Key Concepts Overview Pain assessment is the fifth vital sign. Pain is a highly unpleasant and personal sensation.

Pain must be assessed accurately for treatment to be successful.

 Definition Pain comes from the Greek word meaning penalty. Pain is whatever the person says it is. Pain can be the primary problem or associated with a specific diagnosis, treatment, or procedure. No two people experience pain in the same way. Pain is subjective; however, it can produce objective changes in the individual.

 Physiology of pain Pain is a subjective, complex, multidimensional phenomenon that is not clearly understood. Specificity theory demonstrates that pain neurons are special. Pattern theory indicates clients will respond in a different manner to the same stimulus. Gate control theory says peripheral nerve fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain. Nociception is composed of four processes: transduction, transmission, perception, and modulation. Three types of pain stimuli are mechanical, thermal, and chemical.

 Nature of pain Pain, a subjective and personal experience, can be described many ways. Acute pain, mild to severe, lasts through the expected recovery period and is considered to be of short duration. Chronic pain is prolonged, recurring or persisting over a 6-month or longer time frame. Cutaneous pain originates in the skin or subcutaneous tissue. Somatic pain arises from ligaments, tendons, bones, or blood vessels. Visceral pain results from stimulation of structures in the abdomen, cranium, or thorax. Radiating pain is perceived at the site of origin and surrounding structures. Referred pain is felt in a body part distant from the source of origin.

 Factors influencing the pain experience Age and developmental stage must be considered when assessing a clients pain. Family, culture, and gender will influence a clients ability to express pain and seek treatment. External environmental factors such as heat and cold will influence pain.

 Assessment Pain is considered the fifth vital sign. Accurate and timely assessment is mandatory for effective pain management. Taking a detailed history using many of the focused interview questions provides a detailed subjective database. Unidimensional and multidimensional tools are available for pain assessment