Pain Screening
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ASSESSMENT OF PAIN INTENSITY
If a resident reports pain during an initial screening interview, then further assessment of pain intensity, location, quality and associated symptoms is needed to guide diagnosis and treatment decisions. Our pain interview includes items about presence, frequency, and effect of pain on residents' daily lives, but does not have enough specific items upon which to base diagnosis and treatment. Here are options for follow-up assessments:
- Pain intensity can be assessed with the verbally administered zero-to-ten pain scale (where 0 represents "no pain at all" and 10 signifies "the worst pain I have ever experienced"), or, for residents with mild to moderate cognitive impairment, a word descriptor scale, faces scale, or pain thermometer.
- For residents with more severe cognitive impairment, an assessment of behaviors and family or caregiver's observations are essential.
- For uncommunicative residents, use an observational tool such as the five-item Pain Assessment in Advanced Dementia, also known as PAINAD. DO NOT, however, use the PAINAD to assess pain in patients who can communicate. This is a common but inappropriate use of the tool.
- For an observational assessment, be sure to observe the resident while he or she is moving. Most pain in nursing home residents is musculoskeletal and at its worst when the resident is in motion. Some of the best times for these observations are during morning care, physical therapy appointments, and range of motion exercises.
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