Ask Diane: When do I complete the pain assessment interview under MDS 3.0?

Q: Under the MDS 3.0, when do I have to complete the pain assessment interview?

Diane: The pain assessment interview, which can be found in Section J, should be conducted on the day before, the day of, or the day after the assessment reference date (ARD), according to the most recent MDS 3.0 draft. The draft instructs the interviewer to ask residents:

  • Have you had pain or hurting at any time in the last seven days?
  • How much of the time have you experienced pain or hurting over the last days?
  • Over the past seven days, has pain made it hard for you to sleep at night?
  • Over the past seven days, have you limited your day-to-day activities because of pain?

The 3.0 also instructs the assessor to ask the resident to rate his or her worst pain in the last seven days with a numeric rating or a verbal descriptor (i.e., “mild,” “moderate,” “severe,” “very severe, horrible”).

This represents a shift from the MDS 2.0, which relied on staff assessment and observations of whether a resident experienced pain during the last seven days to code pain. MDS 2.0 instructed staff to ask the resident whether he or she experienced pain, but the coding did not reflect what the resident said. Now, it’s the resident’s interpretation of pain, not staff members’ interpretation.

Although the MDS 3.0 pain interview must be completed the day before, of, or after the ARD, your nursing facility will still need to follow clinical practice guidelines for pain management. CMS recently posted a draft for F309, quality of care, which states that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being. F309 guidance will be expanded to include surveyor guidelines detailing CMS’ expectations for assessment, treatment options, and monitoring of pain.


  1. N. Rei

    90 percent of my residents will tell you they have some type of pain, if you ask them directly. Some complaints are r/t dementia, drug seeking,various diagnosis etc. Asking a resident who has certain diagnosis, and then basing tags or other means of control on the answers, is ridiculous. We have lost the ability to use common sense and the nurse is losing ground r/t her assessment skills.


    Hello Diane,

    1. For the Dementia and Geriatric residents, how frequent do we have to document their ADL status, based on the regulations?

    2. Is monthly good enough, to standardize if resident is stable, for documentation purposes? Of course, we do monitor and document weekly and/or as needed if there is a change in resident’s medical condition. Please advise, as we are revising our P & P. Thank you!

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  4. Sandra

    We ask the patient at least twice a day to rate their pain and this is documented. If they have pain between these assessments it is also documented. Would this documentation be a more accurate than having the patient to recall all the times they have been in pain for the last 7 days? We probably do need to add the question about if the pain has made it hard for them to sleep and do ADL’s. Please email me a respond so we can be compliant with our documentation.

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