Pain Assessment Issues for CRG Discussion

Clinical Reference Groups Nursing CRG
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Posting on behalf of Susan Matney

The Nursing Knowledge Big Data Initiative has been modeling Pain Assessment. We have two patient-reported observations:

We discovered two possible SNOMED clinical finding types that potentially align with exacerbating factors: “Provoked by” and "Aggravated by. For example:

426899007 |Pain provoked by walking (finding)| and 1285122000 |Pain aggravated by walking (finding)|

From our research, we determined that “Provoked by” is defined as a triggering type of event where Aggravated by worsens existing pain. We feel Aggravated by more closely aligns with Exacerbating factors.

Our questions to the Nursing CRG:

  1. Do you use either or both in your pain assessment within your EHR

  2. How do these translate into other languages

  3. Do we need both?

  4. Should we request the missing values in SNOMED?

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Link to previous discussions/files: https://conf.spaces.snomed.org/wiki/spaces/Nursing/pages/133989922/Pain+assessment

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Response from Friso: https://forums.snomed.org/t/re-pain-assessment-issues-for-crg-discussion/1315

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@crichardson the link to the response from Friso isn’t working.

1 Like
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Comments from @Friso @smatney

Thank you for raising this important distinction. From a nursing perspective, I believe both concepts are clinically relevant and should remain distinct.

“Provoked by” appears to describe a triggering event that initiates pain, whereas “Aggravated by” reflects factors that worsen existing pain. In clinical nursing practice, especially in chronic pain assessment, aggravating and alleviating factors are routinely assessed together as part of symptom evaluation and clinical reasoning.

The LOINC concepts:

  • 38209-3 Pain exacerbating factors - Reported

  • 38210-1 Pain alleviating factors - Reported

fit very well with nursing assessment workflows because they capture patient-reported influencing factors rather than only pain intensity.

From a nursing outcomes perspective, these observations are highly relevant to several NOC outcomes, including:

  • Pain Control (1605)

  • Pain Level (2102)

  • Pain: Disruptive Effects (2101)

  • Pain: Adverse Psychological Response (1306)

For example:

  • “Pain aggravated by walking” may relate to impaired mobility, activity intolerance, disrupted sleep, anxiety, or reduced pain control.

  • “Pain alleviated by rest” may reflect effective coping or symptom management strategies.

Regarding translation:
In Dutch, we would likely distinguish:

  • “Provoked by” → “uitgelokt door”

  • “Aggravated by” → “verergerd door”

These are not synonymous clinically. “Uitgelokt” implies initiation/onset, whereas “verergerd” implies increased severity of an already existing symptom.

I therefore believe both concepts should remain available in SNOMED CT.

In addition, it may be valuable to review whether sufficient SNOMED value concepts exist for common aggravating and alleviating factors used in nursing pain assessments, particularly for patient-reported observations captured through structured assessments or patient-reported outcome measures.