Pain Assessment and Management
Click on the titles to display the resource.
-
Show description [+]
This Best Practice Guideline (BPG) Pain: Prevention, assessment and management (Fourth Ed.), replaces the RNAO BPG Assessment and Management of Pain, Third Edition.
The purpose of this fourth edition guideline is to provide nurses and the interprofessional team with evidence-based guidance for the prevention, assessment and management of all types of pain across the lifespan. This BPG recognizes that people at risk of or experiencing any type of pain across the lifespan and their families are experts in their health and decision-making; collaboration among the interprofessional team, the person receiving care and their family (if applicable) is therefore essential to achieving improved health outcomes.
Registered Nurses’ Association of Ontario. (2025). Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author. Retrieved from: https://rnao.ca/bpg/guidelines/assessment-and-management-pain
This work is funded by the Ontario Ministry of Health and Long-Term Care.
-
Show description [+]
A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2025) Gap Analysis: Pain: Prevention, assessment & management, Fourth Ed. Toronto, ON.
-
Show description [+]
On April 11, 2023, changes to Ontario Regulation 246/22 (the "Regulation") under the Fixing Long-Term Care Act, 2021 (the "Act") came into effect.
Informed by engagement with key partners and stakeholders, as well as feedback from the public, the Ministry of Long-Term Care (the "Ministry") has refined the regulatory framework with consideration of the lived experience of residents and long-term care homes and emerging needs in the sector.Retrieved from: https://www.ontario.ca/laws/regulation/220246
-
Show description [+]
The Abbey Pain Scale is an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs, for example, patients with dementia, cognition or communication issues. The scale does not differentiate between distress and pain, so measuring the effectiveness of pain-relieving interventions is essential.
Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002. This document may be reproduced with this acknowledgment retained.
https://www.apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf
-
Show description [+]
Health HQ Neuropathic Pain Resources - This website provides access to resources related to neuropathic pain.
-
Show description [+]
A list of organization and resources for pain prevention, assessment and management.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix f of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author. pp. 97.
-
Show description [+]
This link will take you to the document developed by AdvantAge Ontario to support program objectives, policy, procedures and staff training materials and tools that meet minimum requirements of the LTCH Act and Regulation.
Retrieved from www.advantageontario.com
-
Show description [+]
A succinct, 2-page newsletter that covers myths and facts about pain. Developed by the BPG in LTC Initiative Central South and The Long Term Care Resource Centre, Hamilton, Ontario. Source: http://www.rgpc.ca/
-
Show description [+]
Purpose of the BPI tool is to assess the severity of pain and the impact of pain on daily functions. The tool can be used for patients with pain from chronic diseases or conditions such as cancer, osteoarthritis and low back pain, or with pain from acute conditions such as postoperative pain.
Assessment areas included are severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours or the past week.
The BPI copyright is held by Dr Charles S. Cleeland (1991). The copyright applies to the BPI and all it's derivatives in any language.
Retrieved from http://www.npcrc.org/files/news/briefpain_short.pdf
-
Show description [+]
The Canadian Journal of Pain is an open access journal that publishes research from all disciplines involved in the study of pain, including the clinical and basic sciences, epidemiology, and health policy and health systems. The Canadian Journal of Pain is the Official Journal of the Canadian Pain Society.
The journal aims to advance the understanding and treatment of pain by providing clinicians, scientists and other health care professionals with an interdisciplinary forum in which to share cutting-edge information about new developments in the field of pain, including chronic and neuropathic pain.
The journal operates a single anonymized peer review policy. Source: Canadian Journal of Pain. (2024). Copyright © 2024 Informa UK Limited
https://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ucjp20
-
Show description [+]
The Checklist of Nonverbal Pain Indicators (CNPI), was designed to observe and measure pain behaviors in cognitively impaired elders.
Retrieved from: https://www.caltcm.org/assets/Pain-file/checklist%20nonverbal%20pain%20indicators.pdf
Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs. 2000 Mar;1(1):13-21. Horgas AL. Assessing pain in persons with dementia. In: Boltz M, series ed. Try This: Best Practices in Nursing Care for Hospitalized Older Adults with Dementia. 2003 Fall;1(2). The Hartford Institute for Geriatric Nursing. www.hartfordign.org
-
Show description [+]
This tool demonstrates how the mnemonic OPQRSTUV, can be used to conduct a comprehensive pain assessment. Note that this assessment may not be the most appropriate tool for all presentations of pain.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix C of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author. pp. 81.
