Pain Assessment and Mechanism of Pain

Listen to and believe the patient; pain is always subjective and one must accept the patient's report of pain. It is important to ask the patient what analgesic therapies have either worked or not worked in the past, as well as if they were taking any analgesic agents prior to admission, and if so the exact doses. Ask about all the locations where the patient is experiencing pain and any radiation from the primary location(s). Have the patient rate the intensity of the pain on a regular basis using scales appropriate for the patient (see Chapter 5).

The most commonly used measurement tools for intensity of pain in the postoperative setting are the single dimension scales. A frequently used variation of this scale is the verbal numeric scale where patients are asked to verbally state a number between 0 and 10, where 0 is "no pain at all" and 10 is "the worst pain imaginable," to correspond to their present pain intensity (see Chapter 5).

In order to choose the correct therapy for treating pain, the underlying mechanism or generator of the pain needs to be determined (Table 18.1). One of the best ways to determine this is to have the patient use adjectives to describe the character of the pain (e.g., aching, burning, dull, electric-like, sharp, shooting, stabbing, tender, throbbing). In the postoperative period it is still important to determine the impact of the pain on the patient's functional ability; specifically does the pain affect the patient's ability to cough, get out of bed, and ambulate while in the hospital.

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