• Patients reporting pain
 Patient Factors & Considerations
  • 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:

  1. 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'.
  2. 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.
  3. Physical pain scale (see below): Where available - an instrument with a visual scale of pain that allows the patient to select their pain level.
  4. 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.
  5. 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.
  6. 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

Physical pain scale

Faces Pain Scale - Revised

Category Score 0 Score 1 Score 2
FaceNo particular expression, or smileOccasional grimace or frown, withdrawn, disinterestedFrequent to constant frown, clenched jaw, quivering chin
LegsNormal position, or relaxedUneasy, restless, tenseKicking, or legs drawn up
ActivityLying quietly, normal position, moves easilySquirming, shifting back and forth, tenseArched, rigid or jerking
CryNo cry (awake or asleep)Moans or whimpers, occasional complaintCrying steadily, screams or sobs, frequent complaints
ConsolabilityContent, relaxedReassured by occasional touching, hugging or being talked to, distractableDifficult to console or comfort

Category Score 0 Score 1 Score 2
Breathing (independent of vocalisation)NormalOccasional laboured breathing; short period of hyperventilationNoisy laboured breathing; long period of hyperventilation, Cheyne-Stokes respirations
Negative VocalisationNoneOccasional moan or groan; low-level speech with a negative or disapproving qualityRepeated troubled calling out; loud moaning or groaning; crying
Facial ExpressionSmiling or inexpressiveSad; frightened; frownFacial grimacing
Body LanguageRelaxedTense; distressed; pacing; fidgetingRigid; fists clenched; knees pulled up; pulling or pushing away; striking out
ConsolabilityNo need to consoleDistracted or reassured by voice or touchUnable to console, distract or reassure
Additional Information
Additional information

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Responsible Manager
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Published Date

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