Pain Assessment as a Social Transaction

Abstract

Pain assessment conventionally has been viewed hierarchically with self-report as its "gold-standard." Recent attempts to improve pain management have focused on the importance of assessment, for example, the initiative to include pain as the "fifth vital sign." We question the focus in the conceptualization of pain assessment upon a "vital sign," not in terms of the importance of assessment, but in terms of the application of self-report as a mechanistic index akin to a biologic measure such as heart rate and blood pressure. We synthesize current inclusive models of pain and pain assessment and propose a more comprehensive conceptualization of pain assessment as a transaction based on an organismic interplay between the patient and clinician.

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods

“…Training nurses on a known pain assessment tool also fails to capture the social nature of pain assessment (Schiavenato & Craig, 2010), which is significant when considering reliability and validity of the common pain assessment instruments, such as the visual analog scale (VAS) and numerical rating scale (NRS) (Jensen & Karoly, 2011) -pain cannot be reliably captured in the same way as the other four vital signs because it is not a procedure independent of the patient's communicative or cognitive abilities or emotional state. For example, patients have been shown to use varied strategies for pain assessment completion that make meanings complex to understand (Broderick, Stone, Calvanese, Schwartz & Turk, 2006;Williams, Davies, & Chadury, 2000).…”

Children’s voices – Differentiating a child perspective from a child’s perspective

“…In summary, to use self-reports with children may vary on the continuum from taking more or less the child"s perspective depending on the child"s capacity to participate and to communicate. self-reporting and can even replace self-reporting in young children and children with cognitive disabilities [16]. However, it is difficult to interpret observations, especially if the child cannot verbally confirm the meaning of its behavior [21].…”

“…self-reports or observations of children"s behavior or body language are widely used in attempts to capture a picture of children"s wellbeing and can therefore to some extent be seen as children"s opinions of a situation. The way quantitative data on children"s expressions are collected is likely to vary depending on the research questions asked and the child"s capacity [16]. The format used can be adapted to the target group and questions asked, as with different response methods for self-rating scales.…”

Perceived Injustice and Adverse Recovery Outcomes

“…Social Processes There is increasing recognition that the effective treatment of pain and disability typically involves a social contract between the client and the clinician, in which each agrees to a set of responsibilities (Frantsve & Kerns, 2007;Schiavenato & Craig, 2010). Clearly, clients who perceive their clinicians to be unjust or untrustworthy are at risk of blaming their clinicians for negative developments in the course of their care.…”