Monday Med Mania

Pain Assessment Doesn't End with Pain Scale

As a legal nurse consultant I review massive amounts of medical records. Part of that review includes pain assessments of which I can say without hesitation hardly ever provide a sufficient description of patient pain. I'm sure all nurses understand that pain scale was integrated into nursing documentation to help standardize an important part of pain assessment; however, many nurses still do not grasp the concept that pain assessment does not end with pain scale.

I review many medical records that will note a pain scale above zero describing pain intensity and/or severity which then leaves me hanging with many questions regarding a more descriptive evaluation of pain:

• Where is the pain?


• When did the pain start?


• Is this pain the same as previous pain or something new?


• Is the pain constant or intermittent?


• How long does the pain last?


• How long is the absence of pain?


• What type of pain is it? Burning, Stabbing, Dull, Cramping, Pulling, Tearing, Throbbing, Tingling, Aching, etc.?


• Is the pain deep or superficial?


• Can the patient describe if the pain feels like it originates from bone, muscle, organs or skin?


• Does the pain radiate or is it isolated to one specific area?


• What relieves the pain?


• What exacerbates the pain?


• Is the pain associated with anything specific? Food, Activity, Exposure, etc.?


• Are there any associated symptoms with the pain?


• What are the nonverbal signs? Facial Expressions, Crying, Body Movements, Guarding, Position, etc.?


• What are the paitient's current vital signs?

If all these questions can be answered within a pain assessment then there is sufficient documentation regarding patient pain. Even when patients are admitted for pain, a nurse must never assume the paitient's complaint of pain is derived from the same origin as the presenting complaint. An adequate pain assessment is required routinely to determine if the pain is the same or something new, and that can not be determined with a pain scale alone.