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Ovid: Oxford Handbook of Palliative Care

Editors: Watson, Max S.; Lucas, Caroline F.; Hoy, Andrew M.; Back, Ian N. Title: Oxford Handbook of Palliative Care, 1st Edition Copyright ©2005 Oxford University Press > Table of Contents > Symptom Management > Chapter 6a – The management of pain > Pain assessment tools Pain assessment tools Symptom monitoring by patients can be used to enhance understanding of the symptoms and improve assessment of the effectiveness of management strategies. As an example of symptom monitoring, pain assessment charts and scales have been used extensively. Used appropriately such evaluation tools provide a very useful quantifiable measure which both patient and healthcare professional can use to chart the effectiveness of pain reducing interventions. However, for those patients who may ruminate about their ‘pain scores’, the use of such a method of assessment exacerbates pain, and pain awareness. Other patients who are in the advanced stages of illness will find the completion of pain charts an unnecessary burden. From the health professional viewpoint, the collection of such data can be very useful, depending on the quality of the data collection, and can enhance understanding of how the patient perceives pain. However filling forms may draw the professional’s attention away from the patient. Pain is a multidimensional experience and as such requires a multidimensional assessment tool. The European Pain Group recommends two, the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), as both have been well validated in a number of different languages.3 While such assessment tools cannot provide objective evidence of pain management, if applied appropriately they can provide clear evidence of trends experienced by individual patients. A number of self report tools have been tested for use in palliative care to measure pain intensity in a reliable and valid way. These include: Visual analogue scales (VAS) The VAS is an unmarked line with extremes marked as no pain and worst pain. Patients are asked to mark the point in the line that describes their pain.

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Categorical verbal rating scales (VRS) A VRS involves a sequence of words describing different intensity levels of pain such as: None Mild Moderate Severe Categorical numerical rating scales (NRS) The NRS is similar to the VAS but uses numbers or gradations that indicate the severity of the pain experience

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Fig. 6a.1 Brief pain inventory. Reproduced with permission from Doyle et al. (2005) The Oxford Textbook of Palliative Medicine, 3rd edn. Oxford: Oxford University Press.
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Footnotes 3 Caraceni A., Cherny N., Fainsinger R., Kaasa S., Poulain P., Radbruch L., et al. (2000) Pain measurement tools and methods in clinical research in palliative care: recommendations of an expert working group of the European Association of Palliative Care. Journal of Pain and Symptom Management.

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