How to Recognize and Assess Pain

Being a caregiver for a loved one requires careful attention to their symptoms, especially pain. You are the eyes and ears for the healthcare providers who are managing your loved one's medical care.

The healthcare provider will assess pain at every visit or appointment, but it will be up to you to keep track of your loved one's pain between medical visits. You will be communicating important information about their symptoms back to the healthcare team. Assessing pain and communicating it to the healthcare team will be one of the most important things you can do while caring for a loved one.

So how can you do this in the best way possible? The following information will be helpful to you as you learn to recognize pain.

Understanding Pain

There are several different categories of pain. Pain can be acute (of recent onset) or chronic. It can be localized, or it can be diffuse (spread out).

The important thing to remember is that pain is always what the person experiencing it says it is.

Recognizing pain varies based on how well your loved one can communicate:

• If a person can communicate their pain, you can record it so their healthcare provider will know what's going on.
• If they cannot communicate what they are feeling, it is can be more difficult to assess their pain, but it is still possible. To do so, you must be aware of physical signs and symptoms that convey what your loved one is feeling.
  

Severity of Pain

The first step in assessing pain is to find out how bad it is at the present moment. There are tools that can help someone describe the severity of their pain.

For adults, this is usually done with a numeric scale of 0-10. Zero would describe the absence of pain and 10 would symbolize the worst pain imaginable. Ask your loved one to rate their pain somewhere on that scale.

There are a number of different pain rating scales that can be used to make this process easier. For example, one scale referred to as the FLACC scale uses a description of several signs the person may be demonstrating, in order to estimate a number between 1 and 10.

These signs include facial appearance, legs (whether relaxed, tense, or kicking), activity (whether lying quietly, squirming, or arched and jerking), crying, and consolability (whether things like talking to them can make them feel a little better).

When asking young children or non-verbal adults to describe their pain, the tool most often used by healthcare providers is the Wong-Baker FACES Pain Rating Scale. It is recommended for persons age 3 years and older.

With this scale, you would point to each face using the words to describe the pain intensity. Ask the child to choose the face that best describes their pain, or look at the face of a non-verbal adult to decide which facial appearance on the table corresponds most closely to their facial expression.

Acceptable Level of Pain

Everyone will have their own acceptable level of pain. For some it may be no pain and others will tolerate a pain level of 3 on a scale of 0-10. It is important to find out what the acceptable level is for the individual you are caring for.

If your loved one is happy at a pain level of 3, you wouldn’t want to medicate them to the point of sedation to get them at a zero level of pain.

On the other hand, some people try to tolerate pain levels above a 4, even though these levels of pain often reduce the quality of life. You could ask them to consider whether medication would make them more comfortable.

Location of Pain

The location of pain may be the same every time you ask. For example, someone with end-stage liver disease may always have pain in the upper right side of their abdomen.

Even with chronic pain, it is important to ask about the pain location, however, because new pain may develop.

Palliation and Provocation

Palliation and provocation are important assessments to make when evaluating pain. First, you can ask your loved one what makes their pain better, or "palliates" it. And provocation includes things that make the pain worse.

Palliation

Finding out what reduces pain will help you do things that aid in your loved one's comfort, and may provide important clues to the healthcare provider as to the cause of pain if it's not already known.

This may include things like pain medications, changing positions, or lying only on their left side.

Provocation

Also, ask what makes the pain worse, or provokes it. It could be a certain movement or lying on a particular side. It could also be eating, touching the painful area, or applying pressure to the painful area. This will help you avoid things that cause discomfort and provides important clues to the healthcare provider.

Assessing Non-Verbal Signs

It can be difficult to assess someone’s pain if they are unable to verbalize it and/or unable to point to the FACES scale. You can also try to notice behaviors that are indicative of pain and discomfort.

Signs and symptoms that a person may exhibit if they are in pain:

• Facial grimacing or a frown
• Writhing or constant shifting in bed
• Moaning, groaning, or whimpering
• Restlessness and agitation
• Appearing uneasy and tense, perhaps drawing their legs up or kicking
• Guarding the area of pain or withdrawing from touch to that area

The more symptoms a person has, and the more intense they appear to be, the more you will get a grasp of the degree of pain they are experiencing. You can use these clues to record their pain as "mild", "moderate", or "severe."

Psychosocial Factors

Underlying psychological and social factors often play a role in pain. This does not make the pain experience any less real, but it can help with designing a more holistic approach to pain interventions.

For example, patients living with advanced cancer often go through fear and isolation. Being open to the emotional underpinnings of the suffering of the person you are caring for is key to providing effective and humane care.

Keep a Record

One of the most important things you can do for the person you are caring for is to keep an accurate record of their pain and their pain treatments. Once you assess their pain, record the severity and location, as well as any medications or treatments that you give them.

Take note of whether the medications or treatments were effective. Also, write down anything they may have told you about what makes it feel better or worse. This is a great way to team up with your healthcare professionals to provide the best palliative care possible.

Your pain log doesn't need to be detailed, but a few components will help your healthcare providers better assess both the location and severity of pain, as well as treatments that are or are not effective.

The table below is an example of a pain log for someone who has abdominal pain:

A Word From Verywell

By assessing your loved one's pain, you can play a very important role in making sure they get the best treatment possible while suffering the least amount of pain.

Using pain scales and keeping a pain log are good ways to objectify the pain a bit so that your healthcare provider knows if additional treatment is needed. Keeping a record can also alert you to changes so that you can contact your healthcare professionals as soon as possible when needed.

As a final note, caring for a loved one with a life-threatening illness is perhaps the greatest thing you can do for another human being, but it is also very draining. As much as you can, remember to care for your own needs. Ask for help and be willing to receive it. Pamper yourself, if only for a few minutes here and there.

You may feel guilty trying to meet your own needs. But remember that you need to care for yourself if you are to give your loved one the best care possible. Remember the advice that flight attendants give us prior to taking off. Put on your own oxygen mask first.