(1)
Department of Anaesthesia, Royal Free Hospital, London, UK
Assessment of acute pain includes appropriate pain history and evaluation with regard to different aspects of pain including functional impairment. The focus of assessment should be to ascertain detailed history with current and past analgesic strategies. It also includes current level of pain intensity, its location and character. This helps in identifying lacunae in the care so far provided and formation of appropriate treatment plan. It is important to assess the functional impact of pain as that will help in planning further treatment strategies and rehabilitation therapies. The assessment also helps in determining whether the prescribed medications are safe for the patient.
Key aspects to ascertain in patient history with acute pain:
Establish communication and rapport.
Identify location, character and intensity.
Establish the functional impact of the pain.
All therapies being used and their efficacy.
Any adverse effects.
History should include:
Site
Intensity: pain scores both at rest and on movement
Nature: nociceptive(somatic or visceral), neuropathic
Radiation: referred pain
Aggravating/relieving factors
Accompanying symptoms
Any psychological associations
6.1 Measurement
Adequate measurement of pain is essential for both assessment and treatment of pain. The following are various scales used to assess pain:
6.1.1 Verbal Rating Scale
It includes 4-level VRS-4 (0, no pain; 1, mild pain; 2, moderate pain; 3, severe pain). One variant is the 7-level scale (no pain, mild, discomforting, distressing, horrible, excruciating, unendurable).
