A guide to pain assessment and management in adults

Pain is one of the most common patient problems that health professionals will encounter. It is universally experienced and extremely complex, involving the mind as well as the body, and activated by a variety of stimuli, including biological, physical and psychological (Cook et al, 2020).

For some patients, the pain they experience can be short lived and easy to treat, but for others it can cause significant issues to their overall health and wellbeing (Flasar and Perry, 2021). According to Mears (2018), mismanaged pain can affect an individual's mobility, sleep pattern, nutritional and hydration status, and can increase the risk of developing depression or becoming socially withdrawn. This article, therefore, examines and explores some of the holistic nursing assessment and management strategies that can be used by health professionals.

Knowledge of pain processes has changed considerably over the past 500 years, when there was the belief that pain is a sensation linked to body fluid imbalance, evil spirits or a punishment from God (Ford, 2020). In 1965, Melzack and Wall conceptualised and pioneered a new model of pain, referred to as the ‘gate control theory’. They hypothesised that neurons within the superficial dorsal horn of the spinal cord could modulate the flow of signals from the stimulation of peripheral nociceptors (sensory neurons) through the central nervous system to the brain, thus effectively increasing or decreasing the amount of pain experienced (Todd, 2016). They further postulated that the gate control was influenced by psychological and physiological factors and, accordingly, have been credited with taking the first step in recognising the symbiotic relationship and the interactive, interdependent nature of these factors.