Pain control

R52.0/R52.9

DESCRIPTION

Pain is an unpleasant sensation experience associated with actual or potential tissue injury. It is always subjective. It is affected by the patient's mood, morale and the meaning the pain has for the patient.
Active pain assessment and self-report is the key to effective pain management.
Different pain assessment scales should be used for different ages and intellectual categories of patients.

FLACC SCALE:

For babies and intellectually impaired children and critically ill adults who are unable to self-report pain the FLACC (face, legs, activity, cry, consolability) scale is used. Evaluate each item and arrive at a total score ranging from 0 to10.A score of ≥4 needs active pain management.

Item 0 1 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or frown, withdrawn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, no
need to
console 		Reassured by
occasional touching,
hugging or “talking
to”, distractible 		Difficult to
console or
comfort

REVISED FACES PAIN SCALE:

  • Use in children >4 years of age.
  • Ask them to point to the face that best depicts their level of pain.

VISUAL ANALOGUE SCALE:

  • Use in children over 7 and adults who can communicate
  • Ask: “on a scale of 0 -10, ‘0’ being no pain and to ‘10’ being the worst pain, what number are you feeling right now?”

Pain should be assessed by:

  • duration
  • severity, e.g. does the patient wake up because of the pain?
  • site
  • character, e.g. stabbing, throbbing, crushing, cramp like
  • persistent or intermittent
  • relieving or aggravating factors
  • accompanying symptoms e.g. nausea and vomiting, visual disturbances
  • distribution of pain
  • referred pain