The first step in assuring quality pain care is appropriate pain assessment. While pain is highly subjective, caregivers are often on the frontline in tracking and reporting pain information to their loved one’s health provider. It is important to gather information about several aspects of the pain experience including pain severity/intensity, location, duration, aggravating and alleviating factors that impact pain and the impact of pain on activities (such as ADL’s, physical or psychological functioning, etc.). Assessing pain in older adults can be challenging, especially in individuals with limited cognitive abilities. Gathering data on pain severity and impact on function can be done with simple tools. One tool to assist caregivers in gathering valuable information is the use of a pain severity assessment tool used in combination with a pain impact tool and a Pain Diary . The Caregiver can then assist the healthcare team to have a clear understanding of the individual’s pain reports over a given period and provide key information for treatment planning.
This FAST FACT reviews the types, purposes, and uses of selected Pain Assessment Tools. Pick the pain severity assessment tool that your loved one prefers to use – here are 3 examples, plus a simple tool that includes pain severity and pain impact (the PEG):
Numeric Rating Scale
- PURPOSE: To assess pain intensity in persons who are able to self-report pain.
- WHO CAN USE: with individuals who can point or state the number that reflects their current pain level on a 0-10 scale (0=No pain/10=Worst possible pain).
- HOW TO USE: Have your loved one point to or state the number that best shows how bad his/her pain is NOW.
Verbal Descriptor Scale (VDS) or PAIN THERMOMETER SCALE
- PURPOSE: Used to assess pain intensity in persons able to self-report. Research indicates this is the best choice for most older adults.
- WHO CAN USE: Good for use with any loved one, including those with moderate to serve cognitive impairment or who have difficulty communicating verbally.
- HOW TO USE: Ask older adult to point to the words on the thermometer to show how bad or severe their pain is right now. Compare the words chosen after each use to the previous works to evaluate if pain has increased or decreased.
FACES Pain Scale Revised (FPS-R)
- PURPOSE: Pain intensity rating scale useful for many older adults, including those with mild to moderate cognitive impairment. Some older adults will find this tool easy to use and may prefer it over the Numerical Rating Scale. This scale requires either verbal ability or the ability to point to the image on the scale that most closely represents their pain severity.
- WHO CAN USE: To assess pain intensity in persons who are able to self-report. Some studies show African Americans and Asians prefer the Faces Pain Scale.
- HOW TO USE: Say to the older adult something like - "I'd like you to tell me about the intensity of any pain you are having. I'm going to show you some pictures of some faces. The faces show how much pain or discomfort one is feeling. The face on the left shows no pain. Each face shows more and more pain up to the last face that shows the worst pain possible. Point to the face that shows how bad your pain is right NOW.”
- NOTE: This tool is not to be used by the Caregiver to look at your loved one’s facial expression and pick a face.
PEG Scale Assessing Pain Intensity and Interference (Pain, Enjoyment, General Activity)
- PURPOSE: Pain intensity and impact rating scale. This scale requires either verbal ability or ability to point to the number that most closely represents their pain.
- WHO CAN USE: To assess pain in persons who are able to self-report and use a numeric rating scale (NRS).
- HOW TO USE: Ask the three questions on the pain assessment tool then compute the PEG score as outlined below.
- Computing the PEG Score: Add the three questions, then divide by three to get a mean score (out of 10) on overall impact of points.
- Using the PEG Score: The score is best used to track an individual’s changes over time. The initiation of therapy should result in the individual’s score decreasing over time.
FINAL Comments on Pain Assessment Tools
- Select a pain assessment tool that is appropriate for your loved one and use it each time you assess their pain level.
- Document pain information using a Pain Diary and review with your loved one’s healthcare provider on a regular basis.