2 Pain Assessment and Reassessment
Learn how to assess pain through patient-centered communication, suitable scales, functional goals, and repeated evaluation of treatment response.
Principles of
is a structured, repeated process for understanding a person’s pain and its effects, not simply recording a number. When a patient can communicate, their report is the primary measure. Behavior and physical signs can add information, but they do not substitute for self-report or reliably measure pain intensity in someone able to report it.
Gathering the pain history
Assess pain when the patient reports it, when a condition or procedure may cause it, and when the patient’s condition changes. Ask about the pain’s location and whether it travels; when it began and whether it is constant or intermittent; and what has changed. Explore how it feels, such as aching, burning, sharp, or pressure-like, and ask how strong it is now as well as its best, worst, or usual levels over a relevant period.
Ask what makes the pain better or worse, including movement, rest, or prior treatments. Find out how it affects sleep, mood, mobility, self-care, work, and other valued activities. Ask what the patient has tried, what helped, and what effects or concerns they noticed.
The prompt can organize questions about Provokes/palliates, Quality, Region/radiation, Severity, and Timing. Use it as a guide, not a script; ask follow-up questions in the patient’s own terms and document the patient’s description.
Assessing acute and chronic pain
For acute pain, identify its likely cause or context, onset, changes, and effects on immediate activities. After surgery, for example, consider whether pain affects deep breathing, coughing, resting, or walking. Sudden or new pain may require clinical evaluation as well as symptom relief.
For chronic pain, assess its pattern over time and its effects on physical, emotional, and social functioning. A single current rating may not represent the person’s overall experience. Asking about usual, best, and worst pain over a defined period can provide context; track meaningful function and quality of life alongside intensity.
Selecting and using a pain scale
Choose a scale the patient can understand and use, and explain its endpoints consistently. Common options include:
: The patient rates pain from , meaning no pain, to , meaning the worst pain imaginable.
: The patient selects a word such as none, mild, moderate, or severe.
: The patient marks a point on a line anchored by no pain and worst pain.
: A series of faces can support communication for some children or people who have difficulty using numbers or verbal descriptors. Explain that the faces represent pain intensity, not how the patient thinks they should look.
Use the same scale consistently to compare reports over time, but do not treat a score as the whole assessment. A rating of means what it means to that patient; it does not, by itself, dictate a particular intervention.
If self-report is not possible, use an appropriate validated observational tool and consider information from caregivers or others familiar with the patient. Reassess the person’s ability to communicate and return to self-report if possible.
Communicating with the patient
Create a respectful setting and give the patient time to describe the experience. Listen without judgment, use open-ended questions, and reflect back the patient’s meaning to confirm understanding. Do not dismiss pain because the patient looks comfortable, has a chronic condition, or gives a rating that differs from expectations.
Consider language, hearing, vision, cognition, culture, and other communication needs. Arrange a qualified interpreter or communication aid when appropriate. Ask what matters most to the patient and what degree of relief or activity would be meaningful. This collaborative approach supports a complete assessment and shared decisions.
Reassessing response and updating the plan
Reassess after an intervention at intervals suited to the intervention, the patient’s condition, and local clinical policy. For medicines, follow the prescribed route-specific and setting-specific timing. Reassess sooner if pain worsens, changes character, or new concerns arise; there is no single universal interval for every treatment or care setting.
When possible, use the same scale and ask about the same functional goal so the response can be compared with the baseline. Include:
The pain’s intensity and pattern now, compared with the prior assessment.
The patient’s view of whether the intervention helped and how much.
Progress toward the agreed activity or comfort goal.
Adverse effects or new symptoms, including effects that may require prompt attention.
Whether the plan should continue, change, or be escalated for further evaluation.
Document the intervention, reassessment findings, the patient-reported response, the functional response, and follow-up action. If the intervention did not help or the pain or condition changed, communicate this to the appropriate clinician and reassess the plan rather than repeating the same approach without review.
Setting functional goals
Pain relief matters, but the goal is not always zero pain. Agree on a realistic, measurable goal that reflects the patient’s priorities and clinical situation. Examples include walking to the bathroom with assistance, taking deep breaths and coughing after surgery, sleeping for a longer stretch, or resuming a valued daily activity.
For ongoing pain, the scale assesses average pain and interference with enjoyment of life and general activity. Pair a rating tool with a specific patient-defined goal, such as walking around the block twice this week, and review progress over time.
A sound assessment combines the patient’s report, a suitable scale, pain pattern and context, and effects on function. Reassess after interventions using consistent measures, record both symptom change and functional response, and revisit the plan when goals are not being met or the patient’s condition changes.