Comprehensive pain and symptom management is the hallmark of good palliative care. This begins with a meticulous assessment of the patient and their lived experience with serious illness, not only a cursory yes or no questioning of whether a symptom exists. The PQRST mnemonic is a helpful way to organize this type of assessment.
Patients and caregivers may not always be forthcoming with information due to various reasons, including cultural norms, privacy or even misunderstandings about what symptoms such as pain may mean. Therefore, careful compassionate questioning is needed.
The Edmonton Symptom Assessment Scale (ESAS) is a tool often used by hospice and palliative care clinicians and measures up to 10 symptoms that persons with serious illness may be experiencing. By measuring symptoms in this one tool, the clinician may be able to gain a better understanding of their patient’s overall symptom burden. The ESAS and other assessment tools can be accessed through the links below.
- Dame Cicely Saunders, a key contributor to the hospice movement in the United States, developed the theory of total pain. The theory looks holistically at suffering that occurs not only on a physical level, but also on a psychological, social, emotional, and spiritual level. The cumulative impact of total pain can have an adverse effect on a person’s pain or symptom experience and the ability to manage it effectively solely with medication. For instance, a person with cancer pain may be experiencing frustration with pain as it is a constant reminder of their illness. Increasing analgesics may help moderate some of the pain, but it will not help with the existential grief the person may be experiencing. For the person with serious illness who is struggling with illness and total pain, it may be helpful to refer to an interdisciplinary palliative care team.
Helpful Web Sites
- 1. Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., and Macmillan, K. (1991). “The Edmonton Symptom Assessment System (ESAS): A Simple Method for the Assessment of Palliative Care Patients” Journal of Palliative Care 7 no. 2 (1991): 6-9.
- Goebel, J. R. Doering, L. V., Lorenz, K. A., Maliski, S. L., Nyamathi, A.M., and Evangelista, L. S. “Caring for Special Populations: Total Pain Theory in Heart Failure: Applications to Research and Practice.” Nursing Forum 44 no. 3 (2009): 175-185.
- Mehta, A., and Chan, L. S. “Understanding of the Concept of ‘Total Pain’: A Prerequisite for Pain Control.” Journal of Hospice and Palliative Nursing