FAST FACTS: Selected Pain Assessment Tools
The first step in assuring quality pain care is appropriate pain assessment. While pain is highly subjective, if able to self-report, the individual is always in the best position to provide the most accurate information about their pain. 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 difficult, one tool to assist the caregiver to gather valuable information to share with the healthcare team is the use of a pain assessment tool used in combination with a Pain Diary (see “FAST FACT: Caregivers How to Use a Pain Dairy”). You can then share the information with your loved ones healthcare team to have a clear understanding of their pain over a given period and provide key information for development and ongoing review of the pain treatment plan.
This FAST FACT reviews the types, purposes, and uses of Pain Assessment Tools.
Pain Thermometer Scale or Verbal Descriptor Scale (VDS)
- PURPOSE: Used to access 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 person, including those with moderate to severe cognitive impairment or who have difficulty communicating verbally.
- HOW TO USE: Select the words on the thermometer to show how bad or severe pain is right now. Compare the words chosen after each use to the previous words to evaluate if pain has increased or decreased.
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 current pain level on a 0-10 scale (0=No pain/10=Worst possible pain)
- HOW TO USE: Point to or state the number that best shows how bad pain is NOW
FACES Pain Scale Revised (PRS-R)
- PURPOSE: Pain intensity rating scale useful for all 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.
- WHO CAN USE: To assess pain intensity in persons who are able to self-report but are unable to use a numeric rating scale (NRS). 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 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 intensity 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 dived 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 appropriate for you and use it each time you assess your pain.
- Document pain information using a Pain Diary and review with your healthcare provider on a regular basis.