Appropriate treatment of pain is predicated on an ability to assess the pain. Documentation of pain assessment is mandated by the Joint Commission.35,36 Unfortunately, assessment is often challenging for a variety of reasons. These may include cultural or language differences,37,38 mental status changes, inability to communicate, critical illness39 and developmental stage, to name a few. There are few reliable objective measures to quantify pain. Vital signs often remain normal despite a significant degree of pain.40
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