Challenges in pain assessment.

LAST YEAR WAS the 40-year anniversary of Margo McCaffery’s landmark definition of pain: ‘‘Pain is what the experiencing person says it is, existing whenever he says it does.’’ This definition has been supported by decades of clinical trials of analgesics and other pain research. All accepted pain guidelines today reflect the philosophy of McCaffery’s definition, reinforcing that the patient’s self-report is the single most reliable indicator of the existence and severity of pain. Most health care facilities have implemented policies and procedures that mandate this evidence-based approach to pain assessment by requiring nurses to systematically obtain pain intensity ratings, in addition to other elements of assessment, whenever the patient is able to provide them. This process affords a mechanism for patients to communicate with the health care team about their pain and allows the health care team to evaluate the effectiveness of the pain treatment plan.