Pain Assessment and Pain Management

• Define Acute Pain

  Normal and time-limited response to trauma, including medical procedures and acute medical conditions. If poorly managed, it can lead to more serious health issues, including chronic pain.
• Characteristics of Acute Pain

  • Sudden onset
  • Temporary
  • Localized 
  • Short-term: less than 3 months
  • Identifiable cause such as trauma, surgery, or inflammation
• Signs and Symptoms of Acute Pain

  • Sharp pain, throbbing, burning, stabbing pain
  • Tingling, weakness, numbness
• Causes of Acute Pain

  • Blunt trauma 
  • Broken bones
  • Surgery
  • Dental work
  • Childbirth
  • Cuts and infections 
  • Burns 
  • Pulled or strained muscle 
  • Sprains of body part
• 3 types of Acute Pain

  1. Somatic pain
  2. Visceral pain
  3. Referred pain
• What is the most common type of pain experienced by patients with cancer?

  Somatic Pain
• Define Somatic Pain


  1. Occurs when pain receptors in tissues (skin, muscles, connective tissues) are activated

  2. Typically, stimuli such as force, temperature, vibration or swelling activate these receptors

  3. This type of pain is often described as cramping
• How Somatic Pain Feels Like


  Aching, dull, knife-like, throbbing, spasm, pounding
• Examples of Somatic Pain


  • Cut on the skin or burn
  • Sprained ankle
  • Muscle strain
• Define Visceral Pain


  • Pain emanating from the internal thoracic, pelvic, or abdominal organs
  • Generally vague, poorly localized, and characterized by hypersensitivity to a stimulus such as organ distension
  • This type of pain is often described as a dull ache that stems from the internal organ
• How Visceral PainFeels Like


  pressure, squeezing, deep, dull, cramping
• Example of Visceral Pain


  • Pain from appendicitis
  • Gallbladder pain
• Define Referred Pain

  • Felt at a site distant from the site of origin
  • This happens because all the nerves in the body are part of a huge, connected network
  • Can occur anywhere, but most commonly in the neck, shoulders, back, teeth, jaws
• How Referred Pain Feels Like


  aching, gnawing, annoying, drilling, pressing
• Example of Referred Pain


  • Pain experienced in the jaw or arm by a person having MI
• Define Chronic Pain


  • Long-standing pain that persists beyond the usual recovery period
  • OR occurs along with a chronic health condition such as arthritis
  • Can affect people to the point it impacts their activities of daily living and quality of life
  • (more than 3 months)
• 1 in 5 Australians (including children) live with chronic pain
• 1 in 3 Australians over 65 live with chronic pain
• Chronic pain is the 3rd most costly health burden
• Define Nociceptive Pain


  • Pain associated with tissue injury or damange or even potential damage
  • Nociceptors are sensory endings on nerves that can be excited or sensitised and signal potential tissue damage
• How Nociceptive Pain Feels Like

  sharp, aching, throbbing
• Examples of Nociceptive Pain


  • Osteoarthritis
  • Pelvic pain
  • Rheumatoid arthritis
• Define Neuropathic Pain


  • Pain caused by a lesion or disease of the somatosensory nervous system
  • It includes multiple diseases with various signs and symptoms
• How Neuropathic Pain Feels Like


  burning, tingling, shooting, stabbing
• Examples of Neuropathic Pain


  • shingles
  • sciatica
  • diabetic neuropathy
• Define Nociplastic Pain


  • Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors
  • This may cause changes in the way the nervous and immune systems function
• How Nociplastic Pain Feels Like


  diffuse, poorly localized, hypersensitivity to pain
• Examples of Nociplastic Pain

  • Complex Regional Pain Syndrome (CRPS)
  • non-specfic lower back pain
• Pain perception


  Subjective, influenced by complex interactions of biological, psychological, and social factors
• Pain assessment and management

  Guided by expected severity and assessment of patient-reported pain intensity, and impact of pain on patient's function
• Visual Analogue Scale (VAS)

  Subjective measure for acute and chronic pain, 0-10 scale with 0 being no pain and 10 being the worst pain imaginable
• PQRST


  1. Provoke

  2. Quality

  3. Radiate

  4. Severity

  5. Time
• FLACC tool


  Face, Legs, Activity, Cry, Consolability, 0-2 scale leading to a total pain score between 0 and 10
• Wong-Baker Faces Pain Rating Scale


  Self-reported pain scale with a series of faces ranging from "no hurt" at 0 to "hurts worst" at 10
• Modified Pain Assessment Tool (mPAT scale)


  Focuses on behavioural and physiological responses to painful stimuli based on the nurse's perception
• Non-verbal signs for Dementia Patients

  • Facial grimacing
  • Gestures to indicate distress
  • Moaning with movement
  • Limited range of motion or slow movement
  • Increased HR, BP, sweating
  • Withdrawn social behaviour
  • Disrupted or restless sleep
  • Increased confusion
  • Anger, aggression, irritability
• Pain Assessment in Advanced Dementia Scale (PAIDAD)


  Assesses breathing, negative vocalizations, body language, and the ability to be consoled in patient with advanced dementia
• Assessing pain in Patients with an Intellectual Disability

  • Assessment requires combination of approaches: Pain assessment, Health assessment, Observation of behaviours
• Pharmacological Strategies for Pain Management

  • Simple Analgesics
  • NSAIDs
  • Opioids
  • Anti-convulsant Medications
  • Anti-depressants
  • Ketamine
  • Nitrous Oxide
  • Local Anaesthetic Agents
  • Anti-emetics
• Simple Analgesics


  Treat mild and moderate pain, improve efficacy of morphine when used in combination