Onset

Definition: Description of the experience of the beginning of the pain.

Comment/Importance to Caregiving:

  • Understanding the onset of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Your loved one may describe a sudden or gradual development of the pain, associated with a known injury or illness
  • Asking about onset can also help identify pain triggered by specific movement or activity

Duration

Definition: How long the pain has been experienced and continues to be present (lasting minutes or hours)

Comment/Importance to Caregiving:

  • Understanding the duration of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • As the person that knows your loved one best you may be the one to provide the most accurate information to the healthcare team, especially if your loved one is unable to self-report. This information is vital in helping to support treatment plan decisions
  • Information is critical for evaluating the effectiveness of the treatment plan

Frequency

Definition: The number of occurrences in a specified period of time; how often the pain is experienced in a given time period.

Comment/Importance to Caregiving:

  • Understanding the frequency of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Knowing the frequency of pain is useful in developing treatment strategies and for individualized scheduling of care activities

Location

Definition: Site(s) of pain

Comment/Importance to Caregiving:

  • Understanding the location of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Most older adults have pain in more than one location
  • Document-intensity & quality for all pain locations
  • Pain maps (drawing of a body so you can indicate where the pain is located) are very useful in documenting all pain locations, guiding therapy, etc.

Intensity

Definition: The older adult’s descriptive rating (such as a number, “5” or a word, like “moderate”) that describes the intensity or severity of the pain.

Comment/Importance to Caregiving:

  • Understanding the intensity of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Also called Severity
  • Usually helpful to identify intensity for the ‘worst pain’ over a specified period as well as ‘the best the pain gets’
  • Assessing the older adult’s present pain rating and an identified pain rating acceptable to the older adult is also important
  • Use the most appropriate pain assessment scale individualized to the older adult’s cognitive and sensory abilities to determine their pain intensity level (see the FAST FACT- Caregivers: When to use Pain Assessment Tools)

Pattern

Definition: The progress of the pain over time including changes, often influenced by times of day (e.g., certain hours of the day, night or day, monthly patterns), periods of rest, or specific or general activity/movement.

Comment/Importance to Caregiving:

  • Understanding the pattern of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Helps to determine if there are influences that impact the pain
  • Older adults can experience constant and/or episodic pain
  • Analgesic treatment should be tailored to these patterns

Quality

Definition: Description of the characteristics of the pain, preferably in the words used by the older adult to describe the pain.

Comment/Importance to Caregiving: 

  • Understanding the quality of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Also called “Character” of pain
  • Helpful in determining the type of pain to select the most appropriate treatments, including analgesics and nondrug therapies
  • If the older adult has difficulty describing the pain, it may be helpful to offer examples of descriptions including: aching, sore, cramping, pounding, sharp, throbbing, dull, nagging, shooting, numb, tingling, spasm, burning, gnawing, pressure-like, radiating, stabbing, tingling, tender, knife-like, etc.

References:

https://www.cdc.gov/opioids/; Accessed 1/16/2019

Definitions Related to the Use of Opioids for the Treatment of Pain: a consensus document from the American Academy of Pain Medicine the American Pain Society, and the American Society of Addiction Medicine, 2009. 

Public Policy Statement on the Rights and Responsibilities of Healthcare Professionals in the use of Opioids for the Treatment of Pain. A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.

Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act, a Joint Statement. From 21 Health Organizations and the Drug Enforcement Administration, 2001. Available at:  http://www.deadiversion.usdoj.gov/pubs/advisories/painrelief.pdf  Accessed December 1, 2016.

Fine, PG, Portenoy, RK: A Clinical Guide to Opioid Analgesia, New York: McGraw Hill, 2007.

Reuben, D., Herr, K., Pacala, J., Pollock, B., Potter, J. & Semla, T. (2018). Geriatrics At Your Fingertips, 20th Ed. New York, NY: American Geriatrics Society (pp 247-268).