Page 79 Guide to Pain Management in Low-Resource Settings

Chapter 10

Pain History and Pain Assessment

Richard A. Powell, Julia Downing, Henry Ddungu, and Faith N. Mwangi-Powell

Th e eff ective clinical management of pain ultimately treatment may be delivered to manage the pain. It is
depends on its accurate assessment. Th is entails a com- important, however, that this treatment interven-
prehensive evaluation of the patient’s pain, symptoms, tion be evaluated via subsequent pain assessments to
functional status, and clinical history in a series of as- determine its eff ectiveness. Th e patient’s pain should
sessments, depending on the patient’s presenting needs. therefore be assessed on a regular basis and the result-
Such assessments rely in part on the use of evaluation ing treatment options modifi ed as required to ensure
tools. To varying degrees, these tools attempt to locate eff ective pain relief.
and quantify the severity and duration of the patient’s
subjective pain experience in a valid and reliable man-
Are there key elements to the pain
ner to facilitate, structure, and standardize pain com- assessment process?
munication between the patient and potentially diff er-
ent health care providers. Bates (1991) suggests that the critical components of
the pain assessment process include a determination of
How do you learn about a its: location; description; intensity; duration; alleviating
patient’s pain? What is the pain and aggravating factors (e.g., the former might include
assessment process? herbal medications, alcohol or incense); any associative
factors (e.g., nausea, vomiting, constipation, confusion,
Where pain levels permit (i.e., where severe clinical or depression), to ensure that the pain is not treated in
needs do not demand immediate intervention), the as- isolation from comorbidities; and its impact upon the
sessment process is essentially a dialogue between the patient’s life.
patient and the health care provider that addresses the Th ese components are most commonly embod-
nature, location, and extent of the pain, looks at its im- ied in the “PQRST” approach: Provokes and Palliates,
pact on the patient’s daily life, and concludes with the Quality, Region and Radiation, Severity, and Time (or
pharmaceutical and nonpharmaceutical treatment op- Temporal). In this approach, typical questions asked by
tions available to manage it. a health care provider include:
P = Provokes and Palliates
Is pain assessment a one-off process? • What causes the pain?

• What makes the pain better?
Rather than an isolated event, the assessment of pain
• What makes the pain worse?
is an ongoing process. Following the initial assessment,
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 67
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.