Pain Assessment Questions

Pain is invisible, which is exactly why assessing it well takes discipline. The CBT tests whether you treat the patient’s own account as the starting point, choose the right tool, and check that treatment worked.

Believe the patient

The gold standard for pain assessment is self-report. Pain is subjective, and the person feeling it is the best judge of how bad it is. This sounds obvious until a question shows you a patient who reports severe pain while lying quietly and looking calm. People cope and present differently, and a composed appearance does not disprove real pain. The right answer is to believe the report and act on it, not to override it with an interpretation of how the person looks.

The same applies to cultural difference. People express pain in different ways, and you assess the individual rather than measuring them against an expectation of how pain “should” look.

The right tool for the person

Different people need different tools. A numerical rating scale of 0 to 10 works for many adults. Children may need a faces scale. The important case in the exam is the patient who cannot self-report, someone with advanced dementia, or a very young child. Here you use an observational tool, such as the Abbey Pain Scale or FLACC, reading facial expression, body language, vocal sounds and changes in behaviour. Non-verbal never means pain-free, and assuming no pain because someone cannot describe it is a serious error.

For a fuller picture, a structured history helps. SOCRATES prompts you through site, onset, character, radiation, associations, timing, exacerbating and relieving factors, and severity.

Always reassess

The step most often skipped, and most often tested, is reassessment after analgesia. Giving pain relief is not the end. After a suitable interval you reassess to see whether it worked, whether more is needed, and whether side effects have appeared. Assuming relief, or waiting for the patient to complain again, leaves you blind to whether the treatment actually helped. Next: nutritional screening with MUST. Five pain scenarios first.