13.1 Pain assessment and classification

Pain is a complex sensory experience that affects millions of people worldwide. Understanding its types, characteristics, and assessment methods is crucial for effective management. From nociceptive to neuropathic pain, each type presents unique challenges for patients and healthcare providers alike.

Accurate pain assessment is the cornerstone of effective treatment. Various tools, such as numeric rating scales and comprehensive questionnaires, help healthcare professionals evaluate pain intensity and quality. Distinguishing between acute, chronic, and breakthrough pain guides tailored management strategies, improving patient outcomes and quality of life.

Pain Assessment and Classification

Types and characteristics of pain

Top images from around the web for Types and characteristics of pain

• 

  Frontiers | Neuropathic Itch: Routes to Clinical Diagnosis View original

  Is this image relevant?

• 

  10.4 Nursing Process for Pain and Mobility – Nursing Pharmacology View original

  Is this image relevant?

• 

  Frontiers | Novel Neuropathic Pain Mechanisms Associated With Allergic Inflammation View original

  Is this image relevant?

• 

  Frontiers | Neuropathic Itch: Routes to Clinical Diagnosis View original

  Is this image relevant?

• 

  10.4 Nursing Process for Pain and Mobility – Nursing Pharmacology View original

  Is this image relevant?

1 of 3

Top images from around the web for Types and characteristics of pain

• 

  Frontiers | Neuropathic Itch: Routes to Clinical Diagnosis View original

  Is this image relevant?

• 

  10.4 Nursing Process for Pain and Mobility – Nursing Pharmacology View original

  Is this image relevant?

• 

  Frontiers | Novel Neuropathic Pain Mechanisms Associated With Allergic Inflammation View original

  Is this image relevant?

• 

  Frontiers | Neuropathic Itch: Routes to Clinical Diagnosis View original

  Is this image relevant?

• 

  10.4 Nursing Process for Pain and Mobility – Nursing Pharmacology View original

  Is this image relevant?

1 of 3

• Nociceptive pain
  • Somatic pain originates from skin, muscles, bones, or joints and is usually well-localized, described as sharp, aching, or throbbing (broken bone, surgical incision)
  • Visceral pain originates from internal organs, often poorly localized, and described as deep, dull, or cramping (appendicitis, pancreatitis)
• Neuropathic pain caused by damage or dysfunction of the nervous system, described as burning, tingling, shooting, or electric-like sensations (diabetic neuropathy, spinal cord injury)
• Idiopathic pain without an identifiable cause, may be related to psychological factors or central sensitization (fibromyalgia, chronic pelvic pain)
• Referred pain perceived in a different location than the site of origin, common in visceral pain due to shared nerve pathways (heart attack pain radiating to left arm, gallbladder pain felt in right shoulder)

Tools for pain assessment

• Numeric Rating Scale (NRS) where patient rates pain intensity on a scale of 0 (no pain) to 10 (worst pain imaginable)
• Visual Analog Scale (VAS) involves patient marking pain intensity on a 10cm line, with 0 being no pain and 10 being the worst pain imaginable
• Faces Pain Scale uses illustrations of facial expressions to represent pain intensity, helpful for patients with communication difficulties or cognitive impairments (young children, dementia patients)
• McGill Pain Questionnaire assesses pain quality using descriptive words (burning, stabbing, aching), helps identify the type of pain and potential underlying causes
• PQRST mnemonic guides comprehensive pain assessment:
  1. Provocation/Palliation: What makes the pain better or worse? (movement, rest, heat, cold)
  2. Quality/Quantity: Describe the pain and rate its intensity (sharp, dull, 7/10)
  3. Region/Radiation: Where is the pain located, and does it radiate elsewhere? (lower back radiating to right leg)
  4. Severity: Rate the pain intensity on a scale (NRS, VAS)
  5. Timing: When did the pain start, and how long does it last? (started 2 days ago, constant)

Importance of comprehensive pain evaluation

• Guides appropriate pain management strategies including pharmacological interventions (analgesics, opioids) and non-pharmacological interventions (relaxation techniques, physical therapy)
• Helps identify underlying causes of pain, facilitating accurate diagnosis and targeted treatment (identifying nerve compression causing radicular pain)
• Improves patient outcomes and satisfaction as adequate pain control promotes healing, reduces complications, and enhances comfort and quality of life
• Enables monitoring of treatment effectiveness through regular reassessment, allowing for adjustments in pain management plan
• Facilitates communication among healthcare team members using standardized assessment tools, ensuring consistent documentation and reporting

Acute vs chronic vs breakthrough pain

• Acute pain has sudden onset, usually related to a specific event (injury, surgery), generally resolves within a few days to weeks with appropriate treatment, and serves as a protective mechanism alerting the body to potential tissue damage
• Chronic pain persists beyond the expected healing time (usually >3-6 months), may be related to an ongoing condition (arthritis, cancer) or have no identifiable cause, and can significantly impact quality of life and lead to psychological distress
• Breakthrough pain involves transient exacerbations of pain that occur despite ongoing pain management, often severe and rapid in onset, lasting from a few minutes to a few hours, commonly associated with chronic pain conditions (cancer, neuropathic pain), and may require additional "rescue" medications for adequate control