How to Conduct a Pain Assessment
Marijke Durning | NursingLink
If you ask 10 people to describe pain, you will get 10 different responses. Pain is a very individual sensation and it is interpreted differently depending on so many variables. For nurses, this means that not only do we need to understand the mechanisms of pain, we need to understand how pain is interpreted by others.
Stub Your Toe, Do You Say “Ouch?”
We all know that bumping your toe against a table leg can hurt – badly sometimes. But, for some people, it’s a mere annoyance – it hurts and they continue onwards. For others, the pain is excruciating and they can’t take another step. Is it because one person is tougher than the other? Is one more of a complainer? It depends.
Pain Tolerance Vs. Pain Threshold
Your patient’s pain threshold isn’t the same as pain tolerance. Pain threshold is when your patient notices pain – the stimulus has gone from unpleasant to painful. Pain tolerance, on the other hand, is how long your patient can handle the pain before it becomes too much to handle. For example, the patient whose sore toe hurts a little doesn’t need pain medications, and has not reached her tolerance yet, while the second person has reached their limit and cannot go further due to the pain.
As student nurses, we learn to help patients manage pain by teaching them to recognize when they need pain relief – and this is generally well below their pain threshold. Once the pain has reached this threshold, it usually becomes more difficult to manage than if the pain was interrupted earlier.
Seeing as we’re human, nurses should be wary of bringing their own baggage when assessing a patient’s pain. We react to others’ pain in a few different ways.
Our own reactions
Although we may not be aware of doing this, it isn’t unusual for a nurse to subconsciously put himself into the patient’s situation and decide what is likely to be painful and what isn’t. This could result in under-medicating a patient whose pain levels are intolerable.
Our own expectations
We may feel that someone who is in pain should display certain behaviors, such as grimacing or moaning. If the patient doesn’t act in a way we expect, we may not believe that they are in as much pain as they claim to be in. Or, our assessment may be that pain relief isn’t needed because the patient isn’t displaying the appropriate behaviors and not asking for medication.