Pain Assessment: How to Assess Pain in Patients?

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage the assessment of pain in adults and children.

Hey, guys. In today’s micro lecture we are going to talk about the assessment of pain in adults and children.

Now, as paramedics, you are going to be attending patients who are presenting with quite a bit of pain, and unfortunately, pain is actually pretty complex and it’s not as simple as we like to make out. For example, as an experienced paramedic, you need to understand that pain is whatever the patient says it is.

Now, that can cause a conflict with a lot of paramedics, particularly when they’ve had quite a bit of experience dealing with patients, but when you start to read around how patients present with pain and all the different restrictions on them presenting and externally presenting the pain to you as a paramedic, you will start to understand how complex it actually is.

Now, the other side to this is, it’s extremely unethical and immoral to leave somebody in pain when you have the education, the training and the equipment and drugs to prevent somebody from suffering. Now, it’s not to say that there aren’t going to be those patients who always will call ambulance services for a hit of pain relief, and of course in using your clinical judgment and your clinical experiences you are going to be able to filter those people out and still do the best thing by them, because, let’s face it, just because somebody has a drug addiction doesn’t mean that they need any less of a standard of care, but it just might mean that you choose a different pain relief over, say, an opioid, if they’ve got an opioid addiction.

But anyway, let’s get back to the subject of assessing pain. Now, I’m sure you’ve all heard of this thing called a Numeric Pain Rating Scale. It’s also called a Visual Analog Scale, where you say to the patient, on a scale of nought to 10, nought being no pain, 10 being the worst possible pain you’ve ever had, what number would you give the pain?

Now, when the patient says six or seven but they don’t look like they’re in any obvious discomfort, then, as the paramedic, you have to assume that it’s six or seven. Now, sometimes what we like to do is add things in there. Some of the things I’ve heard, I’ve heard, if five makes you cry and 10 is somebody’s chopped your arm off with a chainsaw.

Now, again, that’s just a completely pointless activity, so when you say to your patient, on a scale of nought to 10 what is your pain, let them think about it and give you a number and then you provide the most appropriate pain relief, depending on the pain that they’re presenting with.

Then, of course, is assessing pain in children, which is even more complex. Now, there is this notion of Wong-Baker Face Scales. The idea is that you have these images somewhere on you or in the ambulance or in your guidelines, maybe they’re in a folder somewhere, so if you do have a child, work with the parents to get the patient to either point to the image that represents how they’re feeling or get them to read the words, if they’re of that age. And again, that will give you an idea.

But also remember that a still child is an ill child, meaning that if they’ve fallen from a height, landed on their wrist and they’re very still, you might want to consider giving them some strong pain relief, as long as the primary service is all okay, because children are generally quite alert and responsive, particularly to pain.

So that’s a bit of a snapshot of assessing pain in adults and children. I look forward to speaking to you again shortly at the next micro lecture. Thanks, guys.

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