5th January 2024

Assessing Pain

Pain can be continuous or intermittent at the end of life. It may be a background pain, best treated with long-acting analgesics, or breakthrough pain, indicating the need for PRN (as required) immediate-release analgesia. Pain can also be incidental, where a clear precipitant can be established. Examples of precipitants include certain movements, the changing of dressings or coughing. Pain may also be due to ‘end-of-dose failure’ when long-acting analgesics wear off sooner than expected. End-of-dose failure is not a breakthrough pain but instead indicates a failure of adequate management of the background pain. Pain can be assessed with history taking, the monitoring of medication charts for frequent use of PRNs, as well as numerical or visual tools.

Source: Created by Dr Tasneem Wadee. Watson M, Campbell R, Vallath N, Ward S, Wells J, editors. Oxford Handbook of Palliative Care. 3rd ed. Oxford: Oxford University Press; 2019. p. 249, 274, 296-297, 306-309