Assessment of pain is essential in home care, as in any other arena. Determining the intensity, quality, site, duration, aggravating and alleviating factors, etc, are important, not only to determine whether a treatment is effective, but to determine which treatment to use. As important, is assessing the patient’s functional status as it relates to pain.

Functional status is often measured by instruments. For research, instruments may evaluate general function or function specific to an activity or based on a disease or disorder, such as arthritis. Pain-related functional status may be measured by interference, such as the Brief Pain Inventory, which measures the amount pain interferes with seven activities including general activities, walking, work, sleep, relations with other people, mood, and enjoyment of life.  Another frequently used instrument to evaluate function is the MOS Short Form 12 or 36 (depending on the number of questions) that yield scores for 8 quality-of-life areas and 2 scores for mental and physical function. While these instruments may be important to measure functional status in research, they may not give a specific enough picture for a clinical focus.

In clinical practice, we often evaluate a patient with pain’s functional status by determining whether they are getting out of bed, walking, going to physical therapy, or returning to work. Even this is a rather rudimentary measure of functioning and may not be specific enough to assist a nurse in determining the necessary focus of care.

My favorite functional status question for patients with pain is: “What does this pain keep you from doing?”  This allows the patient to tell me what is important to them, which activities they find meaningful, and allows me to focus my care towards goals of assisting them to return to these meaningful activities. One patient told me she wanted to keep her grandchildren “in line” and help them with their homework. She said, “When I am in pain, I cannot do this.” Another patient told me, “If I could just get back to my swim group, I would feel better.” Therapy for these two patients might be different based on what was important to them. Assessing what are meaningful activities for the patient is extremely helpful in determining goals to work toward in pain-related functional status.

April Hazard Vallerand, Associate Professor & CHAMP Faculty
Wayne State University College of Nursing