State budget institution of vocational education – college for Further education

“Shentala Medical School”

Yarullina Landysh

Group 2101

Abstract in English

Topic: Methods of assessing pain

Project supervisor

N.N. Arinina

Project Defense

Is permitted by

The Vice – principal

for General Education

College for Further education

Shentala 2012

CONTENTS

Key words ………………………………………………………………..3

Introduction ………………………………………………………………..4

Part I What is pain? ……………………………………………….5

Part II Why is pain difficult to assess? …………………………..6

Part III Methods of assessing pain ………………………………..8

Conclusions ………………………………………………………………14

Bibliography ………………………………………………………………15

Annex ………………………………………………………………16

KEY WORDS

pain, acute and chronic pain, to assess pain, tools of assessing pain, The Wong Baker Faces Pain Scale, The Numerical Rating Pain Scale, The FLACC pain scale, The CRIES Pain Scale, The COMFORT Scale, The McGill Pain Questionnaire, describe the intensity, duration and severity of your pain, the main types of information that are useful for a doctor

Introduction

The subject of this course paper is methods of assessing pain.

The aim of this paper is to find some optimal ways of assessing pain.

Writing this paper there were three goals in mind:

• to find out about the pain in general;

• find the answer to the question “Why is pain difficult to assess?”;

• to get acquainted with the methods of assessing pain.

The books and articles of the following authors constitute the theoretical basis for this work: C. Chan Gunn, MD, Marco CA, Marco AP, Plewa MC, Buderer N, Bowles J, Lee J. and others.

In this paper I first present information about pain in general, then attempt to show the reasons of difficulties in assessing pain, in conclusion the methods of assessing pain are considered.

Part I What is pain?

The dictionary gives several meanings to the word “pain”. There is the archaic definition, meaning punishment: “Upon pain of death thou shalt not.... Even today, when pain is mentioned, there is still a deep down, subconscious feeling that there has to be a guilty reason for it and that the patient must “suffer”, which is another meaning given to the word. Another meaning is that of hardship and toil - “he took pains to accomplish this”. The definition used by the International Association for the Study of Pain is: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage”. But this definition can be misleading because pain, the central perception of noxious input, is not just one, but at least three distinct entities, and pain can also arise when there is no apparent tissue damage.

Pain is a sensation that hurts. It may cause discomfort, distress or agony. It may be steady or throbbing. It may be stabbing, aching, or pinching. However you feel pain, only you can describe it or define it. Because pain is so individual, your pain cannot be “checked out” by anyone else.

Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals.

Chronic pain is distressing because it affects the sufferer on many levels. It affects them:

• physically - with sensations of discomfort

• emotionally - with feelings of despondency and hopelessness

• psychologically - with depression and dissolving self-esteem

• socially - as they descend into isolation

• occupationally - as tasks become more difficult to perform

Chronic pain may range from mild to severe, and it is present to some degree for long periods of time.

Part II Why is pain difficult to assess?

It is important to measure the pain in order to know about it. Pain is something that is experienced by the person at some place for some period at some time. The effective way of communicating the pain is done by the person who has it. If that person describes about it, then it is easy to record the information and convey it to the doctor. If the communication of the suffering patient is not proper, it will be difficult to assess the pain. But still, the pain can be assessed with the help of physical signs and symptoms with which they tell us how they feel. The sufferer has to assess the pain himself though he gives the information to health care provider periodically.

Pain is difficult to be assessed as it will not be identified by blood tests. The similar injury in one person can bring lot of difference in the pain. Pain can be measured by allowing the patient who suffers to explain about it. The patient can be asked to rate their pain as mild or moderate or severe. The chemically paralyzed and those with neurological injury cannot assess their pain. In these situations, the judgement regarding pain can be made based on present circumstances or patient history.

It is often difficult to describe pain, because everyone reacts so differently to it. For example, a person suffering with intense pain may bear it better than someone with a lower level of tolerance does. Because each person's reaction varies, pain must be measured indirectly, based upon information offered by the pain sufferer. This is why it is important to describe pain to your physician as clearly as possible. In order to do that, you must know how to show where it hurts and correctly describe the intensity, duration and severity of your pain.

