Quality statement 2 - Acute pain assessment

Analgesic prescribing for a patient with acute pain is guided by its expected severity and assessment of patient-reported pain intensity and the impact of pain on the patient’s function.

Purpose

To ensure the impact of acute pain on the patient’s function is considered together with pain scores, to guide the appropriate choice of analgesia.

What the quality statement means

For consumers

Being in acute pain can interfere with your ability to participate in your regular day-to-day activities. It is important for your clinician to understand how your acute pain is affecting your ability to function, as well as how much pain you are feeling. This can help them to provide the most appropriate treatment. The treatment may not completely stop your pain. The aim of treatment is to reduce your pain to a level that allows you to return to your regular day-to-day activities.

Your clinician will ask you questions about how your pain is interfering with your ability to function normally and carry out activities. They may also ask you questions about how you are coping with your pain. For example, whether the pain is affecting your sleep, or your ability to carry out regular activities. There are several measurement tools to score your pain and your function, and your clinician will use the ones that best suit your needs when they assess your acute pain.

For clinicians

When treating a patient with acute pain, assess the patient’s functional activity using an evidence-based assessment tool before prescribing an opioid analgesic. The results of the functional assessment should be considered together with patient’s pain scores in discussion with the patient to guide appropriate treatment. The outcome of the assessments should be documented in the patient’s medical record.

Consider the clinical context – such as intensive care or ward – and the patient context including developmental, cognitive, emotional, language and cultural factors, to assist in choosing an appropriate pain assessment tool for acute pain. For example, verbal pain descriptors may be a better choice of pain measurement tool than numerical rating scales for some Aboriginal and Torres Strait Islander people.

Validated tools for measuring pain in neonates, infants and children are available, and the appropriate tool should be selected based on the child’s age and developmental stage.

For health service organisations

Ensure appropriate evidence-based tools to assess patient function and pain are available, and that processes and policies support their use to assess and document acute pain before clinicians prescribe appropriate analgesia.

Related resources

Several evidence-based tools for assessing pain and function are available.

Functional Activity Scale

A No limitation: the patient can undertake the activity without limitation due to pain (pain-intensity score is typically zero to three)

B Mild limitation: the patient can undertake the activity, but experiences moderate to severe pain (pain-intensity score is typically four to ten)

C Significant limitation: the patient cannot complete the activity due to pain or pain treatment-related adverse effects independent of pain-intensity scores.

Pain scoring systems for paediatric patients

A summary of validated tools for measuring pain in paediatric patients is in Acute Pain Management: Scientific evidence, 5th edition (2020).

  • Table 10.1 Acute pain-intensity measurement tools – neonates
  • Table 10.2 Composite scales for infants and children
  • Table 10.3 Self-report tools for children
  • Table 10.4 Sample of observational pain assessment scales for intellectually disabled children.

Pain scoring systems for cognitively impaired patients

A summary of tools for measuring pain in patients with dementia can be found in Acute Pain Management: Scientific evidence, 5th edition (2020)2, including:

Other resources include:

  • Doloplus-2, which is a behavioural pain assessment scale for older people who present with verbal communication disorders
  • Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)
  • Royal Children’s Hospital, Melbourne, Clinical Guidelines (Nursing). Pain Assessment and Measurement.

For consumers

Being in acute pain can interfere with your ability to participate in your regular day-to-day activities. It is important for your clinician to understand how your acute pain is affecting your ability to function, as well as how much pain you are feeling. This can help them to provide the most appropriate treatment. The treatment may not completely stop your pain. The aim of treatment is to reduce your pain to a level that allows you to return to your regular day-to-day activities.

Your clinician will ask you questions about how your pain is interfering with your ability to function normally and carry out activities. They may also ask you questions about how you are coping with your pain. For example, whether the pain is affecting your sleep, or your ability to carry out regular activities. There are several measurement tools to score your pain and your function, and your clinician will use the ones that best suit your needs when they assess your acute pain.

For clinicians

When treating a patient with acute pain, assess the patient’s functional activity using an evidence-based assessment tool before prescribing an opioid analgesic. The results of the functional assessment should be considered together with patient’s pain scores in discussion with the patient to guide appropriate treatment. The outcome of the assessments should be documented in the patient’s medical record.

Consider the clinical context – such as intensive care or ward – and the patient context including developmental, cognitive, emotional, language and cultural factors, to assist in choosing an appropriate pain assessment tool for acute pain. For example, verbal pain descriptors may be a better choice of pain measurement tool than numerical rating scales for some Aboriginal and Torres Strait Islander people.

Validated tools for measuring pain in neonates, infants and children are available, and the appropriate tool should be selected based on the child’s age and developmental stage.

For health service organisations

Ensure appropriate evidence-based tools to assess patient function and pain are available, and that processes and policies support their use to assess and document acute pain before clinicians prescribe appropriate analgesia.

Related resources

Several evidence-based tools for assessing pain and function are available.

Functional Activity Scale

A No limitation: the patient can undertake the activity without limitation due to pain (pain-intensity score is typically zero to three)

B Mild limitation: the patient can undertake the activity, but experiences moderate to severe pain (pain-intensity score is typically four to ten)

C Significant limitation: the patient cannot complete the activity due to pain or pain treatment-related adverse effects independent of pain-intensity scores.

Pain scoring systems for paediatric patients

A summary of validated tools for measuring pain in paediatric patients is in Acute Pain Management: Scientific evidence, 5th edition (2020).

  • Table 10.1 Acute pain-intensity measurement tools – neonates
  • Table 10.2 Composite scales for infants and children
  • Table 10.3 Self-report tools for children
  • Table 10.4 Sample of observational pain assessment scales for intellectually disabled children.

Pain scoring systems for cognitively impaired patients

A summary of tools for measuring pain in patients with dementia can be found in Acute Pain Management: Scientific evidence, 5th edition (2020)2, including:

Other resources include:

  • Doloplus-2, which is a behavioural pain assessment scale for older people who present with verbal communication disorders
  • Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)
  • Royal Children’s Hospital, Melbourne, Clinical Guidelines (Nursing). Pain Assessment and Measurement.