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  • Writer's pictureNikita Chand

Pain Assessment Tool for Caregivers

Pain Assessment Tool for Caregivers: Using the OPQRST Tool on Cognitive Patients

Pain can be a complex and subjective experience for patients. You will want to understand the nature of your patient’s pain so that you can adequately and effectively comfort them. The best way to do this is to do a pain assessment. If your patient is cognitive and able to verbalize that they are in pain, then it would be relatively straightforward to assess their pain. A simple tool that can be used to gather more information about pain is called the OPQRST tool. Each letter represents a prompting question you can ask your patient to elicit additional information about the nature of their pain. Let’s take a closer look at each of these letters:

P – Provocative and Palliation: Start by asking your patient what makes the pain worst (provokes). Do changes in position make the pain worse? Moving from a lying to sitting position? Does walking make the pain worse? Does eating certain foods aggravate the pain? Is there a certain time of day that the pain feels worse, etc? In contrast to provocation, palliation questions aim to discover what lessens the pain. Does sitting and resting decrease the pain sensation? Do hot baths or massages decrease pain? Do certain medications help decrease pain, etc. Get to know what palliation techniques work for your patient so that they can be utilized on the patient once your complete your pain assessment.

Q – Quality: Understanding the quality of your patient’s pain will help you understand some of the descriptive nature of what the patient is experiencing at that time. Ask them what their pain feels like. If they are unable to give you a description, you can prompt them by asking the following: Is the pain feeling like a burning sensation, numbness or tingling, sharp or stabbing, throbbing, pressure-like, heavy-like, pins, and needle, cramping-like, etc.

R – Radiation – Sometimes pain is not just in one place on the person’s body. Pain can start in one place, and gradually move to another place, or it may radiate to another part of the body. For example, in diagnosing the serious medical emergency of appendicitis, many people initially complain of pain first at the epigastric area of the stomach (belly button), and gradually the pain can migrate to the right lower quadrant of the abdomen. You would want to ask your patient where the pain first started, and if it migrated to another body area/part.

S – Severity – Asking the patient to rate their pain on a numerical pain scale will give you an idea of how severe the pain is at that time. A common phrase used by health care providers that you can use with your patients goes like this: “ How would you rate your pain right now on a pain scale from 0 to 10. O being no pain at all, and 10 being the worst pain you’ve ever experienced.” Once you know their pain scale and you’ve completed your pain assessment, go ahead and provide any recommended interventions. After an intervention is completed such as pain medications being given, you can then ask the patient what their pain scale is. Ideally, after an intervention, their pain scale should go down from what it initially was, however, if it doesn’t change, or it increases, then it would be good to make note of this as well as look at other available interventions. The pain scale will help you determine what pain interventions were effective, and which were not in decreasing your patient’s pain severity.

T – Timing: Your patient may complain that the pain is worse at different times of the day. For example, patients with some types of arthritis may complain of more pain upon waking up. However, with movement, they become less stiff and achy. Another example is restless leg syndrome, in which patients complain of restlessness at night when in bed, but not during the day. In addition to understanding what time of day the pain is worse, timing also aims to understand if the pain is constant or intermittent. Constant pain is pain that started at one point and has yet to stop. Intermittent pain is described as pain that comes and goes. Assessing the timing of pain that your patient complains of will help you in understanding the nature of pain being reported.

U – Understanding: Ask your patient when the pain started. Is the pain new (acute) or is this something they have been experiencing for some time (chronic)? What initially caused the pain? Did they maybe have a fall or accident that is causing the pain? If the pain is new, ask them what they were doing when the pain suddenly appeared.

Case Study: Using the Pain Assessment OPQRST Tool

Now that we have gone through all the aspects of the OPQRST tool, let’s take a look at a case study that will help us in the future with communicating our pain assessment.

Case Study # 1: Mary, 73 year old female had a fall this morning. Today she is complaining of left hip and lower back pain. She is rubbing her hip and stated, “ my hip is throbbing” When asking Mary how bad the pain is she said it was a 5 out of 10 using the pain scale. Her pain started on her hip but started to affect her back. Her back feels sore. She isn’t having any other symptoms. Laying down helps a little with the pain, but bending over makes it worse. She hasn’t taken anything for pain yet. She is later given Tylenol 1 gram. After 1 hour the care aide comes back to ask if she is feeling any better, and what her pain scale is now. Mary reports she feels better and her pain scale is now at a 0. Within this case study, it was easy to gather all the relevant information using the OPQRST tool. The next step would be to streamline the above information so that it is concise, but still contains all the relevant information. See the below revised pain assessment using the pain tool. Mary, a 73 year old female complains of acute lower back and left hip pain post-fall. Pain is 5 out of 10 on the pain scale, described as throbbing. Pain is radiating from hip to back. Pain worsens with bending over and improves with laying down. No analgesia is taken yet.

As you can see from this example, it is a great tool to not only gather assessment data about your patients, but also helps you communicate your assessment in case you need further direction or a doctor’s order.

Once you are done assessing your patient’s pain experience using the OPQRST tool, you will feel more confident in communicating with your patient, family members, and other health care professionals about your findings. This is a great starting point to find solutions and interventions to help alleviate some, if not all, of your patient’s pain. You can use this tool dynamically, and come back and use it during different stages of your patient’s pain experiences. In your caregiver-patient interactions try to always remember that everyone’s reaction to pain is a highly subjective experience. Your idea of pain will be completely different then another’s. When we view others in this light we can learn to listen to them without imbuing judgment towards them. This outlook and tool will undoubtedly contribute to foster a trusting-professional relationship with all your patients.

Next time we will look at assessing pain in the nonverbal and/or dementia patient. Just because they can’t say they are in pain, doesn’t mean they are not! Stay tuned.

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