The main types of information that are useful for a doctor are:

• How and when the pain started. Give details on how long the pain has persisted, what caused it (following what kind of event) and how it started (gradually or suddenly).

• The location of the pain. Show the point where it hurts or areas where the pain travels.

• Pain characteristics. Describe the duration, frequency, intensity (mild, moderate, intense, severe, etc.) and quality of the pain (continuous, intermittent, throbbing, etc.). Describing pain is not easy. This is why a pain rating scale is a useful evaluation technique.

• Associated symptoms. Tell your doctor whether other symptoms (sluggishness, fatigue, fever, etc.) are present.

• Pain response to activities. Describe activities that increase the pain and also those that relieve it.

What improves or worsens the pain. Describe situations that make your pain better or worse. These can include changes in weather conditions, living or working environment, lifestyle, etc.).

Part III Methods of assessing pain

Most scales make pain measurable, and can tell providers whether your pain is mild, moderate or severe. They can also set baselines and trends for your pain, making it easier to find appropriate treatments. If your pain rating decreases after you take a certain medication, for example, then clearly that medication worked for you. If there was no change, or if the number increased, then your doctor knows it is time to try something else.

This is also true in the case of a verbal rating scale. Even though there is no numerical rating, doctors can look for a change in the intensity of pain words. You may initially describe your pain using more words from a high-intensity group. A treatment could be considered effective if in you choose more moderate pain descriptors afterward.

When a nurse asks you to rate your pain, try to be honest. Don’t exaggerate your pain. If you rate your pain as 10 out of 10, but are chatting happily on the phone with your spouse, you are probably not rating it accurately. This is also true if you rate your pain as a two, yet you feel like it might make you faint. The more accurately you describe your pain experience, the better your caregivers can help you control your pain.

Pain scales can also be an effective communication tool at home. Teach the scales to your family. Use a face scale to demonstrate the effects of your pain when talking to your children. Tell your spouse when you are a level eight, and show your children when you are at two tears. Using numbers and faces can help you communicate an otherwise subjective experience to the people you love.

• Numerical rating: Usually based on a scale from zero to 10, this scale assigns a measurable number to your pain level. Zero represents no pain at all while 10 represents the worst imaginable pain.

• Wong-Baker: Represented by faces with expressions, this scale follows the same guideline as the numerical scale. Zero is represented by a smiley face, while 10 is represented as a distraught, crying face. This scale is useful when rating pain in children, or for adults with mild cognitive impairments.

• Verbal rating scales: Using words to describe pain rather than a measurable scale makes verbal rating scales a qualitative measurement technique. In other words, the person in pain describes the intensity of pain, and how they feel. An example is the McGill Pain Questionnaire.

• Observer scales: Often used with people who are unable to communicate their pain level effectively, observation-based scales offer objective measurements for pain. These include facial expression, muscle tone, blood pressure and heart rate. Some examples of observer pain scales are the FLACC scale, the CRIES scale and the COMFORT scale.

The primary stage of assessing the pain is to first identify the intensity of the pain at that given moment. There are tools that are available which can make the person suffering from pain to explain clearly about it. In adults, the pain assessment is done at a scale of 0-10. Zero indicates no pain while ten indicates extreme pain. The pain to be expressed by the children or adults who cannot tell about that verbally will be able to assess the pain by using Wong-Baker FACES pain rating scale.

The Wong Baker Faces Pain Scale combines pictures and numbers to allow pain to be rated by the user. It can be used in children over the age of 3, and in adults. The faces range from a smiling face to a sad, crying face. A numerical rating is assigned to each face, of which there are 6 total.

Perhaps one of the most commonly used pain scales in healthcare, the numerical rating scale offers the individual in pain to rate their pain score. It is designed to be used by those over the age of 9. In the numerical scale, the user has the option to verbally rate their scale from 0 to 10 or to place a mark on a line indicating their level of pain. 0 indictates the absence of pain, while 10 represents the most intense pain possible.

The Numerical Rating Pain Scale allows the healthcare provider to rate pain as mild, moderate or severe, which can indicate a potential disability level.