Page 82 Acute Pain Management
P. 82






2. ASSESSMENT AND MEASUREMENT OF PAIN

AND ITS TREATMENT



2.1 ASSESSMENT


Reliable
and
accurate
assessment
of
acute
pain
is
necessary
to
ensure
patients
experience

safe,
effective
and
individualised
pain
management.
The
assessment
and
measurement
of
pain

are
fundamental
to
the
process
of
assisting
in
the
diagnosis
of
the
cause
of
a
patient’s
pain,

selecting
an
appropriate
analgesic
therapy
and
evaluating
then
modifying
that
therapy

according
to
a
patient’s
response.
Pain
should
be
assessed
within
a
biopsychosocial
model
that

recognises
that
physiological,
psychological
and
environmental
factors
influence
the
overall

pain
experience.

CHAPTER
2
 The
assessment
of
acute
pain
should
include
a
thorough
general
medical
history
and
physical


examination,
a
specific
‘pain
history’
(see
Table
2.1)
and
an
evaluation
of
associated
functional

impairment
(see
Section
2.3).
In
acute
pain
management,
assessment
must
be
undertaken
at

appropriately
frequent
intervals.
At
these
times,
evaluation
of
pain
intensity,
functional

impact,
and
side
effects
of
treatment
must
be
undertaken
and
recorded
using
tools
and
scales

that
are
consistent,
valid
and
reliable
(Scott
&
McDonald,
2008).
In
addition,
pain
assessment

must
lead
to
changes
in
management
and
re‐evaluation
of
the
patient
to
ensure

improvements
in
the
quality
of
care
(Gordon
et
al,
2005).

Although
not
always
possible
in
an
acute
setting,
a
complete
pain
history
provides
important

diagnostic
information
that
may
help
distinguish
different
underlying
pain
states
such
as

nociceptive
(somatic
and
visceral)
or
neuropathic
pain
(Victor
et
al,
2008).
Somatic
pain
may
be

described
as
sharp,
hot
or
stinging,
is
generally
well
localised,
and
is
associated
with
local
and

surrounding
tenderness.
By
contrast,
visceral
pain
may
be
described
as
dull,
cramping,
or

colicky,
is
often
poorly
localised
and
may
be
associated
with
tenderness
locally
or
in
the
area

of
referred
pain,
or
with
symptoms
such
as
nausea,
sweating
and
cardiovascular
changes
(Scott

&
McDonald,
2008).

While
nociceptive
pain
typically
predominates
in
the
acute
pain
setting,
patients
may
also

experience
neuropathic
pain
(see
Section
1.3).
Features
in
the
pain
history
that
may
suggest
a

diagnosis
of
neuropathic
pain
include
(Gray,
2008;
Dworkin
et
al,
2007):

• clinical
circumstances
associated
with
a
high
risk
of
nerve
injury
eg
thoracic
or
chest
wall

procedures,
amputations
or
hernia
repairs;

• pain
descriptors
such
as
burning,
shooting
and
stabbing;

• the
paroxysmal
or
spontaneous
nature
of
the
pain,
which
may
have
no
clear
precipitating

factors;

• the
presence
of
dysaesthesias
(spontaneous
or
evoked
unpleasant
abnormal
sensations),

hyperalgesia
(increased
response
to
a
normally
painful
stimulus),
allodynia
(pain
due
to
a

stimulus
that
does
not
normally
evoke
pain
such
as
light
touch)
or
areas
of
hypoaesthesia;

and

• regional
autonomic
features
(changes
in
colour,
temperature
and
sweating)
and
phantom

phenomena.

It
is
useful
to
draw
the
distinction
between
the
different
types
of
pain
because
the
likely

duration
of
the
pain
and
the
response
to
analgesic
strategies
may
vary.
The
concept
of

‘mechanism‐based
pain
diagnosis’
has
been
promoted
(Woolf
&
Max,
2001)
and
although
the

34
 Acute
Pain
Management:
Scientific
Evidence

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