The way physicians and nurses conduct a pain assessment impacts how WE come to listen to, understand, anticipate and treat pain.  

After observing countless ‘pain assessments’ over the course of my brother’s 61-day acute hospital stay, it was apparent so much was missing from the patient-practitioner interaction. Here was a critical opportunity for listening, evaluating, engaging and educating that was conducted as a transaction with the simple goal of checking a box and not much more.

Does this ‘pain assessment’ sound familiar to you?

A nurse walked into my brother’s room, said “Hello, it’s time for your pain assessment. On a scale of one to ten with ten being unbearable pain, what is your pain level?” My brother, who looked shocked and bewildered, paused and then mumbled - seven??? Sometimes he would not respond at all to the question. His face looked strained, his eyes faraway, and he winced with micro movements. The nurse would not look at him, make eye or physical contact. The nurse would just go to the computer, turn away from my brother and then say, “Do you want something for your pain?” My brother would shrug his shoulders and say “It doesn’t help.” The nurse would reply without acknowledging him, “You have Tylenol, Norco, Fioricet, Flexeril, and…” My brother understood none of this. The entire encounter seemed to take less than a minute or two. When pain medication was administered, few words were exchanged aside from the name of the medication. Here again was an opportunity to educate and engage that was missed.

My brother was experiencing severe and intense pain on multiple levels, yet no one bothered to explore with him the source of his pain sensations and options for relief.

My brother was treated at ‘teaching hospitals’. However, it seemed to me that neither the patient nor the provider were well educated about pain. I’ve concluded that most healthcare facilities (acute and post acute) assume they have a pass on educating patients and providers on ways to listen to the body. Healthcare facilities treat ‘acute pain’ as if it were all related to tissue injury such as post surgical, broken bones, dental work, childbirth, and cuts/bruises. Acute pain is expected to go away once the injured tissue heals. So, why bother understanding more fully the source of the patient’s pain, which may or may not be acute, when it is going to resolve soon? Why bother empowering the patients with techniques they can use to communicate more effectively what they are sensing when those sensations are assumed to go away soon? Too many implausible assumptions are made at the expense of individualized patient care.

The reality is that for a large number of patients, these pain sensations do not resolve completely. One in three people in the US have serious chronic pain. That’s 100 million people. The cost to lives not fully lived and our economy are astounding. It is estimated that chronic pain costs the US 1/2 a trillion dollars a year. (https://nationalpain.org/about-pain#understanding-pain). WE cannot afford to give our healthcare systems a ‘pass’ on how pain assessments are conducted.

Join a WE Bridge The Gaps workshop or schedule a consultation with WE Bridge The Gaps to review your facility’s pain management policies.