The Therapeutic Value of a Good Pain Assessment

Fully attending to your patient while assessing their pain can powerfully activate belief. This belief activation actually triggers physiological and psychological changes, thereby altering one’s perception and their experience of pain.⁶ Even if you only have a short amount of time to spend with the patient, refrain from saying or indicating that your time with them will be brief. By putting away all distractions from your paying full attention (computer or phone screens, reading the chart, pagers), communicating with your verbal and body language that you are fully present, sitting close to the person (if you are physically together), and appropriately touching them (holding their hand), the person will perceive that you have spent far more time with them than you actually did. 

I once had a patient referred to me by her pulmonologist who said she had “intractable cancer-related pain” not helped by the lowest dose fentanyl patch. I prepared a quiet, pleasant space for us to meet, and wore my lab coat with my name badge clearly identifying me as an oncology clinical nurse specialist. She came to this thoughtfully prepared space with her husband, and I gently put my hand on her back and led her to a comfortable chair, with her husband sitting next to her and holding her hand. I sat across from her in a chair, with no desk or table separating us. 

I told her about what she could expect from this meeting. I asked her to rate her pain on a scale of 0-10, with 10 being the worst possible pain. She looked distressed, anxious and exhausted. She said her pain at the moment was 8, but most of the time it is 10+ and keeps her from sleeping well and from doing most things that she finds enjoyable. I let her tell me the story of her pain (AKA pain assessment) and talked to her about what I was going to recommend to her doctor and what she could expect from her pain management plan. I told her that the first goal would be to control her pain well enough so that she could get a good night’s sleep. I asked her to tell me what she finds helpful in making her more comfortable and suggested she use those measures as well. 

I gave her choices about pain management measures and incorporated her choices into the final plan. I taught her how to communicate about not only the pain but also her improvements in comfort. I finalized the plan with her physician, which included adjustments to her opioid regimen, and instructed her and her husband on their part in carrying out the plan. For my part, I told her I would be following up with her regularly. This all took about an hour. 

At the end of the session, I asked her to rate her pain, and she gave an astonished look to me and her husband and elatedly said, “I hardly notice it—maybe it’s about a 1.” I called her the next day to ask her what improvements she’d noticed since yesterday, and she said “If I could reach through this phone and hug you, I would, because last night I slept the best I’ve slept in weeks.” This was clearly a case of therapeutic presence, reassurance, and belief activation being a medicine in itself.

Adapted from Integrative Oncology Patient Navigation Training.¹Pole L, O’Toole C et al. Integrative Oncology Patient Navigation Training [Online Course]. Maryland University of Integrative Health. 2022. Viewed September 16, 2023.