tEAM 5

PAIN ASSESSMENT

Group 2
 REV : SOURCES OF PAIN

• Cutaneous pain • Somatic

pain

Neuropathic Breaktrhough
pain pain

Phantom
Psychogenic
limb
pain
sensation

• Visceral pain • Referred

pain
REV : FACTORS AFFECTING PAIN

Perception of Pain

Socio Cultural Factors

Age

Gender

Meaning of Pain

Anxiety

Past experience with Pain

 INTRODUCTION

Pain is both a physical and psychological phenomenon

Pain is the signals of our body when it has any problem

The pain experience is subjective & individualized

 WHY WE NEED TO ASSESS PAIN?

For documentation

To find the evidence for diagnoses

Produces a baseline to find an appropriate

therapeutic interventions.
E.g: administration of analgesic drugs

Facilitates communication between staff looking after

the patient
 HOW TO ASSESS PAIN?
1. Patient’s self report: (the gold standard)
- Patient’s experience is subjective -> not trust 100%
- Characteristic of pain:
• Onset: When did the pain start?
• Location: Where is the pain?
• Duration: How long does the pain last?
• Intensity: How bad is the pain
• Quality: How is the pain? Sharp, burning, cramping, radiating?
• What makes the pain worse/better?
2. Observer assessment

- Observation of the patient’s behavior

• Does it match with the description about pain
- Use pain assessment tools
• Uni-dimensional measurement tools
• Multi-dimensional pain measurement tool
Uni-dimensional measurement tools
ASSESSING PAIN IN CHILDREN
Scales used in children / infants and in cognitively
impaired patients

 Wong Baker Faces Scale

 FLACC scale
 Observational pain assessment
 Wong Baker Faces Scale
(0) “This face is happy and does not hurt at all.”
(2) “This face hurts just a little bit.”
(4) “This face hurts a little more.”
(6) “This face hurts even more.”
(8) “This face hurts a whole lot.”
(10) “This face hurts as much as you can
imagine, but you don’t have to be crying to feel
this bad.”

• Ask the child to choose a face which best describe

his/her pain?
• Multiply the score below the face by 2, to get a
maximum total score of 10
• Be careful as some children might confuse the faces as
measure of happiness
FLACC Scale

- This is a behavior scale that has

been tested with children age 3
months to 7 years.
- Behavioral pain scores need to be
considered within the context of
the child’s psychological status,
anxiety and other environment
factor.
Observational pain assessment
 WHEN SHOULD PAIN BE ASSESSED?

1. At regular intervals – as the 5th vital sign during routine observation of

BP, heart rate, respiratory rate and temperature).
This can be 4 hourly, 6 hourly or 8 hourly.
2. On admission of patient
3. On transfer-in of patient
4. At other times apart from scheduled observations:
Half to one hour after administration of analgesics and nursing
intervention for pain relief
During and after any painful procedure in the ward e.g. wound dressing
Whenever the patient complains of pain
 WHO SHOULD BE ASSESSED?

o All inpatients
o Including patients in labour room, recovery room
(OT), High dependency units, Coronary Care Units
o All patients in Emergency department
o Ambulatory care units
o Exclusion
Patients in NICU
 WHO does Pain Assessment?

All Student
All nurses ...Everyone!
nurses

01 02 03 04 05

All medical
All doctors
students
 IS IT POSSIBLE TO GET A PAIN
SCORE IN ALL PATIENTS??

Some groups where pain score may be difficult to

elicit may be
 Adult cognitively impaired patients
Use FLACC score where possible
 Patients with severe head injury
 Patients with language barriers
Use the visual analogue scale if possible

“Unsble to score” may be recorded if all efforts to

get a pain score have failed
 PAIN SIGNS IN COGNITIVELY
IMPAIRED

o Facial expressions
o Verbalizations
o Body Movement
o Change in Interaction
o Change in Activity or Routine
o Mental Status Changes