Pain Assessment

Father talking to toddler daughter
An accurate assessment of pain is essential to determine the best pain relief method. In addition to describing the intensity of pain (how much pain and how painful it is), an assessment will tell health care professionals about whether the pain is acute or chronic and the location of the pain. Chronic and acute pain treatment strategies can be different, so it is important to understand what type of pain your child is having. Assessment will also help to distinguish between pain and related feelings of discomfort, fear, and anxiety.

Because of the individual nature of pain, assessment is not easy. Only your child truly knows how the pain feels. Like sadness or fear, only the individual who is experiencing it can tell how intense it is or how much it bothers him.

Pain assessment cannot be absolutely precise. Unlike reading a temperature with a thermometer, there is no objective measure to tell us how much pain someone is in. But using a variety of methods in combination, a reasonably accurate assessment of pain is possible.

Three parts to pain assessment

Assessment has three components each contributing to the overall picture. These components include:

1) Self report -- what your child says about her pain

This assessment method can only be used if your child can respond verbally. It involves a health care professional asking questions about the pain and the child responding. These questions may be similar to ones you would ask if your child came and told you she was in pain or you noticed she was guarding a body part that he may have injured.

These questions include:

  • Do you have a hurt/owie/pain?

  • Can you show me where it hurts? Does the hurt go anywhere else on or in your body?

  • When did the hurt start? How long has the hurt been there?

  • Do you know what might have started the hurt?

  • How much does it hurt? (Here, your child may be asked to use a pain intensity scale, For example, on a scale of 0 to 10, 0 meaning no pain and 10 meaning severe pain, how much do you hurt?

  • Can you tell me words that might describe the hurt? (The child may be given key words if she doesn’t come up with her own, such as "sharp," "pins and needles," "burning.")

  • What helps to take away the hurt? (Medicines you’ve had before, massage, heat/cold, playing with your friends?)

2) An observer’s report

Health care professionals observe your child’s behaviour for signs of pain and injury. Specifically, they observe facial expression and body movements, and assess the qualities of your child's cries. Parents are in a good position to comment on whether there have been any changes in their child's usual behaviour, which might indicate pain. Parents may be asked the following:

  • Do you think that your child is in pain? How do you know? Where is the pain?

  • How much pain do you think he has? (Here the parent may be asked to use a pain intensity scale, described above.)

  • Has your child had difficulty sleeping since the pain started?

  • Have you noticed any changes in your child’s mood, appetite, or interest in favourite activities?

  • What do you think helps your child deal with the pain?

3) Physical changes -- how the body reacts

These are measures of body changes such as increases in heart rate, breathing rate, and paleness or sweating, all of which can be signs of pain.

In addition to these three assessment methods, a history of pain will be recorded. Parents and their children may be asked the following:

  • Has your child had pain before and how did he cope?

  • What helped/hindered the pain relief?

A pain assessment will also take into consideration your child’s emotional, family, and cultural circumstances, and previous experiences with pain.

The emotional context within which your child experiences pain is extremely important. Some children may be willing to suffer in pain, knowing that the surgery they have just undergone will improve their lives. Other children may be very depressed, confused, or angry about their pain. These emotional extremes, and many in between, have an impact on the amount and intensity of pain in children.

Which part of assessment is most important?

Although all three of the assessment methods will be used, how much weight is given to each method will depend on the child's age and developmental capacity, and the situation. For example, an infant or a child who has a neurological or cognitive disability will not be able to self-report in the same manner as an older, typically developing child. In these cases, observational reports and physiological measures will be relied upon more heavily. Conversely, the self-reports of a school-aged child or a teenager in pain may be relied upon more heavily than the reports of parents or other caregivers.

Changing needs of pain relief

Pain and pain relief needs change over time. This means assessment is a continuing process. A single assessment is only a snapshot of what the pain is like at that moment. Multiple assessments provide a changing picture and can reveal an overall sense of how much pain your child is in and how well the pain relief strategies are working. As a child heals, the need for pain relief may be reduced. If a child’s condition worsens, the need for additional pain relief measures may increase. Additionally, some pain relief methods work better than others, depending on the condition and individual nature of the child.

Continuing, repeated assessments will help health professionals determine if a pain relieving strategy is working, and will provide the information necessary to initiate optimal pain treatment strategies.

Jennifer Stinson, RN, PhD, CPNP