City of Hope Pain & Palliative Care Resource Center

III.   Pain and Symptom Management
        A.   Pain Assessment Tools (Also see Research Instruments)

This section includes various tools to assess pain and its management.  Specifically, pocket reference cards,      rating scales, assessment packets, chart forms, database tools, home health flow sheets, chart documentation packets, and tools for infant and pediatric pain assessment are among the resources available.

1.     Advanced Practice Nursing (APN) Toolkit  
         -       The APN toolkit contains a compendium of tools used in APN related research.  The measurement instruments listed on this website have been organized according to the Participatory, Evidence-based, Patient-focused Process, for guiding the development, implementation, and evaluation of Advanced practice nursing (PEPPA) framework.

2.     Communication Cards for Patients and Their Care Team, City of Hope, Duarte, CA
        -       Pain assessment tools include phrases in English, Spanish, Chinese, Armenian and Korean.           

3.      Pain Care Fast Facts: 5-Minute Clinical Inservice  - UW Health, Madison, WI
         -     Establishing Pain Relief Goals
         -     Insomnia Assessment and Treatment 
       -     Pain, Suffering and Spiritual Assessment

4.      Fact Sheets – International Association for the Study of Pain (IASP)
         -    Assessment of Cancer Pain

5.       Home Health Pain Management Flow Sheet - University of Wisconsin Hospitals & Clinics, Madison, WI 
          -    A one-page pain management flow sheet to be used in the home care setting.

6.      Pain Scales in Multiple Languages
         -     The British Pain Society has produced a series of pain scales in multiple languages (Albanian, Arabic, Bengali, Chinese (simplified), Chinese (traditional), Greek, Gujurati, Hindi, Polish, Punjabi, Somali, Swahili, Turkish, Urdu, Vietnamese, and Welsh).  

7.      Veterans Affairs Pain Management - United States Department of Veterans Affairs 
         -     Chronic Pain Primer
         -     Pain as 5th Vital Sign Toolkit
         -     Pain Outcomes Toolkit
         -     Pain Outcomes Questionnaire    

8.      Pain Assessment Packet/Chart Forms
         -     Initial Pain Assessment Tool - Margo McCaffery, RN, MS, FAAN and Alexandra Beebe, RN, MS, OCN - a charting form to be used on the patient's initial hospital admission to document location, intensity, quality of pain, and relief.
         -     Nursing Assessment and Care Plan - City of Hope, Duarte, CA  - comprehensive pain assessment tool for use in initial evaluation of patients referred to a pain service
         -     Pain Rating Scales -  InteliHealth  - three pain rating scales included are: 0-10 visual analog scale, Wong-Baker Faces rating scale and the verbal scale.     

9.      Pain Assessment Packet/Chart Forms - Dartmouth-Hitchcock Medical Center, Lebanon, NH
         -     Initial Pain Rating Tool & Pain Flow Sheet 
         -     Post-Operative Pain Management Needs Assessment          

10.      Pain Assessment Packet/Chart Forms - Via Christi Regional Medical Center - St. Francis Campus, Wichita, Kansas
         -     Initial Pain Assessment for Pediatric Use 
         -     Initial Pain Assessment for Adult Use 
         -     Pain Flow Sheet for Adults and Pediatrics - one-page documentation form to record pain assessment and management.

11.    Pain Assessment Tools -  Pain Treatment Topics, Glenview, IL
         -   Pain scales and checklists offered are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time.  These pain management tools are designed for different age groups, as well as individuals who do not speak English and/or cannot verbalize responses.        

12.    Pain Management Tools
         -     Bedside Pain Manager
         -     Pain Assessment Guide
         -     Pain Management Pocket Tool
         -     SCCPI Equianalgesic Pocket Card 

13.    Pain Rating Instrument  - Johns Hopkins University, Baltimore, MD
             -        American Society of Clinical Oncology (ASCO) permits users to download and make presentation slides of this instrument for personal and educational use.  
         -     Feasibility of Quantitative Pain Assessment in Outpatient Oncology Practice - Journal of Clinical Oncology

14.    Psychosocial Pain Assessment Form - City of Hope, Duarte, CA
          -    Developed by Shirley Otis-Green, MSW, LCSW. This 8-page assessment and guided interview form measures the impact of pain on five domains; economics, social support, activities of daily living, emotional problems, and coping behaviors as perceived by the interviewer, patient and significant other.
         Psychosocial Pain Assessment Forms in Spanish (for adults and children/adolescents):
         -      Formulario de Análisis Psicosocial del Dolor Para Adultos
         -      Formulario de Analisis Psicosocial del Dolor Para Nińos y Adolescentes

15.     State of the Art Review of Tools for Assessment of Pain in Nonverbal Older Adults  (New Tools Added)
          -      Overview  
          -      Criteria for Evaluation
          -      Comparison Grid
          -      Comparison of Tool Items
          -      Review References
          -      Detailed Information or Brief Summaries
         Tools:
          -      Abbey Pain Scale (Abbey, J., et al.)
          -      Assessment of Discomfort in Dementia (ADD) Protocol, (Kovach, C.R., et al.)
          -      Certified Nurse Assistant Pain Assessment Tool (CPAT) (Cervo, F., et al.)
          -      Checklist of Nonverbal Pain Indicators (CNPI), (Feldt, K.)
          -      Disability Distress Assessment Tool (Dis DAT) (Regnard, D., et al.)
          -      Discomfort Behavior Scale (DBS) (Stevenson, K.)
          -      Discomfort Scale-Dementia of the Alzheimer’s Type (DS-DAT), (Hurley, A., et al.)
          -      Doloplus 2, (Wary, B.)
          -      Elderly Pain Caring Assessment 2 (EPCA-2) (Morello, R., et al.)
          -      Face, Legs, Activity, Cry and Consolability Pain Assessment Tool (the FLACC), (Merkel, S.I., et al.)
          -      Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID) (Husebo, B.S., et al.)
          -      Nursing Assistant-Administered Instrument to Assess Pain in Demented Individuals (NOPPAIN), (Snow, A.L., et al.)
          -      Pain Assessment in Advanced Dementia (PAINAD) Scale, (Warden, V., et al.)
          -      Pain Assessment for the Dementing Elderly (PADE), (Villaneuva, M.R., et al.)
          -      Pain Assessment in Noncommunicative Elderly Persons (PAINE) (Cohen-Mansfield, J., et al.)
          -      Pain Assessment Scale for Seniors with Severe Dementia (PACSLAC), (Fuchs-Lacelle, S.K., et al.)                
          -      Pain Behavior for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE) (Tsai, P., et al.)

17.     Survivorship Needs Assessment Tools
Survivorship Care Summary/Plan 
-         American Society of Clinical Oncology (ASCO) Cancer Treatment Plan & Summary
-         Journey Forward Survivorship Care Plan Builder 
-         Livestrong Care Plan - Penn Medicines Oncolink  
-         NCI Community Cancer Centers Program  (NCCCP) Breast Cancer Survivorship Care Plan   
Survivorship Needs Assessments 
-         Cancer Survivors Survey of Needs - Mayo Clinic Cancer Center     
-         Transition Plan for Cancer Survivors: Survey of Needs - Pearlman Cancer Center, Adapted from Mayo Clinic Cancer Center
-         Survivor Needs Assessment (English) - St. Luke's Hospital and Health Network
-         Survivor Needs Assessment (Spanish) - St. Luke's Hospital and Health Network
-       Survivor Assessment Tool (Patient) - University of Tennessee Medical Center Cancer Institute
-         Survivor Assessment Tool (Physician) - University of Tennessee Medical Center Cancer Institute