Table 1.

The 5-step approach to pain assessment

Step	Pain Assessment
1. Self-report	• Attempt to obtain a self-report of pain from the patient Use a 0-10 scale if able  ∘ If the patient is unable to use a 0-10 scale, attempt a verbal descriptor scale such as mild, moderate, severe  ∘ Ask the patient if they have pain or if they are hurting  ∘ Ask the patient to squeeze your hand if they are hurting
2. Pathology	• Consider the patient’s physiological condition (s)  ∘ History of arthritis or chronic pain  ∘ Type of cancer and its potential to cause pain  ∘ Procedures that can cause pain • Physiologic measures such as heart rate and blood pressure are the least sensitive indicators of pain but can be elevated in the presence of acute pain
3. Behaviors	• Assess for any patient behaviors that may indicate the presence of pain  ∘ Facial expressions  ∘ Crying or yelling • Use a nonverbal pain assessment tool if the pain if the patient is unable to communicate the pain
4. Caregiver Input	• Ask the caregiver about their perceptions of their loved one’s pain  ∘ Recent change in behavior that could indicate pain - withdrawal or agitation  ∘ Actions that indicate the presence of pain
5. Analgesic Trial	• Assume pain present  ∘ If any of the above measures suggest pain, an analgesic trial should be initiated  ∘ Analgesics should be consistent with the pathology of the pain, for example, opioids should be employed for cancer pain