Assessment of pain

Wherever possible, patients should be the primary assessor of their own pain. Nurses must actively listen to their patients and be guided by their verbal and non-verbal cues.

In order to wholly assess pain, attention must be given to the different aspects of pain, including pain history, intensity of pain, psychological distress and functional impairment. This information will help determine the best course of treatment to manage the pain and provide consistency between members of the patient’s healthcare team.

Questions about pain can include:

• Site and extent of pain, whether it radiates
• Intensity/severity of pain
• Timing of pain – is there a pattern?
• Description/type of pain e.g. acute, chronic, intermittent, musculoskeletal, neuropathic, breakthrough or total
• Aggravating and relieving factors e.g. lying/sitting/walking, analgaesia
• Aetiology of pain – where is the pain coming from?
• Analgesic drug history – how effective has it been?
• Existing pain, e.g. due to arthritis or other comorbidities
• Presence of clinically significant psychological disorder e.g. anxiety and/or depression- consider using an anxiety/depression tool

There are several pain assessment tools available for use in the clinic. Which tool to use should be chosen with the patient’s individual needs in mind – no single scale can meet all needs. The British Pain Society produces pain scales in multiple languages to try and combat the issue of language barriers in effectively assessing pain.

One tool developed by The British Pain Society is the Numerical Pain Rating Score (NPRS). This allows a healthcare professional to undertake a full pain assessment and gain a quick understanding of how much it is affecting a person’s mental and physical wellbeing. Patients are asked to score their pain on a 0-10 numerical scale (where 10 is extreme pain and 0 is no pain). This tool can be used at any time when health professionals are interacting with myeloma patients, for example, at diagnosis, follow-up visits and on the ward.

Body charts, such as the one within the Brief Pain Inventory, are also helpful for patients (Figure 1). Using this, patients can pinpoint the exact position of their pain to help understand the nature of the pain better. If patients have more than one site of pain these should be assessed and recorded separately as they may have different causes and require different management.

Figure 1: Body chart from the Brief Pain Inventory

A diary may help patients to pinpoint activities that trigger their pain and identify patterns of when their pain is worse and where it is. Patients can utilise the free Myeloma UK ‘Your Patient Diary’ to document this.