A guide to pain assessment and management

Pain is a complex phenomenon, a sensation ranging from mild discomfort to agony. The sensation of pain may be localised or systemic (widespread) and is subjective (varies from person to person). It is caused by stimulation of pain receptors. Pain thresholds vary between individuals, so what is severe pain to one person might be minor to another.

Nerve cells convey information from receptors in the extremities and organs of the body to the brain, where they are processed and perceived by the casualty as pain.

Pain often serves as a protective mechanism, as sudden pain initiates a reflex that causes muscle contraction, thereby moving the limb away from the painful stimulus (such as burns or treading on a nail).

The World Health Organisation describes a “pain ladder” with three steps – mild, moderate and severe pain:

Mild pain

Mild pain is self-limited. It is relieved either with no therapy or with the use of nonprescription medication

Moderate pain

Moderate pain is worse than mild pain. It interferes with function. A person suffering moderate pain may be unable to ignore the pain and go on with all of the activities of daily living. It goes away after a while and doesn’t return following treatment by medication

Severe pain

Severe pain is defined as pain that interferes with some or all of the activities of daily living. The person may be confined to bed or chair rest because of the severity of the pain. This pain is not readily eased, and treatment may need to be continuous (for days, weeks, months, or years)

Analgesia is the relief of pain without the loss of consciousness. An analgesic is any of the drugs used to relieve pain and may more commonly be known as a pain killer.

These work by:

  • blocking receptors in the central nervous system that receive pain signals
  • blocking transmission of pain signals along nerve pathways

Assessing pain

Verbal numerical rating scale

This scale asks the casualty to rate their pain from no pain (0) to worst pain possible (10) and is suitable for use in adults and children over six years of age who have an understanding of the concepts of rank and order.

The first aider should avoid saying the numbers on this scale to prevent the casualty receiving cues. Some casualties are unable to use this scale with only verbal instructions but may be able to look at a number scale and point to the number that describes the intensity of their pain.

Wong–Baker faces pain rating scale

This scale can be used with young children aged three years and older and may also be useful for adults and those from a non-English speaking background. Point to each face using the words provided to describe the pain intensity. Ask the child to choose the face that best describes his/her own pain and record the appropriate number.

WongBaker First Aid

Holistic assessment

Pain scales should never be used in isolation. Watching the casualty’s face, and listening to their voice, will give the first aider a broader picture of the level of pain the casualty is experiencing.

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