**3. Tools for analysing pain intensity**

Pain intensity is subjective from person to person hence a common ground is picked which either in pictorial form or in the form of a questionnaire is communicated between the patient and the caregiver where the caregiver gets an idea of the situation and can plan before the treatment. These pain intensity tools play a major role in the assessment of pain and the tools used to analyze. There are many tools, but few are used quite often such as the McGill pain questionnaire, Wong-baker face pain scale, (**Figure 2**) visual analogue and numerical scales (**Figure 3**). Much of them work in a similar method by presenting the patient with a pictorial or a numerical based scale that the person can relate to and the person can pinpoint on which part of the scale he/she thinks the pain suffered stands [7].

#### **3.1 Unidimensional pain assessment tools**

The unidimensional assessment tool consists of mainly 2 categories which include the visual analogue scale or numerical rating scale and the pictorial rating

**171**

severity of pain [7].

*matches the scale. Ages 3 and above [7].*

screening of the pain.

**3.2 Multi-dimensional pain assessment tools**

scaling [7].

**Figure 2.**

**Figure 3.**

*Assessment and Management of Pain in Palliative Care DOI: http://dx.doi.org/10.5772/intechopen.96676*

scale. These may or may not include verbal descriptions of the pain such as - moderate, severe, or less pain. In the visual analogue and the numerical method of scaling, a patient is asked to choose and mark the word or the number they compare/relate their pain to [17, 19]. The other method is utilizing the pictorial representation (**Figure 2**) such as faces which utilizes the comical representation of the reactions suffered during pain this method is best suited for children as it is difficult for them to translate a sensory experience to a spot on the scale example of such pictorial scale is Wong-baker face pain scale which utilizes 6 facial expressions describing the

*Wong-baker face pain scale. The physician and the patient can look and state which expression they feel* 

*Visual analogue pain intensity scale. Patient has to pin-point on where their pain stands on the scale [7].*

The drawback of these methods is that these methods rely on the opinion of the patient and the opinion may vary due to different pain tolerance limits in different patients to the same pain sources [7]. Tolerance of a patient can be judged for a specific area using a dolorimeter which uses heat, electricity, or pressure to analyze the sample area's sensitivity and this can be later noted for further

As the name implies this type of tool assesses a patient on different levels/ dimensions compared to the unidimensional pain assessment method. The Multidimensional method includes an assessment of more features such as the impact of pain, quality of pain and phenotype of pain for example to determine whether the person is suffering from neuropathic pain or not [19]. These tools utilize different types of the questionnaire to achieve its goal such as determining the impact and

*Assessment and Management of Pain in Palliative Care DOI: http://dx.doi.org/10.5772/intechopen.96676*

#### **Figure 2.**

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

suggested by Gierthmühlen, J. and R. Baron in 2016 [10].

*2.2.2 Psychological effect on pain*

of the nerves. The release of hormones during flight/fight response increases awareness and due to this the nerves also get more sensitized leading to such pain

Psychological factors are the major players in how the patient perceive the pain. Factors such as initial awareness, emotional status, interpretation and processing of pain and coping strategy play an important role in the perception of the pain [15]. Research on the effect of psychology and mental state by S.J. Linton and W.S. Shaw defines that initial detection of pain plays a crucial role in building up the psychological effects of it [16]. It is noted that pain needs attention and it is mostly under our conscious control. If the pain is deemed a threat, the autonomous nervous system kicks in, and also for later stages the object is likely to be avoided. Emotional state and interpretation can play a major role in sensitization and interpretation of pain [16]. Pain behaviour can be linked to how the person interprets the pain while suffering from it like verbal or non-verbal action and also after suffering from pain like the patient may start avoiding the source of stimuli as it generates the fear response. Negative thoughts about life such as anxiety, depression and fear can negatively affect the perception of pain and this may consequence in not only increasing the intensity but also prolonging the pain. Studies such as in S.J. Linton and W.S. Shaw in 2011 have shown 52% of people suffer from such a negative emotional state during pain [16]. Patients with imminent fear of the future also fall in this category and this all consequences in poor rehabilitation of the patient [15]. The next stage comes to coping with the pain, it has been seen that painful stimuli trigger the flight response with epinephrine released that can greatly affect the sensation of pain [15, 16]. It can be inferred by this that in both cases, the sensation seems to be more tolerable as the person either avoids pain or confronts the source. The other method that seems to work is having a relaxed state of mind. Effects such as phantom limb pain are still considered to be a psychological phenomenon [17, 18]. Even though the limb does not exist, the pain is still perceived. In all, pain is greatly affected by the mental state of the person, but it has to be well understood

Pain intensity is subjective from person to person hence a common ground is picked which either in pictorial form or in the form of a questionnaire is communicated between the patient and the caregiver where the caregiver gets an idea of the situation and can plan before the treatment. These pain intensity tools play a major role in the assessment of pain and the tools used to analyze. There are many tools, but few are used quite often such as the McGill pain questionnaire, Wong-baker face pain scale, (**Figure 2**) visual analogue and numerical scales (**Figure 3**). Much of them work in a similar method by presenting the patient with a pictorial or a numerical based scale that the person can relate to and the person can pinpoint on which part of the scale he/she thinks the pain suffered stands [7].

The unidimensional assessment tool consists of mainly 2 categories which include the visual analogue scale or numerical rating scale and the pictorial rating

**170**

and more studied.

**3. Tools for analysing pain intensity**

**3.1 Unidimensional pain assessment tools**

*Visual analogue pain intensity scale. Patient has to pin-point on where their pain stands on the scale [7].*

**Figure 3.**

scale. These may or may not include verbal descriptions of the pain such as - moderate, severe, or less pain. In the visual analogue and the numerical method of scaling, a patient is asked to choose and mark the word or the number they compare/relate their pain to [17, 19]. The other method is utilizing the pictorial representation (**Figure 2**) such as faces which utilizes the comical representation of the reactions suffered during pain this method is best suited for children as it is difficult for them to translate a sensory experience to a spot on the scale example of such pictorial scale is Wong-baker face pain scale which utilizes 6 facial expressions describing the severity of pain [7].

The drawback of these methods is that these methods rely on the opinion of the patient and the opinion may vary due to different pain tolerance limits in different patients to the same pain sources [7]. Tolerance of a patient can be judged for a specific area using a dolorimeter which uses heat, electricity, or pressure to analyze the sample area's sensitivity and this can be later noted for further scaling [7].

### **3.2 Multi-dimensional pain assessment tools**

As the name implies this type of tool assesses a patient on different levels/ dimensions compared to the unidimensional pain assessment method. The Multidimensional method includes an assessment of more features such as the impact of pain, quality of pain and phenotype of pain for example to determine whether the person is suffering from neuropathic pain or not [19]. These tools utilize different types of the questionnaire to achieve its goal such as determining the impact and screening of the pain.
