Pain assessment in children
PAIN
• Pain is a highly complex & subjective experience that originates from the central
(CNS) or peripheral nervous system (PNS) or both.
• Pain is a highly unpleasant sensatory& emotional experience associated with
acute or potential tissue damage.
Types of Pain.
• Pain in term of origin:
• Coetaneous pain originates in the skin surface & subcutaneous tissues.
• Deep somatic pain originates from ligaments, tendons, bones, muscles, blood
vessels, & nerves.
• Visceral pain originates from the larger interior organs (E.g.: kidney,
stomach).
Pain in terms of experience
• Radiating pain: is perceived at the source of pain & extends to the near by
tissues (cardiac pain).
• Referred pain:
• Referred pain is pain perceived at a location other than the site of the painful
stimulus/ origin. ... It is the result of a network of interconnecting sensory
(abdominal visceral pain may be perceived in an area of the skin remote from the
organ causing the pain).
• Intractable pain: is highly resistant to relieve: (advanced malignancy).
• Neuropathic pain: results from current or past damage to peripheral or CNS,
& may haven’t a stimulus.
• Phantom pain: is a painful pain sensation perceived in a body part that is
missing. (E.g. amputated leg).
Pain in term of duration
• Acute Pain is a sudden or slow onset regardless of the intensity& self-limiting.
• Chronic Pain is a prolonged usually recurring or persisting over 6 mos. Or
longer, interferers with function.
-Malignant pain (E.g. Intractable pain).
-Non- Malignant pain ( joints pain).
• Assessment of pain in children continuous to be complex and challenging
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• Children’s ability to describe pain changes as they grow older and as they
cognitively mature
• Accurate pain assessment is essential for effective pain management.
• Assessment of pain includes physiologic, psychologic, behavioral, emotional,
& sociocultural aspects.
I. Pain History
The nurse should collect the following data:-
1. Chief complaint.
2. Present history.
3. Past history.
A. Past surgical history.
B. Past medical history.
C. Past pain history.
D. Medication & Allergies.
E. Psychosocial history.
• Three types of pain measures :-
1. Behavioral
2. Physiologic
3. Self- report
Pain measures( scales)
Pain scales have been developed to assist the nurse in determining the severity of
pain
The advantages of standardized scales
• Reliable & objective
• Little time to implement
• Assess the effectiveness of intervention.
Pain rating scales”PRS”
PR S; is unit-dimensional & intended to reflect intensity.
Behavioral Measures
It Needs a trained observer to watch and record children’s behaviors such as
vocalization, facial expression, and body movements .
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Its the most reliable when measuring short, sharp procedural pain, such as during
injections
• In children with mental clouding and confusion that limit their ability to
communicate meaningfully
• Infants and preverbal children who do not have the language skills to
communicate that they are in pain.
• FLACC pain Assess. Tool; (face, leg movement, activity, cry, &
consolability): It’s for children age 2mos – 7 yrs, is scored from 0-2 &the
total scores from 0 – 10.
FLACC Scale
Physiological measures
• Physiological parameters; HR, RR, BP, palmer sweating, cortisone levels,
transcutaneous oxygen, vagal tone
• Physiologic parameters provide useful information about general distress
levels of children who are experiencing pain.
Self report measures
• Numeric rating scale: is a number that rate the level of pain; with 0 ‘no pain’
& with 10 ‘worse pain’.5yrs
• Visual analogue scale (VAS): It usually a horizontal line, 10 cm in length,
anchored by word descriptors at each end. 7 -18yrs
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• Color Visual analogue scale (CVAS): It’s a colored stripe in which color
gradually changes from white (no pain) through shades of pink to dark red (no
possible pain). 4 Yrs
• Descriptive rating scale; words describe how much pain you may have. 7-
18yrs
Color scale ; uses markers for child to construct own scale that used with body
outline.4yrs
• Faces pain rating scale consists of 6 cartoon faces rating from smiling face
for "no pain” to tearful face for “ worst pain”
Color scale
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Multidimensional measures
• Use for 8yrs &older children
• Pain intensity, quality, pain location and spatial distribution.
• Multidimensional measures
APPT( Adolescent Pediatric Pain Tool)
PPQ (pediatric pain questionnaire);assess child and parents’ perceptions .
PPQ includes
PPQ components
1. visual analog scale
2. color coded rating scales
3. verbal descriptors = sensory, effective, and ,chronic pain, family Hx,
interventions
• PPQ consists of 8 questions:-
1.pain history
2.pain language
3.colors children associate with pain
4.emotions they experience
5.their worst pain experience
6. the ways they cope with pain
7.positive aspects of pain
8. location of their current pain
Pain assessment in specific populations
• Pain in neonate
• Assessment of the physiological changes and behavioral observations of the
neonate
• The preterm infant’s response to pain may be behaviorally blunted or absent
• One pain assessment tool used by nurses who work with preterm and full
term infants in the neonate intensive care setting
CRIES ;Crying, Requiring Increased oxygen, Increased vital signs, Expression
and Sleeplessness each indicator is scored from 0 to 2 similar to the Apgar score
for neonates
• The total possible pain score representing the worst pain is 10
5
• Greater than 4 should be considered significant
CRIES ;Neonatal POP Scale
