- Patients reporting pain
- Pain is always subjective and multifactorial involving both physical and psychological processes.
- Evidence suggests that concurrent use of multiple pain relieving strategies, including pharmacological and non-pharmacological interventions, provides superior pain relief when compared to any single approach to pain management alone.
Information Needed:
- Type of pain
- Onset
- Location, radiation
- Intensity - intermittent or constant
- What makes it better or worse?
- Relevant medications
- Associated problems
- Level of consciousness
- Potential cause for pain
Assessment of Pain and Effectiveness of Pain Management:
Assess pain score, when possible using verbal report, visual analogue or scoring tool. Pain score should be obtained on initial assessment and following treatment or pain relieving measures.
Pain scores are reported from 0 (No pain) to 10 (Worst pain possible). Pain can be scored using the following methods:
- Numbered rating scale: The patient is asked to score their pain with a number from 0-10 that best describes the pain experienced, with zero being 'no pain' and 10 being the 'worst pain imaginable'.
- Verbal rating scale: The patient is asked to choose a phrase that best describes the pain - 'mild', 'moderate' or 'severe'. A score is then applied in the following ranges: Mild - 1 to 3, Moderarate - 4 to 6, Severe - 7 to 10.
- Physical pain scale (see below): Where available - an instrument with a visual scale of pain that allows the patient to select their pain level.
- Faces Pain Scale - Revised (see below): A visual representation of faces to best describe pain, the patient selects a face best representative of their level of pain and the corresponding score is selected.
- FLACC (see below): Scored based on a 0-2 range for descriptors on each of Face, Legs, Activity, Cry, Consolability. Total score produces a pain score. For use in pre-verbal and non-verbal paediatric patients.
- PAINAD (see below): Scored based on a 0-2 range for descriptors on each of Breathing, Vocalisation, Facial Expression, Body Language, Consolability. Total score produces a pain score. For use in non-verbal patients with advanced dementia.
- Prior to treatment taking effect, show the instrument to patient with the slider set to 'No Pain'
- Ask patient to slide the pointer along the scale between 'No Pain' and 'Worst Pain Ever' so it best matches their pain level
- Read off the scale of 0-10 (figure below) and document the score
- Leave pointer in place and repeat procedure as appropriate for patient’s condition
- For re-assessment, offer the instrument again, pointer in position of last assessment
- Ask if pain level has changed. Patient is to re-position slider
- Read revised score and record
| Category | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Face | No particular expression, or smile | Occasional grimace or frown, withdrawn, disinterested | Frequent to constant frown, clenched jaw, quivering chin |
| Legs | Normal position, or relaxed | Uneasy, restless, tense | Kicking, or legs drawn up |
| Activity | Lying quietly, normal position, moves easily | Squirming, shifting back and forth, tense | Arched, rigid or jerking |
| Cry | No cry (awake or asleep) | Moans or whimpers, occasional complaint | Crying steadily, screams or sobs, frequent complaints |
| Consolability | Content, relaxed | Reassured by occasional touching, hugging or being talked to, distractable | Difficult to console or comfort |
| Category | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Breathing (independent of vocalisation) | Normal | Occasional laboured breathing; short period of hyperventilation | Noisy laboured breathing; long period of hyperventilation, Cheyne-Stokes respirations |
| Negative Vocalisation | None | Occasional moan or groan; low-level speech with a negative or disapproving quality | Repeated troubled calling out; loud moaning or groaning; crying |
| Facial Expression | Smiling or inexpressive | Sad; frightened; frown | Facial grimacing |
| Body Language | Relaxed | Tense; distressed; pacing; fidgeting | Rigid; fists clenched; knees pulled up; pulling or pushing away; striking out |
| Consolability | No need to console | Distracted or reassured by voice or touch | Unable to console, distract or reassure |
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
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