2.3 Explain how pain or discomfort is monitored: • observational • self-monitoring • pain measurement or scoring tools

This guide will help you answer 2.3 Explain how pain or discomfort is monitored: • observational • self-monitoring • pain measurement or scoring tools.

Monitoring pain or discomfort is an essential part of care. It ensures that individuals get the right support to reduce their distress and improve their quality of life. Pain intensity and reactions can vary widely between people. By using different methods of monitoring, carers can better identify pain levels, causes, and improvements over time.

This can be done in three main ways:

• Observational monitoring
• Self-monitoring
• Pain measurement or scoring tools

Observational Monitoring

Observational monitoring involves carers and healthcare workers carefully watching for signs and behaviours that indicate pain or discomfort. This is especially important for individuals who cannot communicate effectively, such as those with dementia, learning disabilities, or physical impairments.

Using this method requires assessing both physical and behavioural changes. Observations might include:

• Facial expressions – such as grimacing, frowning, or clenching the jaw.
• Body language – such as holding or guarding certain body parts, restlessness, or avoiding movement.
• Vocal sounds – such as crying, groaning, moaning, or sharp intakes of breath.
• Changes in behaviour – such as increased irritability, withdrawal from activities, or aggressive responses.
• Physical symptoms – such as sweating, rapid breathing, or changes in skin colour (pale, flushed).

By keeping a close eye on these signs, carers can determine if the individual is experiencing pain and how their pain changes during care or treatment.

Key Points for Observational Monitoring:

• Be familiar with the person’s usual behaviour and routine, as changes are often a strong indicator of pain.
• Document what you observe, including when the signs occur (e.g., during movement, after meals).
• Combine observations with other methods of monitoring for a more complete understanding of the individual’s pain.

Self-Monitoring

Self-monitoring empowers individuals to communicate their own experience of pain and how it affects them. This is helpful when working with people who can describe their pain clearly.

Individuals can self-monitor pain by:

• Keeping a pain diary – recording when the pain occurs, how long it lasts, and what it feels like (sharp, dull, throbbing).
• Describing triggers or patterns – for example, “The pain starts after walking up stairs,” or, “It gets worse after meals.”
• Reporting responses to medication or treatments – for example, “The pain diminished after taking paracetamol,” or, “The heat pack didn’t help.”

Benefits of Self-Monitoring:

• Provides a direct account of the individual’s experience.
• Helps track pain over time to identify patterns.
• Gives insights into what treatments or activities worsen or relieve the pain.
• Increases the person’s involvement in managing their own care.

Challenges with Self-Monitoring:

Some individuals may have difficulties with self-reporting, such as:

• Those with cognitive impairments, memory challenges, or communication barriers.
• People hesitant to describe their pain due to cultural or personal reasons (e.g., fear of being seen as weak).

In such cases, combining self-monitoring with observational techniques or using tools like pain scales can help.

Pain Measurement or Scoring Tools

Pain measurement tools provide a structured way to assess pain levels. These tools allow carers to quantify pain, making it easier to monitor changes and outcomes. Here are some widely used tools:

Verbal Numeric Pain Scale

This simple method asks individuals to rate their pain on a scale from 0 to 10:

• 0 means “no pain.”
• 10 means “the worst pain imaginable.”

This scale works well for people who can communicate verbally. For example, someone might say their pain is a “2” (mild pain) or “8” (severe pain).

Visual Analogue Scale (VAS)

The VAS is similar to the numeric scale but uses a visual representation. The individual marks a point on a straight line between “no pain” and “worst pain.” This tool is helpful if verbal responses are limited, but the person can use gestures.

Faces Pain Scale

The Faces Pain Scale features images of faces ranging from happy to distressed. The individual points to the face that best represents their pain. This tool is especially useful with children or individuals with communication difficulties.

FLACC Scale (Face, Legs, Activity, Cry, Consolability)

The FLACC scale is used for non-verbal individuals, such as young children or those with cognitive impairments. It measures:

• Face: Are they smiling, grimacing, or frowning?
• Legs: Are they relaxed, tense, or kicking?
• Activity: Are they still, writhing, or stiff?
• Cry: Are they silent, whimpering, or screaming?
• Consolability: Can they be calmed, or are they unable to settle?

Each area is scored to give an overall pain level.

Abbey Pain Scale

This tool is often used for older adults with dementia. It assesses pain based on six areas:

• Vocalisation (e.g., groaning)
• Facial expressions (e.g., grimacing)
• Change in body language (e.g., guarding)
• Behavioural changes (e.g., agitation)
• Physical changes (e.g., weight loss related to prolonged pain)
• Physiological changes (e.g., elevated heart rate)

Scores guide carers in understanding and managing pain appropriately.

Choosing the Right Method

The method of monitoring pain depends on the needs and abilities of the individual. Some suggestions include:

• For verbal, cognitively aware individuals – self-monitoring and numeric scales work well.
• For children or non-verbal individuals – use methods like the FLACC scale or Faces Pain Scale.
• For older adults with dementia – combine observational monitoring with a tool such as the Abbey Pain Scale.

Recording and Reporting Pain

Once pain is monitored, it is important to document findings. Record:

• What the individual described or what was observed.
• The pain level at specific times (e.g., before or after medication).
• Any patterns, such as worsening pain during physical activity.
• Responses to interventions, such as relief after applying heat or ice.

Share this information with other carers or medical staff to ensure continuity of care.

Conclusion

Monitoring pain or discomfort helps carers ensure the individual gets timely, effective relief. Observational monitoring works well for those who cannot self-report, while self-monitoring enables people to express their pain experiences. Tools like pain scales provide structure and accuracy, helping assess both verbal and non-verbal individuals. Combining these methods ensures a more complete understanding of the person’s pain, leading to better outcomes in their care. Always tailor monitoring methods to fit the individual’s needs and abilities.