SCOPE OF THE PROBLEM

The measurement of a patient's pain intensity is inherently complex. The pain experience is unique to each individual, influenced by many factors such as medical condition, developmental level, emotional and cognitive state, culture, the hospital environment, family issues and attitudes, language barriers, and levels of fear and anxiety. The often chaotic, loud, and hurried emergency department (ED) environment only serves to compound these difficulties. It is well documented in scientific literature that oligoanalgesia is a significant issue within emergency medicine. In order to appropriately manage patients' pain, we must attempt to accurately assess their pain.

CLINICAL ASSESSMENT

There are multiple barriers to the clinical assessment of pain, including, but not limited to, provider biases, patient anxiety, family attitudes, cultural beliefs, and provider suspicion of “drug-seeking” behavior. The National Institutes of Health has stated that patient self-report is the most reliable indicator of the existence and intensity of pain. Barriers to pain assessment are greatest for those patient populations who cannot self-report their pain experience.

Pediatric patients and those with impaired cognition communicate and display pain in very different ways. Infants and young children often cry or whimper when they are in pain. They often cannot localize or describe their pain and, therefore, it may be difficult to assess and quantify. This may be similar in the elderly patient with dementia or other cognitive and communicative impairments.