Pain has major implications for adults who are older and can lead to a decline in mobility, isolation, sleep disturbances, depression and overall poor quality of life. Recognizing and assessing pain can be challenging. The resources contained in Nursing Pain Management will provide nursing staff with best practice tools and information for the management of pain.
Evidence-based best practice
Successful implementation of a pain management program includes administrative and IDT support. Policies and procedures should include a process to provide education and training, utilize available resources to stay familiar with ways to improve the program and provide for ongoing monitoring of the pain management program.
Pain is a significant problem for many older adults and can lead to a decline in mobility, isolation, sleep disturbances, depression and overall poor quality of life. Because pain is subjective, self reporting of pain is the “gold standard” in pain assessment. The key to a successful pain management program is open communication and collaboration with an interdisciplinary approach. The goal for pain management and the best possible outcome is the relief and control of pain regardless of cognition and verbal abilities.
Key Elements for Pain Assessment include:
Comprehensive pain assessments are completed:
Reassessment(s) using the identified validated pain intensity/behavioral scale(s):
Key elements for care plans include:
Comprehensive pain assessments and periodic reassessments should be conducted by a licensed nurse. All assessments should be in a language the person understands and based on the person’s cognitive and verbal abilities. Validated pain intensity scales and/or behavioral pain scales should be used consistently with each assessment. The interdisciplinary team (IDT) should develop care plans and a process to evaluate the effectiveness of the individualized interventions implemented.
Subject matter expertise by the American Medical Directors Association (AMDA), The American Geriatric Society, and The University of Iowa Gerontological Nursing Interventions Research Center. For a printable version of Nursing Pain Management best practice guidelines in PDF, please click here.
American Academy of Pain Management
The American Academy of Pain Management is a nonprofit organization that educates clinicians about pain and its management through an integrative interdisciplinary approach. The Academy provides credentialing, accreditation of facilities, networking opportunities, continuing education, quality publications and an annual clinical meeting.
American Academy of Pain Medicine
The American Academy of Pain Medicine is the medical specialty society representing physicians practicing in the field of pain medicine. Various clinical practice guidelines are available on the website.
American Geriatrics Society
The American Geriatrics Society is a not-for-profit organization of health professionals devoted to improving the health, independence and quality of life of all older people. Articles from the Journal American Geriatric Society include: “Pharmacological Management of Persistent Pain in Older Persons (2009)”
American Medical Directors Association (AMDA)
The American Medical Directors Association is a professional association of medical directors, attending physicians and others practicing in the long-term care continuum, dedicated to excellence in patient care. AMDA’s Clinical Practice Guideline: Pain Management (revised 2009) is available for purchase on the website.
American Society for Pain Management Nursing
The mission of the American Society for Pain Management Nursing is to advance and promote optimal nursing care for people affected by pain by promoting best nursing practice. Articles from the Journal Pain Management Nursing include: Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations by Keela Herr, et al. (2006) [PDF format].
International Association for the Study of Pain (IASP)
The International Association for the Study of Pain brings together scientists, clinicians, health care providers, and policy makers to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide. IASP holds the copyright and permission information on the Faces Pain Scale – Revised.
Texas Pain Society
The Texas Pain Society’s mission is to be the organization of pain medicine practitioners in the State of Texas that represents the interests of patients, the public, physicians and others involved in the care of Texans who suffer from pain. Also available on this websites is a report of the Texas Pain Summit: The Politics of Pain: Balancing Vigilance and Compassion (2007) [PDF format].
Assessment, Reassessment and Treatment by Pain Severity and Chronicity (PDF format)
A severity and chronicity grid developed by the Texas Department of Aging and Disability Services Quality Monitoring Program. This resource may be used to assist nursing staff in identifying the frequency of pain assessments.
Pain Assessment in Advanced Dementia (PAINAD) [PDF format]
Pain Assessment in Advanced Dementia (PAINAD) is a behavioral pain scale which may indicate if pain is present. Individuals should be assessed during movement and/or activity. Please note that the scoring method used in the PAINAD should not to be confused with other 0-10 numerical rating pain intensity scales. Review all instructions for the use and interpretation of the scale.
Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT) [PDF format]
A behavioral pain scale developed by Dr. A. Hurley. This resource may be used to indicate if pain is present. Review all instructions for the use and interpretation of the scale.
