-
- ABC approach – identify and manage acute illness.
- Assess the nature/severity
- Assess if nociceptive / neuropathic/ mixed.
- Assess the cause
- Assess current analgesia and analgesic side effects.
- Identify if oral route available – if not, use IV/IM/SC.
- Identify and treat any underlying cause.
Assessment
An accurate assessment of the pain is vital. It’s necessary to identify the cause and determine whether it might give threat to life and/or limb.
SOCRATES is a helpful mnemonic for taking a history.
| S | Site |
| O | Onset |
| C | Character |
| R | Radiation |
| A | Associated symptoms |
| T | Time course |
| E | Exacerbating and relieving factors |
| S | Severity |
Other things to consider are:
-
- The presence of previous pain problems and treatments
- Previous analgesic use
- Previous or active substance misuse
- Physical restrictions and disabilities resulting from the pain
- Past medical history, drug history and allergies
It is also important to always consider if exacerbations of pain are a part of the patient’s normal clinical course, or whether they might herald a significant deterioration in the patient’s condition.
For example:
-
- An exacerbation of ischaemic limb pain may represent acute-on-chronic ischaemia requiring revascularisation.
- Increasing abdominal pain while recovering from abdominal surgery could herald a complication.
A large number of severity scoring systems have been described. The numerical “0-10” descriptor is commonly used. In NHS Tayside an alternative scoring system is recorded on the patients’ SEWS chart along with the vital signs.
|
Pain |
Score |
| No pain at rest No pain on movement |
0 |
| No pain at rest Slight pain on movement |
1 |
| Intermittent pain at rest Moderate pain on movement |
2 |
| Continuous pain at rest Severe pain on movement |
3 |
The opioid side effects of sedation and nausea are also recorded using a similar system.
|
Sedation |
Score |
| Awake and alert |
0 |
| Occasionally drowsy, easy to rouse |
1 |
| Frequently drowsy, easy to rouse |
2 |
| Somnolent, difficult to rouse |
3 |
| Normal sleep |
S |
|
Nausea |
Score |
| No nausea or vomiting |
0 |
| Nausea only |
1 |
| Vomiting once |
2 |
| Vomiting more than once |
3 |
