When a self-report cannot be obtained, the Hierarchy of Importance of Pain Measures (Table 5-1) directs the clinician to consider the presence of a potentially painful condition (e.g., surgery) or pathology (e.g., cancer). When such conditions exist, nurses should assume that pain is present and should provide appropriate treatment, such as the administration of starting doses of analgesics. This action is commonplace in PACUs where nurses appropriately assume surgery is painful and administer analgesics, regardless of the patient’s ability to report pain (Pasero, 2009a).
Nurses should never presume that patients cannot feel pain and should realize that medications such as neuromuscular blocking agents, propofol (Diprivan), and midazolam (Versed), do not produce analgesia (Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011). When pain is assumed to be present, the condition thought to be present is documented, and when approved by institutional policy and procedure, the abbreviation APP (assume pain present) may be used (McCaffery, Herr, & Pasero, 2011; Pasero & McCaffery, 2002).