Pain levels

Pain is a subjective experience (Royal College of Nursing, 2023), so its measurement is not as simple as many physiological parameters of wellbeing, such as temperatures or blood pressure. Pain can be defined as:

The measurement of pain is closely associated with the ability of health and social care professionals to be able to manage it. It must be as accurate as possible and consistent. Measuring pain is useful in:

• setting baselines for disease management
• measuring the impact of pain relief strategies
• measuring recovery from surgery or ill health
• creating goals, such as rehabilitation milestones

Since pain is a response to both acute and chronic events, the need for assessment and the type of assessment undertaken will vary widely.

It is important that the nurse is alert to the different processes, practices and tools involved in the measurement of pain. The choice of tool used to measure and record pain will vary according to the characteristics of the person, the reasons for the recording and the measurement tools available. In general, the nurse needs to select the right tool for the right patient, otherwise the measurement of pain may be invalid. 

There are several ways is which pain might be measured and a number of tools which the nurse can use. The more commonly used pain measurement tools include:

• visual analogue scale 
• verbal rating scales 
• numerical rating scales
• Wong–Baker faces scale

Different pain measurement tools are suited to different people and some are validated for use in specific conditions. For example, the Abbey Pain Scale is used for people who are unable to clearly articulate their needs, such as

When assessing pain, nurses need the ability to communicate, as well as access to and understanding of a pain scale. They will also need access to and the means to record the results in the patient’s care record.

The nurse should observe the patient for some of the signs of pain, although they should refrain from trying to score the person's pain. The nurse should explain the nature of the pain assessment procedure to the patient, as well as why it is being undertaken. Establishing a rapport is especially important when undertaking a protracted pain assessment, for example for a chronic condition (Kettyle, 2022). The assessment should ideally be undertaken in a private setting. 

Nurses should observe the patient for non-verbal signs of pain, and should empower the patient to use whatever terms they wish to describe their pain, rather than prompting them. 

When undertaking a rapid pain assessment the nurse might consider:

• Numerical rating scales, for example by asking, 'on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain imaginable, how would you score your pain at this time?'

The biggest risk related to assessing pain is that the nurse either tries to assess the pain without asking the patient, or they apply a pain measurement tool which is not suitable either to the patient or the problem that the patient has presented with. Poorly assessed pain has the potential to become poorly managed pain. 

Nurses should review the options for pain measurement in the areas in which they work, learning not only how to use them, but also which ones are most suitable in which circumstances.

Nursing and midwifery council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3.1 observe and assess comfort and pain levels and rest and sleep patterns

3.5 take appropriate action to reduce or minimise pain or discomfort

Arsyawina A, Parellangi P, Widiastuti HP, Hilda H. The Validity of the Abbey Pain Scale for Assessing Pain in Stroke Patient. J N Practice. 2020;5(1):162-167 https://doi.org/10.30994/jnp.v5i1.167 

Chapman S, Carvalho F, Dinen C. Pain assessment and management. In: Lister S, Hofland J, Grafton H, Wilson C (eds). The Royal Marsden Manual of Clinical Nursing Procedures. 10th edn. Chichester: Wiley Blackwell; 2021: 457-496

Gregory J. Use of pain scales and observational pain assessment tools in hospital settings. Nurs Stand. 2019;34(9):70-74. https://doi.org/10.7748/ns.2019.e11308 

Kettyle A. Pain management. In: Delves-Yates C (ed). Essentials of Nursing Practice. 3rd edn. London: Sage; 2022

Ludvigsson C, Isaksson U, Hajdarevic S. Experiencing improved assessment and control of pain in end-of-life care when using the Abbey Pain Scale systematically. Nursing Open. 2020;7:1798– 1806. https://doi.org/10.1002/nop2.566 

Raja SN, Carr DB, Cohen M et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982.