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Pain is the most common symptom reported by patients who present to the ED. Early assessment of pain enables effective management and relief of suffering.
Pain is the response to actual or potential tissue damage, and involves physiological, behavioural and emotional responses. The patient’ s self-report is regarded as the gold standard for measuring pain. 57
The experience of pain is recognised as being subjective, personal and as severe as the patient reports. However, this recognition does not currently extend into clinical practice, particularly in EDs, with numerous studies demonstrating that pain is often underrecognised, poorly assessed, and inappropriately treated. 59
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Pain can be acute or chronic. Chronic pain differs from acute pain in that it has usually been present for more than three months. Chronic pain has a potential for under-treatment. 58 The incidence of chronic pain is increasing in Western populations, with an estimated one-third of the Australian population experiencing chronic pain, and is commonly associated with the elderly.
The ATS has included the severity of pain as a factor in determining the triage code. The inclusion of pain severity as a physiological discriminator in triage assessment is in recognition both of the humane factors associated with providing care to members of the community, and of the physiological effects of pain. 61 These latter effects include increased risk of infection, delayed healing, and increased stress on cellular function and on organ-system stability.
Assessment of pain
Assessment should attempt to determine the mechanisms producing the pain, other factors influencing the pain experience, and how pain has affected physical capacity, emotions and behaviour.
As with the experience of pain itself, the assessment of pain requires a multifaceted approach, with no single tool able to provide an objective measurement of pain. Elements to be included in assessing pain include:
• Descriptors and verbal expressions used by the patient
• Information obtained from the patient relating to location, intensity, time factors such as onset and duration, and alleviating and aggravating factors
• Heart rate, respiratory rate, blood pressure and other physiological parameters
• Facial expressions and body language displayed by the patient
• Pain severity scales.
Department of Health and Ageing – Emergency Triage Education Kit