Pain Assessment and Management, 2nd Edition _ _________________________________________________
Although health professionals frequently work with clients who are experiencing pain, there is evidence that supports an interdisciplinary biopsychosocial approach when treating clients with chronic pain. Practitioners with a more detailed knowledge of pain can be more effective when working with a variety of clients, groups, and populations. The purpose of this basic course is to elaborate on the definition of pain and its perception, factors hampering pain management, assessment of a client for pain, and interventions to improve function in clients with pain. OVERVIEW OF PAIN Pain is defined as “an unpleasant sensory and emotional experi- ence associated with or resembling that associated with actual or potential tissue damage or described in terms of such dam- age” (International Association for the Study of Pain [IASP] Task Force on Taxonomy, 2023). McCaffery (1968) offered a useful definition: “Pain is whatever the experiencing person says it is, existing whenever he/she says it does” (p. 95). Pain is complex, and the effectiveness of treatment depends on a “constellation of biological, psychological, and social factors” (National Research Council, 2011). Over time, the pain paradigm has shifted from a medical model to one with an increasing emphasis upon “interdisciplinary, patient-centered care and the use of multimodal approaches, including pharma- ceutical, behavioral, restorative, and complementary therapies” (National Academy of Medicine [NAM], 2023). Pain can be categorized not only by source or severity but also by duration. Pain may be acute or chronic. The National Academy of Medi- cine (2023) defines acute pain as “sharp, sudden, and caused by something specific” (p. 5). It is further described as lasting less than 6 months and will go away when the underlying cause is resolved. In contrast, chronic pain is defined as having a dura- tion of at least 6 months and will continue after the injury or illness has resolved (NAM, 2023). Both the World Health Orga- nization (WHO) and IASP state that chronic pain lasts longer or recurs for more than 3 months (IASP, 2023; WHO, 2024). The World Health Organization (2020) states that there are biological, psychological, and social factors that contribute to chronic pain. Chronic pain was classified into seven categories by the IASP in 2015. The World Health Organization released the seven subgroups of pain in the International Classification of Disease , 11th edition (ICD-11; Athitakis, 2020). Chronic pain often serves as a symptom of a medical condition or injury where intervention for the underlying cause is critical and may serve to alleviate the pain. The exact mechanisms involved in the pathophysiology of chronic pain are poorly understood, but new treatment discoveries are evolving (Cohen & Lema, 2020). Identifying a single physiological reason that accounts for all the mechanisms that produce pain would be difficult due to the multiple underlying causes (Dydyk & Conermann, 2024). There are several distinct types of pain, as shown in Table 1 .
INTRODUCTION There has been much discussion around pain as the fifth vital sign in the past few years. The American Pain Society Quality of Care Committee suggested the designation in 1995. Since that time, studies have measured how well this “vital sign” was being assessed. Ruben et al. (2015) systematically reviewed the literature and found differences in the accuracy based on the provider’s clinical experience, the timing of the assessment, the intensity of the pain, and populations considered vulner- able. Others have reported that there continues to be a need for research, training, and standardization of practices around pain assessment and management (Abdelmalik et al., 2024, Pozza et al., 2021). More recently, there has been a push to move beyond pain as the fifth vital sign and to begin to focus on improvement in pain management (Scher et al., 2018). This change in focus demonstrates the continued difficulty in the assessment and treatment of pain. Multiple studies have attempted to measure the percentage of Americans experiencing pain. According to the Centers for Disease Control (CDC), data obtained from the National Health Interview Survey (NHIS) indicates that during 2021, approximately 20.9% of adults in the United States, or 51.6 million persons, experienced pain lasting at least 3 months (Zelaya et al., 2019). Additionally, 17.1 million U.S. adults (6.9%) experienced high impact chronic pain (Rikard et al., 2023). The cost of pain extends beyond physical debilitation. The value of productivity lost to pain can be estimated based on days of work missed, hours of work lost, and lower wages. The economic burden of acute and chronic pain in the United States is approximately $736 billion (Schoenfeld et al., 2024). Demographically, non-Hispanic or Alaska Native adults, adults identifying as bisexual, and those individuals who are divorced or separated experience a higher prevalence of pain (Rikard et al., 2023). Anxiety, depression, pain catastrophizing, and pain- related fear are identified as psychological risk factors (Giusti et al., 2020; Mullins et al., 2023; Pan et al., 2019). Studies show that women, minority populations, clients with addic- tions, and older adults are likely to be underserved when it comes to adequate pain management (Denny & Guido, 2012; Interagency Pain Research Coordinating Committee, 2022; Shavers et al., 2010). Additional work is currently in progress to address the disparities identified as Goal 1 of the new National Institutes of Health (NIH) Wide Minority Health and Health Disparities Strategic Plan, 2021-2025 (Nahin, 2021). Effective pain management is an integral part of rehabilitation therapy. Many clients arrive at their first appointments after surgery, trauma, or degenerative injury in pain. Serious conditions resulting from spinal trauma, amputation, and other orthope- dic and neurologic injuries can result in intense and prolonged pain. Throughout the therapy process, practitioners must remain mindful of the effects that the therapeutic techniques are having on the client.
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