Assessing Pain & Discomfort Levels in Patients

Instructor: Jennifer Mitchell

Jennifer is a clinical professor for nursing students in critical care and has several years of experience in teaching nursing.

You are caring for someone who tells you they are experiencing pain. Is it really pain and how can you tell? The purpose of this lesson is to give you some guidelines as well as signs and symptoms that will alert you to whether or not a patient requires medication for pain.

What Is Pain?

Have you ever experienced pain? Do you wonder what pain is and why it is experienced by the human body? If you are just beginning to care for patients as a medical assistant or patient care technician, you may be wondering how the nurses tell if a patient is experiencing pain, especially if they can't tell you about it. Let's discuss the mechanism of pain.

Pain is the body's way of telling you that something is wrong. Whether it's from a cut or scrape, trauma from a fall or car accident, or surgery, it's a disruption of the body's normal processes. When injury occurs, the body responds by sending signals to the brain that are interpreted as pain. Discomfort is a lower level of pain that generally does not require medical treatment or medication. For example, when you sit in one position for a long period of time and your backside gets sore. How is it relieved? By repositioning yourself. Now let's discuss the two different types of pain.

The pain can either be acute pain, that is, it starts suddenly as the result of an injury, or it can be chronic pain, which is usually the result of damage to nerves or a psychological disturbance. Chronic pain can be caused by many factors ranging from an old bed mattress to an injury that occurred a long time ago but left an impression on the brain. Now let's talk about assessing pain and discomfort levels in patients.

Is a Patient Experiencing Pain or Discomfort?

Unless an obvious injury has occurred, it can be difficult to tell if a patient is experiencing pain. Everyone has different levels of pain tolerance, which is why pain rating systems are used. These systems generally use a 0 to 10 scale where 0 is no pain and 10 is the worst pain ever experienced. You can see the faces pain scale in the image with a slightly different rating shown.

Pain Scale

Healthcare professionals will ask patients what level of pain is acceptable to them to help figure out when pain medication should be given. There are many pain rating scales available, and a pain scale with faces is frequently used. This tool is effective for assessing the pain of anyone over the age of 3. Let's say you've got two patients who both have a headache. One patient says the pain is tolerable and is a 2 on a 1 to 10 scale. He is watching the TV and talking to his spouse. The other patient says the pain is a 9 and is also experiencing nausea and vomiting as well as requesting the lights be turned off. Clearly, the second patient needs more medical attention or additional medication.

So how does it work if the patient is blind or deaf? We can still ask them what their pain is if they are blind, but they are unable to point at a face scale to describe their pain. If they are deaf, they can point at the face that best describes their pain on a face scale.

What if the patient can't tell you what their pain level is? What if the patient is a child under the age of 3? This is when we look at nonverbal signs of pain. Nonverbal signs include vital signs, physical appearance, and other expressions of pain. Let's discuss vital signs as an indicator of pain or discomfort.

Vital Signs

The last time you were injured and felt pain, did you notice your heart rate increase? Vital signs can be greatly influenced by discomfort and pain. Vital signs include heart rate, blood pressure, and rate of breathing. When someone is experiencing pain, vital signs change. The heart rate, blood pressure, and rate of breathing will all increase.

You might be thinking, 'This happens when I exercise, but it doesn't mean I'm in pain.' That's why we also need to look at physical or nonverbal expressions of pain. What are some physical expressions of pain? Let's cover that next.

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