The Role of OTs in Pain Assessment

Occupational therapists are crucial in pain assessment and understanding its impact on everyday activities.

Occupational therapists (OTs) assess patients’ pain levels and determine the effect on functional performance. Pain can affect all areas of occupation, including self-care, work, leisure, and educational activities. To comprehensively evaluate pain, occupational therapists utilize a combination of standardized pain assessment tools, clinical observations, and subjective reports from the patients.

Recommended course: Pain Assessment and Management: The Role of Occupational Therapy, 3rd Edition

Acute pain vs. chronic pain

Acute pain is a type of pain that is typically caused by an injury or a disease. It arises suddenly and usually lasts a month or less, subsiding as the underlying condition heals or improves. Acute pain is a protective mechanism that alerts the body to potential harm and prompts individuals to take action to prevent further injury. Examples of acute pain include a broken bone or after surgery.

Chronic pain lasts three months or more and the cause can be unknown. Chronic pain can result from conditions such as arthritis, fibromyalgia, neuropathy, or after the resolution of an acute injury.

Challenges with assessing the pain of children

• Communication barriers. Some children have difficulty with verbal communication requiring a communication device.
• Developmental considerations. Some assessments require a child to have enough self-awareness and cognitive ability to choose an item on a rating scale that correlates with their pain level.
• Cultural considerations. Cultural backgrounds need to be considered when assessing pain in children, as cultural beliefs and norms influence pain expression.

Recommended course: Cultural Influences on Pain Management

Challenges with assessing the pain of adults

• Subjectivity of pain reporting. Pain is a subjective experience, making it challenging to quantify objectively. Adults may express pain differently, influenced by their cultural background, personal beliefs, or previous experiences. This subjectivity can result in inconsistency and potential bias during pain assessment, hindering accurate evaluation.
• Communication barriers. Some adults face difficulties communicating pain due to cognitive impairments, language barriers, or communication disorders. OTs must utilize alternative methods, such as non-verbal cues, communication boards, or caregiver reports, to gather relevant information and assess pain accurately.
• Comorbidities. Adults may face multiple comorbidities, making it challenging to attribute the cause of pain solely to a specific ailment. Pain can be multidimensional, involving physical, emotional, and cognitive aspects, further complicating the assessment process. This complexity requires OTs to understand how these factors intersect.

Pain assessment tools

Pain can be assessed using various methods. Since the patient subjectively measures pain, providing a means for the patient to relay their pain is important. Patients can provide a narrative regarding their pain, providing qualitative information about it.

However, an OT may need the pain quantified, prompting them to use a pain rating scale. Examples of pain rating scales that can yield a number are:

• Wong-Baker FACES Pain Rating Scale
• Numerical Rating Scale
• Functional Pain Scale

Although all the previously mentioned pain scales can be used to assign a number to the various types of pain. The Face, Legs, Activity, Cry, Consolability (FLACC) scale differs from the other scales because it does not have the patient assign a numerical number to their pain. The clinical observer uses observation to determine the patient’s pain level.

Face, Legs, Activity, Cry, Consolability

The Face, Legs, Activity, Cry, Consolability scale is a behavioral assessment that relies on observations in five areas to determine the amount of pain the patient is experiencing. A study published in 2013 found the FLACC was reliable for assessing pain in toddlers receiving immunizations. It also demonstrated good inter-rater reliability. This assessment can be used with children who are pre-verbal or non-verbal.

Wong-Baker FACES Pain Rating Scale

The Wong-Baker FACES Pain Rating Scale was initially designed to obtain children's pain ratings. However, it is now widely used for people three and older. This rating scale contains pictures on a continuum from smiling to tearful that are used to correlate with feelings of pain.

The faces are also paired with numbers 0-10, with 0 representing no pain and 10 representing the worst pain imaginable. Children who use augmentative and alternative communication (AAC) devices to communicate and verbal children can use this rating scale.

Numerical Rating Scale

The Numerical Rating Scale (NRS) uses numbers to relay pain levels. 0 is not pain, and the highest number is also the worst pain imaginable. However, the highest number could be 10, 20, or 100, depending on the scale range.

Functional Pain Scale

The Functional Pain Scale (FPS) uses a 0 to 5 scale also with 0 indicating no pain and five indicating the worst pain. The FPS differs from other pain scales because it includes subjective and functional indicators to help assess the pain level. This scale uses three categories of assessment.

• Determine if there is pain
• The patient rates the pain subjectively
• The pain is rated objectively as it relates to functional performance

Strategies for pain assessment

• Use of culturally sensitive assessments. OTs should use culturally sensitive pain assessment tools considering cultural variations in pain expression. This approach ensures that individuals' pain experiences are accurately captured and understood.
• Clinical observations. Observing individuals during occupational therapy sessions or activities of daily living can provide valuable insight into the presence and impact of pain. OTs can assess changes in functional abilities, quality of movement, or adaptations in response to pain, enhancing the overall pain evaluation process.
• Collaboration with patients. Engaging individuals in their pain assessment process empowers them and improves the accuracy of pain evaluations. OTs can encourage clients to actively participate by using pain diaries, scales with pictorial representation, or digital applications, promoting ongoing pain monitoring and self-management.
• Interprofessional collaboration. A team of multidisciplinary professionals can collaborate to get a more comprehensive picture of a patient’s pain.

Pain is a complex and highly subjective experience. It affects individuals differently based on their experiences, cultural backgrounds, and emotional states. Occupational therapists are crucial in assessing pain and understanding its impact on everyday activities. Whether an occupational therapist uses a visual, verbal, or observation rating scale, OTs assessing pain should always focus on functional performance.