Source: Adapted from: Fraser Health. Hospice palliative care program: symptom guidelines [Internet]. Surrey (BC): Fraser Health; 2019. Available from: https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Hospice-palliative-care/SectionsPDFs-for-FH-Aug31/9524-01-05-FH---Sym_Guide-Intro-v05FINAL.pd
-
Show description [+]
The Leading Change Toolkit includes two frameworks- the Social Movement Action (SMA) Framework and the Knowledge-to-Action (KTA) Framework. Both frameworks outline the concept of implementation and its interrelated components. The toolkit is based on available evidence, theoretical perspectives and consensus. We recommend the Leading Change Toolkit for guiding the implementation of any BPG in health care or social service organizations, including academic centres.
Reference: Registered Nurses’ Association of Ontario, (2025). Appendix G of Pain: prevention, assessment and management. Fourth edition. Toronto, Canada: Author. pp. 98-99 .
-
Show description [+]
Behavioral pain assessment scale for the elderly presenting with verbal communication disorders, DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).
Retrieved from: https://www.doloplus.fr/pdf/doloplus-en.pdf
Copyright
-
Show description [+]
This link takes you to the resources that include pain assessment terminology and Power Point presentations.
Reference: Sigma Theta Tau International for the Center for Nursing Excellence in Long Term Care 2013. Pain assessment terminology and narrated power point presentations. Retrieved from http://www.geriatricpain.org
-
Show description [+]
This link takes you to the Geriatric Pain website http://www.geriatricpain.org
The website was created to provide nurses who work in LTC environments with access to free best practice pain assessment tools and resources to help manage pain in older adults, including quality improvement processes focused on pain management
-
Show description [+]
This resource is a glossary of terms used throughout the best practice guideline, Pain: Prevention, assessment and management. Fourth edition.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix A of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author.
pp. 69-75.
-
Show description [+]
The revised ESAS-r is available in multiple languages. The link will take you to the guidelines for using the ESAS-r tool. The ESAS-r tool is freely available to use, with appropriate acknowledgement of its source.
Website: http://www.palliative.org
-
Show description [+]
You may need to seek assistance from a health-care professional when you have concerns about people you care for who are in pain. Uncontrolled pain is a common problem. Pain can affect anyone at any age and include people who are unable to communicate that they are experiencing some form of pain. If people have pain during their day-to-day activities or during any medical procedure, this can affect the way they behave and function. This behaviour may cause you to feel helpless and distressed, especially if you can not help them with their pain and they are not able to speak for themselves.
Retrieved from: http://rnao.ca/bpg/guidelines/fact-sheets/helping-people-manage-their-pain
-
Show description [+]
Watch a video of nurses implementing the Assessment and Management of Pain Guideline into their practice.
RNAO (2009) Implementation of Pain Assessment and management Guideline
Source: http://www.youtube.com/watch?v=Ssymdf8CFQ4&feature=channel_page.
-
Show description [+]
Fiche de renseignements pour la sensibilisation en matière de santé.
Association des infirmières et infirmiers autorisés de l’Ontario (2002, Novembre). Maîtriser sa douleur. Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/sites/rnao-ca/files/Maitriser_sa_douleur_0.pdf.
-
Show description [+]
This tool is designed to help family physicians and nurse practitioners (primary care providers) develop and implement a management plan for adult patients with Chronic Non Cancer Pain (CNCP) in the primary care setting. CNCP is defined as pain that typically persists or recurs for more than 3 months or past the time of normal tissue healing.1,2,3,4 This tool applies to, but is not limited to pain conditions such as osteoarthritis (OA), low back pain (LBP), musculoskeletal (MSK) pain, fibromyalgia (FM) and neuropathic pain (NP). This tool focuses on a multi-modal approach to manage CNCP.
Web Address or Source: https://thewellhealth.ca/wp-content/uploads/2017/03/CEP_CNCP_Main_V1.pdf
-
Show description [+]
This tool can be used to guide healthcare professionals with assessment of patient pain. It includes diagrams of the human body to help patients locate the pain they experience and questions to prompt the patient to describe the intensity, quality, causes, effects, and contributing factors of their pain.
Reference: McCaffrey M, Pasero C. (1999). McCaffrey Initial Pain Assessment Tool
-
Show description [+]
A pain rating scale used to determine a persons level of pain.
- Scored 0-10 with the anchors of 0 being ‘no pain’ and 10 being ‘pain as bad as it can be’ Used in adults, older adults, and adolescents and children over age 8.
- Well established evidence of reliability, validity, and ability to detect change
- No equipment is needed to administer this measure
- High feasibility (quick and easy to use)
Reference: McCaffery, M., Beebe, A., et al. (1989). Pain: Clinical manual for nursing practice, Mosby St. Louis, MO
-
Show description [+]
The Opiod Manager condenses key elements from the Canadian Opiate Guideline into a workable format for prescribing opiates for persons with chronic, non-cancer pain.
