When assessing a patient’s pain, hospice staff will often consider its:
📷A terminally ill patient may often have different types of pain in several locations. However, not all complaints of pain may be disease-related. For example, a patient might complain of general soreness thatmay be caused from being bedridden and immobile. To accurately assess a patient’s pain, it is best to ask the following questions:
Location : Where is the pain?
Onset : When did it start?
Onset : How did it start or what caused it?
Intensity : Average pain level – What is the intensity of the pain? Is it mild, discomforting, distressing, excruciating? A commonly used pain rating scale is the 0-10 pain scale such as the examples below:
You can implement the 0-10 pain scale by first explaining that zero means no pain and 10 is the most unbearable pain ever experienced. Ask the patient to rate her pain between 0 and 10. Visualization of the pain scale sometimes assists the patient to better assess her degree of discomfort. You can make a 0-10 pain-rating scale by drawing a horizontal line on a piece of paper. Write a zero on one end and a 10 on the opposite end. Fill in the numbers in between. The 1-4 range is considered to be mild pain, the 5-6 range is moderate pain, and the 7-10 range is severe pain. However, one patient may be able to tolerate pain in the 6 or 7 range, for example, while another patient may need pain relieved to a 1 or 2 in order to be comfortable. Again, pain is subjective and individualized. (The Final Journey Pg.80)
📷Quality : Describes the nature of pain i.e. sharp and stabbing vs. dull and aching vs. throbbing vs burning in nature (This will give clues as to the source of the pain, such as bone, visceral, nerve, or muscle. For example, nerve pain tends to feel like an intense burning or tingling pain, while bone pain may feel like a throbbing or aching pain. Allow the patient to describe the pain in his own words.)
📷Duration /Frequency : How long has it been going on? How long does the pain last? Is it sporadic? Is it constant? Does the pain feel worse at a specific time of day?
📷Aggravating/Alleviating factors : What makes the pain worse? Sitting?Standing? 📷Walking? Change in position? Exertion? Does anything help to relieve the pain? Although it is desirable, the goal “zero” in pain relief is not advisable (or realistic, on average, given the disease process). It also means that there are times when the body has more pain medications (especially opioids in the system which may lead to more undesirable side effects). A good pain relief system allows the patient to be able to do their desirable physical activities without undue distress and rest well when asleep. This should be the goal for every hospice patient. Constant reassessment of the patient’s pain is essential. Terminal pain can intensify and new pain can develop, sometimes daily. Inappropriate or infrequent assessment of a patient’s pain can result in ineffective treatment and unnecessary suffering.
*For further information on Pain Assessment and Management, please refer to The Final Journey — 📷Complete Hospice Care for Departing Vaishnavas by Susan Pattinson, RN (Sangita Devi Dasi)
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