Overview
This lecture covers the essential components of a pain assessment, introduces common pain assessment tools, and discusses key considerations in accurately evaluating and documenting a patient's pain.
Components of a Pain Assessment (OLD CARTS)
- OLD CARTS stands for Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Radiation, Treatment, Severity.
- Onset: Ask when the pain started.
- Location: Ask the patient to point with one finger to where it hurts most.
- Duration: Determine if the pain is constant or intermittent.
- Characteristics: Ask the patient to describe the pain (e.g., aching, stabbing, throbbing).
- Aggravating factors: Identify what makes the pain worse.
- Relieving factors: Identify what makes the pain better.
- Radiation: Ask if the pain moves to other locations.
- Treatment: Ask what the patient has tried to alleviate the pain.
- Severity: Use a pain scale to rate the pain's intensity.
Pain Assessment Scales
- CRIES: Used for infants ≤6 months.
- FLACC: Used for children aged 2 months to 7 years; assesses Face, Legs, Activity, Cry, Consolability.
- FACES (Wong-Baker): Used for children aged ≥3 years, involves choosing a face that matches their pain level.
- Oucher: Uses real-life photographs to assess pain in children.
- Numeric Pain Scale: For individuals ≥8 years who can understand numbers; rates pain from 0 (no pain) to 10 (worst pain).
Special Considerations in Pain Assessment
- Pain is subjective and should be documented exactly as the patient reports.
- Chronic pain may not change vital signs, unlike acute pain.
- Patients' pain history and baseline medication use must be considered when planning interventions.
- Do not judge or reinterpret the patient's reported pain level.
Key Terms & Definitions
- OLD CARTS — Mnemonic for pain assessment: Onset, Location, Duration, Characteristics, Aggravating, Relieving, Radiation, Treatment, Severity.
- Nociceptive pain — Pain from tissue injury; typically described as aching or throbbing.
- Neuropathic pain — Pain from nerve injury; often described as shooting, burning, numbness, or tingling.
- Subjective Pain — Pain as self-reported by the patient, considered factual for assessment.
Action Items / Next Steps
- Review and memorize all components of OLD CARTS.
- Practice selecting and using age-appropriate pain scales.
- Prepare for exam questions on pain assessment tools and documentation protocols.