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(IPAI) Includes diagram for illustrating sites of pain McGill Pain Verbal Extensively tested Long form takes 5-15 minutes to complete Questionnaire Assesses sensory and affective Some patients confused by vocabulary (MPQ) dimensions of pain Total score, but not individual scale scores, Short form takes only 2-3 minutes is considered valid measure of pain severity Memorial Pain Visual Rapid to use Assesses pain relief and mood on VAS and adds Assessment Correlated with other longer measures a set of adjectives reflecting pain intensity Card of pain and mood Can fold card so that the patient views only one scale at a time Pain drawing Written May demonstrate nature of pain at a glance (e.g., radiculopathy, peripheral neuropathy, trigeminal neuralgia, arthritis) Helps to avoid overlooking pain that the patient fails to mention Sources: References 7, 12, and 32-38. BPI: Brief Pain Inventory; HIV: human immunodeficiency virus; IPAI: Initial Pain Assessment Inventory; MPQ: McGill Pain Questionnaire; VAS: Visual analog scale. 3. Neuropathic Pain Scale Although the Short Form MPQ39 provides some information about neuropathic pain, it does not quantify it. The recently developed Neuropathic Pain Scale provides information about the type and degree of sensations experienced by patients with neuropathic pain.27 It evaluates eight common qualities of neuropathic pain (i.e., sharp, dull, hot, cold, sensitive, itchy, and deep versus surface pain). The patient rates each item on a scale from 0 to 10, with 0 for none and 10 for the “most imaginable.” Although still in its developmental form, this scale may hold diagnostic and therapeutic promise.7 Early data suggest that this scale is easy to use and sensitive to treatment effects.27 C. R EASSESSMENT OF PAIN Reassessment of pain is integral to effective pain management. Many factors influence its frequency, scope, and methods. This section reviews some approaches to reassessment in common clinical settings and situations. 1. Frequency The 1992 Agency for Health Care Policy and Researchb CPG states that pain should be reassessed: 1) within 30 minutes of parenteral drug administration, 2) within one hour of oral drug administration, and 3) with each report of new or changed pain.5 However, these recommendations pertain to the reassessment of acute pain in an acute care setting. Multiple factors determine the appropriate frequency of pain reassessment, including characteristics of the pain (e.g., duration, severity), patient factors and needs, the clinical setting, and pain management plan (i.e., type of drug or intervention). Reassessing pain with each evaluation of the vital signs (i.e., as a fifth vital sign) is useful in some clinical settings. However, the frequency of vital signs checks in others settings suggests the need for more or less frequent reassessment. Clinicians should instruct outpatients to contact them to report changes in the pain’s characteristics, side effects of treatment, and treatment outcomes. Periodic reassessment is recommended in patients with chronic pain to evaluate improvement, deterioration, or treatment-related complications.9,40 Residents of long-term health care facilities should be assessed for pain upon admission, at quarterly reviews, with changes in the patient’s medical condition, and whenever pain is suspected.41 2. Scope and Methods The scope and methods of reassessment vary with factors including the setting, characteristics of the pain, the patient’s needs and medical condition, and responses to treatment. Routine screening for pain with a pain rating scale provides a useful means of detecting unidentified or unrelieved pain. Appropriate tools, as well as terms synonymous with pain (e.g., burning, discomfort, aching, soreness, heaviness, tightness), should be used to screen elderly patients.40 The presence of any pain indicates the need for further assessment, consideration of painrelieving interventions, and post-intervention followup.3 For example, reassessment of pain in a stable and comfortable postoperative patient may be relatively simple and brief (i.e., score on NRS alone). However, sudden, unexpected intense pain, especially if associated with altered vital signs, should prompt immediate and thorough assessment for potential complications (e.g., wound dehiscence, infection, or deep venous thrombosis).5 Patients who have not responded to treatment and/or have complex types of pain (e.g., chronic pain, neuropathic pain) often require more comprehensive reassessment of pain. A pain diary may facilitate this process.9 A pain diary or log is a patient-generated record that is used to track various aspects of the pain and its management (e.g., pain intensity, associated activities, medication use, side effects, and other responses to treatment). National Pharmaceutical Council 29 Section II: Assessment of Pain bThe Agency for Health Care Policy and Research is now the Agency for Health Care Research and Quality. Section III: Types of Treatments A. PHARMACOLOGIC TREATMENT Treatments for pain can be broadly categorized as pharmacologic and nonpharmacologic. This section of the monograph provides an overview of: 1) a commonly used analgesic classification system, 2) some commonly used analgesic classes and individual drugs, and 3) general principles of pharmacologic treatment. 1. Drug Classifications and Terminology
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