Pain Assessment and Management
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The guideline contains recommendations for best nursing practices in the assessment and management of pain for Registered Nurses (RNs) and Registered Practical Nurses (RPNs). It is acknowledged that the individual competency of nurses varies between nurses and across categories of nursing professionals (RNs and RPNs) and is based on knowledge, skills, attitudes, critical analysis and decision making which is enhanced over time by experience and education. This guideline is endorsed by the International Association for the Study of Pain.
Registered Nurses’ Association of Ontario. (2013). Assessment and management of pain. (3rd Ed.). Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain_15_WEB-_FINAL_DEC_2.pdf This work is funded by the Ontario Ministry of Health and Long-Term Care.
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A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2022) Gap Analysis Assessment & Management of Pain 3rd edition. Toronto, ON.
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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
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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
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Health HQ Neuropathic Pain Resources - This website provides access to resources related to neuropathic pain.
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An assessment tool that uses the mnemonic OPQRSTUV to assist health care professionals systematically assess people who screen positively for the presence or risk of any type of pain and who can self report.
Figure 1 (page 21) RNAO BPG Assessment and Management of Pain 3rd Edition (2012) http://rnao.ca/bpg/guidelines/assessment-and-management-pain
Adapted from "Symptom Assessment Acronym "OPQRSTUV", in Fraser Health Authority, 2012, Hospice Palliative Care Program Symptom Guidelines. Retrieved from https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Hospice-palliative-care/SymptomAssessmentRevised_Sept09.pdf
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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
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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/
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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Asks persons to rate their pain from 0 to 10
- 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:
Registered Nurses’ Association of Ontario. (2013). Appendix E of Assessment and Management of Pain, Third Edition.Toronto, Canada: Author. 81-82.
McCaffery, M., Beebe, A., et al. (1989). Pain: Clinical manual for nursing practice, Mosby St. Louis, MO
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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
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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
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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.
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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.
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A validated and reliable sedation scale for assessing and reporting opioid induced sedation.
Registered Nurses' Association of Ontario. (2013). Appendix O of Assessment and Management of Pain Third Edition. Toronto, ON, Canada p.99
Used with permission from: Pain Assessment and Pharmacologic Management, by C. Pasero and M. McCaffery, 2011, St. Louis, MO: Mosby/Elsevier. Copyright (1994) by Chris Pasero
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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 -
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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
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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
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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.