Pain in Malignant Hematology

Pasquale Niscola; Andrea Tendas; Laura Scaramucci; Marco Giovaninni; Luca Cupelli; Vitaliana De Sanctis; Gregorio Antonio Brunetti; Francesco Bondanini; Roberto Palumbo; Michela Lamanda; Roberta Battistini; Claudio Cartoni; Claudio Romani; Edoardo Arcuri


Expert Rev Hematol. 2011;4(1):81-93. 

In This Article

Evaluation of Pain

Several distinct pains, each of which should be assessed separately, usually coexist in a patient with HM. Irrespective of the type of pain, the evaluation and the regular monitoring of the pain, considered as the fifth vital sign,[16] represent the essential basis of an appropriate treatment approach. The patient's report is the primary source for the assessment. The simplest method to measure pain intensity is the verbal descriptor, which is often incorporated in pain assessment charts and is quick and easy to administer. Visual analog score (VAS), consisting of a 10 cm (100 mm) line, with the anchor words at either end providing extreme descriptions of pain, is another widely used tool. A modification of VAS is represented by the numerical rating scale, which is applied by asking the patient to rate their pain intensity on a scale from 0 (no pain) to 10 (the worst pain imaginable): mild pain is given a rating of 1–4; moderate pain 5–6; and severe pain 7–10.[16] Some groups of patients may not understand the visual analog or verbal descriptor scales. There are scales specifically available for these groups using facial expression, and verbal and non-verbal descriptors, such as physiological indicators, which can be a useful tool for rating pain in noncommunicative and unconscious patients.[16] A brief description with an outline of the advantages and disadvantages of the most commonly used tools for pain assessment is presented in Table 2. Pain considerations in children are unique and differ from those in adults.[17] Pain can be assessed in children using any of the several validated scales (Table 2). Children as young as 3 years old can quantify their pain with reasonable accuracy. The Wong-Baker faces scale and VAS are the most commonly used tools in this setting (Figure 1).[17] For the evaluation and monitoring of neuropathic pain states, several tools are available in clinical practice and for research purposes (Table 2).[18]

Figure 1.

Pain assessment tools. Visual analog scale, numerical analog scale and facial expressions scale.
Used with permission. © 1983 Wong-Baker FACES™ Foundation.