The Fifth Vital Sign

What is Pain?
"an unpleasant sensory and “Pain is whatever the
emotional experience, which we experiencing person says it is,
primarily associate with tissue existing whenever he says it
damage or describe in terms of does” - Margo McCaffrey
such damage” - The International
Association for the Study of Pain
(IASP)
The
Controversy
on the "Fifth
Vital Sign"
and Opioid
Crisis
The Pathophysiology of Pain
 Physiologic Responses to Pain
Focus on pain, Decrease in Increased heart Decreased urinary
reports of pain, cognitive function, rate; peripheral, output, resulting in
cries and moans, mental confusion, systemic, and urinary retention,
frowns, and facial altered coronary vascular fluid overload,
grimaces temperament, high resistance; depression of all
somatization, and increased blood immune responses
dilated pupils pressure

Hyperglycemia, Increased Muscle spasm, Increased

glucose antidiuretic resulting in respiratory rate and
intolerance, insulin hormone, impaired muscle sputum retention,
resistance, protein epinephrine, function and resulting in infection
catabolism norepinephrine, immobility, and atelectasis
aldosterone, perspiration
decreased insulin,
testosterone
Physiologic Processes Involved in
Pain Perception
Classifications
of Pain
Classification of pain can assist assessment.
Pain is classified in several ways, and these
ways may overlap. Causes, etiology, duration,
intensity, location, and severity are some of
the ways pain can
be classified.
Other Classification Categories
for Pain
 Collecting Subjective Data
on Pain

The exact words used to describe the experienced pain are used to help in the diagnosis
and management. A thorough pain assessment includes questions about location,
intensity, quality, pattern, precipitating factors, and pain relief, as well as the effect of the
pain on daily activities, what coping strategies have been used, and emotional responses
to the pain. Past experience with pain, in addition to past and current therapies, is
explored.
Pain
Assessment
Tools
There are many assessment tools,
some of which are specific to special
types of pain. The main issues in
choosing the tool are its reliability and
its validity. Moreover, the tool must be
clear and, therefore, easily understood
by the client. It must require little effort
from the client and the nurse.
Pain Assessment Scales:
Visual Analog Scale (VAS)
Numeric Rating Scale (NRS)
Numeric Pain Intensity Scale
Behavioral Pain Scale
Pain Assessment in Advanced Dementia (PAINAD) Scale
Verbal Descriptor Scale
Faces Pain Scales (FPS, FPS-R), including the Wong-Baker FACES Scale
Collecting
Objective
Data
Objective data for pain are
collected by observing the client’s
movement and responses to touch
or descriptions of the pain
experience.
During examination of the client,
remember these key points:
Choose a reliable assessment tool.
Explain to the client the purpose of rating the intensity of pain.
Ensure the client’s privacy and confidentiality.
Respect the client’s behavior toward pain and the terms used to express it.
Understand that different cultures may express pain differently and maintain
different pain threshold and expectations.
Validating and
Documenting
Findings
Validate the pain assessment data you have
collected with the client. It is also useful to
validate the findings with other caregivers and
family members, especially if the client is
reluctant to express pain. This is necessary to
verify that the data are reliable and accurate.
Document the assessment data following the
health care facility or agency policy.
Analyzing
Data
to make informed clinical
judgments

After collecting the assessment data, identify

abnormal findings and client strengths using
diagnostic reasoning. Then, cluster the data
to reveal any significant patterns or
abnormalities. The following sections provide
possible conclusions that the nurse may make
after assessing a client’s pain.