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Pain Management

A medical apporach on prevention, diagnosis, and treatment of pain,

What is pain?

In clinical practice, pain has been identified as the fifth vital sign. Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain, 2017 as cited in Registered Nurses Association of Ontario, 2013, p. 17).

The Registered Nurses Association of Ontario (2013) describes the two broad classifications of pain as

  • nociceptive pain: a warning signal that results from actual or threatened damage to non-neural tissue resulting in the activation of nociceptors in a normal functioning nervous system.
  • neuropathicG pain: a clinical description of pain thought to be caused by damage from a lesion or disease of the somatosensory nervous system that is confirmed by diagnostic investigations.

Pain Assessment

Pain is multidimensional and subjective in nature. Therefore, pain assessment must include intensity, duration, location, and other factors that may influence perception of pain. Numerous pain assessment scales, tools, and techniques are available to assist patients to describe and rate their pain intensity and to help clinicians assess pain, observe associated behaviours, and monitor the effectiveness of medical interventions. Pain assessment tools are classified in to two categories.

  • Self-report: patients self-rate their pain intensity using a uni-dimensional scale. Some of the widely used pain assessment tools are the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Descriptor Scale (VDS), a Numerical Descriptor Scale (NVDS) and the Wong Baker smiley faces.
  • Observational or behavioural: devised for patients, such critical care patients and people with dementia, who cannot self-report pain. Assessment tools. These types of tools are developed to analyze and assess "verbalization, facial expression, body movements, changes in interaction, and changes in activities of living and mental status changes" (Gregory & Richardson, 2014, p. 140).

Pain Management

Pain can be mild or extreme; can feel on one part of the body to the whole body.  Recommended pain management strategies include

  • pain-relieving medications (pain medicines)
  • physical or occupational therapy such as Cognitive Behavioural Therapy (CBT), Mindfulness Based Stress Reduction (MBSR), and Acceptance and Commitment Therapy (ACT)
  • complementary therapies such as acupuncture and massage, and
  • counselling.


Gregory, J., & Richardson, C. (2014). The use of pain assessment tools in clinical practice: A pilot survey. Journal of Pain & Relief, 3(2), 140-146. https://doi.org/10.4172/2167-0846.1000140 

Morone, N. E., & Weiner, D. K. (2013). Pain as the fifth vital sign: Exposing the vital need for pain education. Clinical Therapeutics, 35(11), 1728-1732. https://doi.org/10.1016/j.clinthera.2013.10.001

Registered Nurses Association of Ontario. (2013). Assessment and Management of Pain. http://rnao.ca/sites/rnaoca/files/ AssessAndManagementOfPain2014.pdf