Reference: National Opiod Use Guidelines Group (2010), Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Practice Toolkit, Opioid Manager. Retrieved from http://nationalpaincentre.mcmaster.ca/opioidmanager/
© 2016 McMaster University
-
Show description [+]
PACSLAC is a tool to observe and assess both common and subtle pain behaviours. Copyright © Shannon Fuchs-Lacelle and Thomas Hadjistavropoulos. The PACSLAC may not be reproduced without permission. For permission to reproduce the PACSLAC, please contact the copyright holders (Thomas.Hadjistavropoulos@uregina.ca).
Retrieved from: https://gerocentral.org/wp-content/uploads/2013/12/Pain-Assessment-Checklist-for-Seniors-with-Limited-Ability-to-Communicate-PASLAC.pdf
-
Show description [+]
This resource from Interior Health, is a pain assessment tool useful for scoring pain levels of people with dementia who are unable to verbally express their pain. It focuses on assessing behaviours and provides a score rating of mild, moderate or severe pain levels.
Retrieved from: https://www.interiorhealth.ca/sites/default/files/PDFS/810310-pain-assessment-advance-dementia-scale.pdf
Warden, V., Hurley, A. & Volicer. L. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. JAMDA, 4(1), 9 -15. Horgas, A., & Miller, L. (2008). Pain assessment in people with dementia. American Journal of Nursing, 108(7), 62-70.
-
Show description [+]
These pain screening and assessment tools can be self-reported (by the individual experiencing pain and/or their family) or observational (behaviours observed by a health provider in an individual who is unable to communicate or is unconscious). This is a list of validated tools that can be used to assess pain in various populations and contexts. However, this is not an exhaustive list. Please follow organizational policies for pain tool usage. Not all tools are validated for all populations and settings. RNAO does not endorse the use of any one specific pain screening and assessment tool.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix D of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author.
-
Show description [+]
This link takes you to PARC which supports, educates and informs persons with Reflex Sympathetic Dystrophy (RSD), otherwise known as Complex Regional Pain Syndrome (CRPS) the community and the medical professionals treating RSD, about the importance of early diagnosis and treatment.
-
Show description [+]
A validated and reliable sedation scale for assessing and reporting opioid induced sedation.
Retrieved from: https://www.qualityhealthnd.org/wp-content/uploads/Pasero-Opioid-induced-Sedation-Scale.pdf
Nisbet AT, Mooney-Cotter F. Comparison of selected sedation scales for reporting opioidinduced sedation assessment. Pain Manag Nurs. 2009 Sep;10(3):154-64.
Kobelt P, Burke K, Renker P. Evaluation of a standardized sedation assessment for opioid administration in the post anesthesia care unit. Pain Manag Nurs. 2014 Sep;15(3):672-81
Pasero C. Assessment of sedation during opioid administration for pain management. J PeriAnesthesia Nurs. 2009 Jun;24(3):186-90.
-
Show description [+]
This policy and procedure for pain assessment and management provides examples for inclusion of evidence –based recommendations in an organization’s policy to address acute and chronic pain. This document was created prior to the LTCHA (2007).
Toronto Best Practice in LTC Initiative. (2006). Policy and Procedure: Pain Assessment and Management. Retrieved 2013, from http://rgp.toronto.on.ca/torontobestpractice/Policyprocedurepainassessmentmanagement.pdf -
Show description [+]
A list topics and suggested RNAO guidelines and resources from other organizations that align with Pain: Prevention, assessment and management. Fourth edition. Toronto, Canada: Author. pp. 76-78.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix B of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author.
-
Show description [+]
A number of systematic reviews focused on non-pharmacological approaches (NPI) to pain management: Type of NPI and population.
Reference: Registered Nurses’ Association of Ontario. (2025). Appendix E of Pain: Prevention, assessment and management. (Fourth Ed.). Toronto, ON: Author. pp. 89-96
-
Show description [+]
Symptom Management Algorithm for pain in adults with cancer developed by Cancer Care Ontario.
Cancer Care Ontario (2018) Symptom Management Algorithm- Pain in Adults with Cancer retrieved from https://www.cancercareontario.ca/en/symptom-management
-
Show description [+]
The link takes you to screening questionnaires for neuropathic pain that incorporates the persons signs and symptoms.
https://cdn-links.lww.com/permalink/aap/a/aap_40_3_2015_02_20_brulotte_rapm2014-216_sdc2.pdf
Source: Bennett M, The LANSS Pain Scale: The Leeds assessment of neuropathic symptoms and sign. Pain 2001;92: 147- 157
-
Show description [+]
The educational website contains:
- A narrated presentation about pain and dementia
- A downloadable resource pack for family members, and
- A downloadable pain-log and the PAINAD assessment tool (Warden, Hurley, Volicer, 2003)
A facilitator's toolkit of background material, a planning guide, promotional material, and supplemental information for organizations who wish to conduct a workshop using he materials.
Retrieved from: http://brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Pain.aspx
This link takes you to the CDRAKE and AKE combined activities to form an exciting new network.