Pharmacists Play Critical Role in Pain Assessment

For most patients, pain is a very distressing symptom.

Pain should be considered the fifth vital sign, according to the American Pain Society, which is working to increase awareness of pain treatment. There have been many attempts within the health care industry to understand pain, but it remains a huge challenge.¹ Pain is an indicator to the nervous system that there is a problem, and the unpleasant feeling is an alarm to the body that something must be done to alleviate it. Although pain can assist in diagnosing, it can also reach a point where it may no longer be curable, so it is imperative that immediate steps are taken to identify the underlying issue. Acute pain can transition to chronic pain and have a profound impact on an individual’s quality of life.

High predominance of pain and pain-related disease are leading causes of disability and disease throughout the world, according to results of the Global Burden of Disease Study 2016.²

To fully combat pain, its contribution to disability must be understood within the context of biological, physical, psychological, and social factors.^2,3

It has been shown that patients are willing to accept pain, particularly postoperatively, given high pain intensity scores, so it is important for pain management to include a collaborative approach.⁴ A pain assessment is considered a significant first step toward achieving optimal pain management interventions. Pharmacists can play a key role in pain assessments, because they possess unique knowledge and skills to assist the care team with evaluating and recommending ways to manage pain.⁵ Pain management should focus on the description of the pain, duration, intensity, location, and identification of aggravating or alleviating factors.⁶ Additionally, it is important for pharmacists engaged in the interviewing process to have an awareness of the pathophysiology of the pain in combination with objective data, such as imaging or laboratory tests, that can help determine the gravity of a patient’s pain.⁷ For any health care professional, the performance of a comprehensive pain assessment screening to deliver adequate pain management is viewed as a universal requirement.⁸

Pharmacists can begin an assessment by asking patients to rate their pain on a scale from 0 to 10, with 10 being the worst possible pain and 1 being no pain.⁹ Pharmacists should then ask how long the pain has been felt, whether the pain radiates to other locations, what the associated symptoms are, what events precipitate the pain, what type of pain it is, where the pain is located, and whether the pain is constant or intermittent.⁹ The more focused and thorough the assessment, the more likely that the pain’s characteristics can be identified and treated.

Conclusion

Pharmacists serve a critical role in pain management for patients, so it is vital that their expertise and training be used to the fullest when it comes to the thorough assessment of pain.

Abimbola Farinde, PhD, PharmD, is a professor of health care administration at Columbia Southern University College of Business in Orange Beach, Alabama.

References

1. Raffaeli W, Arnaudo E. Pain as a disease: an overview. J Pain Res. 2017;10:2003-2008. doi:10.2147/JPR.S138864

2. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi:10.1016/j.bja.2019.03.023

3. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2

4. van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. Moving beyond pain scores: multidimensional pain assessment is essential for adequate pain management after surgery. PLoS One. 2017;12(5):e0177345. doi:10.1371/journal.pone.0177345

5. Halpape K, Jorgenson D, Ahmed A, et al. Pharmacist-led strategy to address the opioid crisis: The Medication Assessment Centre Interprofessional Opioid Pain Service (MAC iOPS). CPJ. Published online September 21, 2021. doi:10.1177/17151635211045950

6. Fink R. Pain assessment: the cornerstone to optimal pain management. Proc (Bayl Univ Med Cent). 2000;13(3):236-239. doi:10.1080/08998280.2000.11927681

7. Erickson AK. Navigating the complexities of pain management: pharmacists offer insight, lively debate on controversial pain topics. Pharmacy Today. 2012;18(1):7-8. doi:10.1016/S1042-0991(15)32047-8

8. Glowacki D. Effective pain management and improvements in patients’ outcomes and satisfaction. Crit Care Nurse. 2015;35(3):33-41. doi:10.4037/ccn2015440

9. Patient assessment. Doyle GR, McCutcheon JA, eds. In: Clinical Procedures for Safer Pain Care. BC Campus Open Education; 2015.