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January '98
Karen Macmillan
Palliative Care Consultant Nurse, Regional Palliative Care
Program Edmonton.
Is pain "whatever the patient
says it is"? Unfortunately this unidimensional assessment
is too simplistic for a problem as complicated as pain. Because
of the complexities of the individual's experience of pain,
the assessment needs to be multidimensional. A multidimensional
assessment explores physical, psychological, social, cultural
and spiritual components of pain.
Assessment is the cornerstone of pain
management. Management is aimed at eliminating, reducing or
interfering with the cause of pain. This is determined by
conducting a thorough multidimensional assessment. Nurses
usually spend more time with an individual than any other
health care professional and therefore have the ability to
perform a holistic assessment.
The following are components of a
multidimensional pain assessment:
- Pain History: (assess each
area separately)
- what is the location? Use
of a body diagram is helpful; use numbers or letters
to indicate all areas of pain.
- what is the quality of pain
- what does the pain feel like?
- what is the nature of the
pain - is it constant or intermittent?
- what is the relationship to
other pains, does the pain move?
- what is the severity of the
pain - rate the pain at present, at best and at worst?
(see ESAS tool)
- how long has the pain been
present?
- what relieves/exacerbates
the pain?
- what impact does pain have
on mood, anxiety, depression, well-being and quality
of life?
- Medication History:
- what medications are currently
being used - dose route and frequency?
- what has been tried in the
past, what happened?
- Cognitive Dimensions:
-
what is the individual's meaning
of the pain?
-
what is the individual's
attitude and beliefs about pain?
-
what is the individual's perception
of self?
-
is there presence of cognitive
impairment?
- Psychological Status:
- what coping skills and strategies
does the individual use? How someone has coped in the
past will provide insight into how they will cope now.
- what is the individual's sense
of well-being?
- Social and Family History:
- what supports and resources
does the individual have?
- what stressors does the individual
have?
- how has the pain affected
the individual's social roles and abilities to perform
them (work, leisure, family)?
- what do they do for recreation/leisure/distraction?
- what environmental factors
are present?
- what are the work and home
responsibilities?
- what is the family life like?
- how does the family communicate?
- are finances a concern?
- Cultural Influences:
- what is the ethno cultural
background and expression? (ie stoic versus expressive)
- what are their beliefs and
values?
- Spiritual Perspectives:
- what is the individual's meaning
of life?
- what is the individual's belief
in life after death?
- what gives meaning to the
individual?
Collection of information related to
all components of the pain experience coupled with a physical
assessment and possibly medical diagnostics, help determine
the multifactorial causes of pain. Management should always
encompass a holistic approach to treat the cause of pain.
References:
- Cantwell, P., Mackay, S., Macmillan,
K., Turco, S., Mckinnon, S., Read-Paul, L. (1997). 99
questions (and answers) about palliative care: a nurses'
handbook. Regional Palliative Care Program, Capital Health
Authority, Edmonton, Alberta, Canada.
- Mcguire, D., (1992). Comprehensive
and multidimensional assessment and measurement of pain.
Journal of Pain and Symptom Management. Vol.7(5), July,
312-319.
- Pereira, J., Bruera, E., (1996).
The Edmonton aid to palliative care. Universtiy of Alberta,
Edmonton, Alberta, Canada. First Edition.
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