Basic Principles

Assessing Severity of Pain

Pain assessment is essential to identify whether a patient has pain, how severe it is, and whether the intervention to treat it has been successful.

The patient should be asked to rate both their

• pain at rest to guide prescribing for background pain (constant), and
• pain on movement (coughing, being rolled, walking with the physio) to guide prescribing for breakthrough pain (intermittent).

There are numerous pain assessment tools.

• VRS - verbal rating scale  VRS - Verbal Rating Scale - MOST COMMONLY USED

• NRS - numerical rating scale  NRS - Numerical Rating Scale
• VAS - visual analogue scale  VAS - Visual Analogue Scale

• Wong-Baker faces scale  For Children - Wong Baker Faces Scale
• r-FLACC scale  For Children or non-verbal Adults - FLACC
• Abbey Pain Scale  For Patients with Dementia - Abbey Pain Scale

We also now use the Functional Activity Score to assess the impact of pain on function.  The function measured is related to the surgery or injury: we may want to assess a patient's ability to comply with physiotherapy after a knee replacement, or the ability to take a deep breath and cough in a patient with rib fractures, as in the example below.