is used for pediatric patients, elderly patients who are cognitively or verbally impaired, and patients whose do not speak the language.
Location
The majority of patients experience pain at two or more sites, so it is important for the clinician to be clear regarding which pain site the patient is describing.
Duration
The duration of the pain over a period of time is significant. It is also important that the patient reports any flare-ups during a period of persistent pain.
Aggravating or Alleviating Factors
Doctors can discover a great deal about the source of pain from understanding factors that make the pain worse or better. Emotions, as well as physical acts or medications, may affect the intensity of pain.
In addition to medication, factors helpful in reducing pain may include:
- Music
- Relaxation or visualization techniques
- Massage
- Biofeedback
- Applications of heat or cold
- Injected corticosteroids
- Nerve deadening agents
- Acupuncture
Factors that may exacerbate pain may include:
- Particular movements
- Exertion
- Cold or heat
- Blood draws
- Depression, fear, anxiety,
Factors that aggravate or alleviate pain are individualized, and may even change at times for the same patient. Physical therapy or exercise may either improve the patient's condition or worsen it, depending upon the individual circumstance.
Once pain has been assessed, many types of medications are available to treat various kinds of pain, including: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants, anticonvulsants, benzodiazepines, bone-seeking radio pharmaceuticals, muscle relaxants, and biphosphonates. There are also times when pain requires other medical interventions, or surgical procedures, to be alleviated.