**Abstract**

Palliative care is an essential component in any disease management. Pain assessment acts as the connecting link between the nerves, brain and spinal cord. Classification and assessment of the pain have great significance in controlling the pain-related symptoms. Pain is broadly divided into three types nociceptive, neuropathic and mixed depending upon the damage caused. Nociceptive pain is caused due to the stimulation of the pain receptors in the tissues and is further divided into visceral and somatic depending on the pain site. Neuropathic pain arises when the nervous system gets damaged or start dysfunctioning. Cancer pain assessment includes several factors like the site, intensity, syndrome, timing and temporal variation of pain. Edmonton staging system for cancer pain prognostic is widely used for pain management includes emotional/psychological distress cognitive impairment caused by pain. A comprehensive understanding of pain assessment will help in enhancing the quality of life of the patients.

**Keywords:** Pain assessment, Pain management, Nociceptive, Neuropathic, Opioids

#### **1. Introduction**

Pain is broadly defined as the unpleasant sensations in the body resulting due to the complex experience of various factors like physical, psychological and emotional [1]. Pain is subjective as pain tolerance differs from person to person. Pain cannot be quantified as it is associated with the effective as well as sensory components. Most cancer patients claim pain as the most common symptom and are quite dreaded, a major cause of anxiety [1]. Palliative care is an essential component in disease management. Good pain management is an important step towards palliative care. First of all, it is very important to understand the cause of pain, then assessment and manage pain, finally reassessment and monitoring the factors resulting in the pain. Managing and correct assessment of these symptoms are important for the wellbeing of the person to whom palliative care is being given.

It is very important to note that palliative care is intended to provide quality life by symptom control. To accomplish this, it is must to classify and assess the effects of pain. Pain is classified into various categories depending upon the duration, location, intensity and etiology of the pain (**Figure 1**). Pain can be acute or chronic depending on the duration of the pain. Acute pain is not long-lasting

**Figure 1.** *Classification of pain.*

as it gets resolved within a short duration whereas pain that cannot be resolved within six months is considered chronic pain. Chronic pain is further of three types: non-cancer, cancer and episodic. The intensity of pain ranges from mild to severe. Pathophysiology is mostly done by the utilization and knowledge of the damage caused to the tissue (nociceptive) and nerve (neuropathic) or could be unlocalized (visceral) or break-through that was given by the International Association for the Study of Pain (IASP) [2, 3]. It is noteworthy that pain can be physical as well as emotional. European Association for Palliative Care (EAPC) conducted an extensive review on the management of the use of pain assessment tools in palliative care research [3–5]. The newly revised version of cancer pain prognostics has included emotional/psychological distress, cognitive impairment caused by pain in the Edmonton staging system for cancer pain [4]. This improvement in pain prognostics has been able to be predictive than the previous methods used by IASP [3]. There are methods for the staging and progression of cancer like TNM Classification of Malignant Tumors (TNM). Unfortunately, there is no consensus on a single standardized tool for pain assessment [6]. The reason behind this is the varied nature of cancer and its malignancy and different perceptive and tolerance of pain in patients [6, 7]. Also, to blame is less predictability of the nature of tools available, as sometimes the mechanisms are not well known. To work on this problem, an extensive literature study on the physical, medical, psychological background and education on self-awareness/acceptance of pain should be deemed feasible.
