pain assessment, an evaluation of the reported pain and the factors that alleviate or exacerbate it, as well as the response to treatment of pain. Responses to pain vary widely among individuals, depending on many different physical and psychological factors, such as specific diseases and injuries and the health, pain threshold, fear, anxiety, and cultural background of the individual involved, as well as the way the person expresses pain experiences. See also pain intervention, pain mechanism. ▪ METHOD: The patient is asked to describe the cause of the pain, if known; its intensity, location, and duration; the events preceding it; the pattern usually followed for handling pain; previous treatments and effectiveness; allergies; and ways in which the pain has affected the activities of daily living. Intensity of pain is often assessed by using pain scales (numeric or face scales). Severe pain causes pallor; cold perspiration; piloerection; dilated pupils; and increases in the pulse, respiratory rate, blood pressure, and muscle tension. When brief, intense pain subsides, the pulse may be slower and the blood pressure lower than before the pain began. If pain occurs frequently or is prolonged, the pulse rate and blood pressure may not increase markedly, and, if pain persists for many days, there may be an increased production of eosinophils and 17-ketosteroids and greater susceptibility to infections. The patient’s statements regarding pain; tone of voice, speed of speech, cries, groans, or other vocalizations; facial expressions; body movements; or tendency to withdraw are all noted. Pertinent background information in the assessment includes a record of the patient’s chronic conditions, previous surgery, and any illnesses that caused pain; the patient’s experiences with relatives and friends in pain; the role or position of the patient in the family structure; and the patient’s use of alcohol and drugs, including use of OTC and illicit drugs. Key aspects in evaluating pain intensity are the size of the area, the tenderness within the pain area, and the effects of movement and pressure on the pain. Duration of pain is considered in terms of hours, days, weeks, months, or years. Pain patterns are associated with various sensations such as burning, pricking, aching, rhythmic throbbing, and effects on the sympathetic and the parasympathetic nervous systems. Evaluation includes the meanings the individual may attach to pain, such as a test of character, a penance, or a sign of worsening illness. Such interpretations may affect the intensity of pain and mask its significance. ▪ INTERVENTIONS: Health care providers must establish a relationship with the patient; they often use individual or group counseling to teach patients about pain and how to modify the anxiety associated with it. Analgesics are usually prescribed and should be administered before the pain becomes intense. In addition to rest and relaxation, approaches to pain relief may include the reduction of noxious stimuli, the provision of pleasant sensory input, and the distraction of the patient by using guided imagery. A referral of the patient to a pain clinic is appropriate for chronic pain. ▪ OUTCOME CRITERIA: Dramatic relief of intense or chronic pain is often difficult to accomplish, but the patient can be helped to learn to handle pain effectively and to function fairly normally.