Faces Pain Scale – Revised (FPS-R) [PDF format]
The Faces Pain Scale – Revised is used with the permission of the International Association for the Study of Pain (IASP) and was developed by IASP. This resource has adult faces/expressions and includes facial action units that are known to occur in humans when experiencing pain (raised brow, open mouth, nasal fold increases and tightened eyes). Individuals must be able to choose the face which corresponds with the severity of their pain. The FPS – R is never to be used to measure facial grimacing by the nurse. Review all instructions for the use and interpretation of the scale.
Pain Thermometer – Verbal Descriptor Scale (PDF format)
The Pain Thermometer – VDS is a verbal descriptor scale adapted with permission from by Keela Herr, PhD, RN at University of Iowa, College of Nursing. This resource is used to assist individuals in identifying the severity of their pain. The descriptions are assigned numerical values of 0-6 with zero being “no pain” and six being “pain as bad as it could be.”
0-10 Numeric Rating Scale (PDF format)
This specific scale, 0-10 numeric rating scale, was developed by Geriu Long Term Care website developed by Florida Teaching Nursing Program. This resource is a common pain scale used with individuals residing in long-term care facilities. The person is asked to assign a number ranging from 0-10 rating the severity of their experienced pain. All instructions need reviewed for the use and interpretation of the scale.
0-10 Pain Thermometer (PDF format)
This 0-10 numeric rating scale was prepared by Northeast Health Care Quality Foundation. This resource uses a vertical presentation with a thermometer to assist individuals in identifying the severity of their pain. Instructions for the use and interpretation of the scale are the same as the numeric rating scale.
Iowa Pain Thermometer (IPF) [DF format]
The Iowa Pain Thermometer, used with permission of its developer Keela Herr, Ph.D., RN, University of Iowa College of Nursing, is a verbal descriptor scale in a vertical presentation with a thermometer to assist individuals in identifying the severity of their pain. The IPT descriptions may be assigned numerical values of 0-6 with zero being no pain.
Pain: Nursing Home Communication with Physician Pain Management Form (PDF format)
This form was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri. This form may be used by nursing staff to effectively communicate pain assessment findings or changes with the individual’s physician.
Pain: Organizational Commitment to Pain Management in Your Facility (PDF format)
This flowchart was prepared by Primaris may assist nursing home staff in the organizational commitment and development of an effective pain management system.
Pain Scale Determination Process (PDF format)
The pain scale determination process developed by Texas Department of Aging and Disability Services Quality Monitoring Program may be used to assist nursing staff in identifying the best pain scale to use based on the individual’s cognitive and verbal abilities.
Pain Knowledge and Attitude Survey (PDF format)
This survey developed by Nursing Home Quality Initiatives may assist in assessing facility staff’s knowledge and an attitude about pain. The results of the survey provide potential learning opportunities.
This website was developed by the Center for Nursing Excellence in Long-Term Care. This resource shares free evidence-based tools and best practices for nurses who work in nursing homes, including implementation of quality improvement processes for pain management. A brief registration is required for use of the website.
How to Try This: Using Pain-Rating Scales with Older Adults
An article by Ellen Flaherty PhD, GNP-BC in American Journal of Nursing, Volume 108(6), June 2008. This resource describes the use of various pain rating scales.
How to Try This: Pain Assessment in Older Adults Video (approximately 1hr)
A video developed by Lippincott’s Nursing Center demonstrates the use and interpretation of various pain scales including the Pain Assessment in Advanced Dementia. This is the companion video for the How to Try This: Using Pain-Rating Scales with Older Adults article. An e-mail address is required to view the video.
Heartbeats: Decreasing Pain Poster 1 (PDF format)
Heartbeats: Decreasing Pain Poster 1 developed by Illinois Foundation for Quality Heath Care explains how people with pain in nursing homes is sometimes under recognized and under treated.
Heartbeats: Decreasing Pain Poster 2 (PDF format)
Heartbeats: Decreasing Pain Poster 2 developed by Illinois Foundation for Quality Heath Care explains how pain can be defined.
Got Pain Poster (PDF poster)
The Got Pain Poster developed by Illinois Foundation for Quality Heath Care describes nonspecific signs and symptoms that suggest pain.
Pain Management: What all nursing home persons and families need to know (PDF poster)
This handout developed by Primaris may be used with individuals and family members to help educate them about pain.
If you have any further questions or comments, please contact us at TQM@dads.state.tx.us.
Updated: April 3, 2013