Pain Score in
Practise
Dr Zainab binti Kusiar
Definition of Terms
•“Pain is whatever the experiencing person says it is, existing whenever the
experiencing person says it does” (McCaffery, 1989)
•“Pain is an unpleasant sensory and emotional experience, associated with or
expressed in terms of actual or potential tissue damage” (IASP, 1989)
Assessment
• Pain assessment: is a multidimensional observational assessment of a
patients’ experience of pain.
• Pain measurement tools: are instruments designed to measure pain.
Assessment
• Tools used for pain assessment share a common numeric and
recorded as values 0 – 10 and documented on the clinical
observation chart as the 5th vital sign.
• The importance of using the same numeric value (0 – 10) is that the
number relates to the same pain intensity in each tool.
• Classification on Level of Pain :
Level of pain Score
No pain 0
Mild 1–3
Moderate 4–6
Severe – Very Severe 7 – 10
Scale Status Example
0 No pain No pain
1 Unpleasant sensation Mild skin irritation
2 Minimal Small bruise
3 Mild Scraped knee, Jammed finger
4 Mild to Moderate Major bruise, Ankle sprain
5 Moderate Moderate toothache, Headache for the day
6 Moderate to Severe Day after major surgery
7 Severe Stabbed by knife, Broken Leg
8 Debilitating Natural childbirth, Small Renal Calculi Pain
9 Agonizing Hand burn in fire, Large Renal Calculi Pain
10 Worst Imaginable Being torn while alive
Three Ways Of Measuring Pain
1. Self report – what the person says ( the
gold standard)
2. Behavioural – how the person behaves
3. Physiological – clinical observations
Pain Assessment
Tools
Visual Analogue scale
• Self-report pain to assess a patient’s experience of pain.
• It can used in children aged 8 years and older, depending upon their
cognitive ability.
• How to use the Visual Analogue scale?
• Ask patient to rate their experience of pain using numbers from 0 (being no
pain) through to 10 (being the worst pain).
Wong-baker Faces Pain Scale
• The Wong-Baker faces pain scale used self-report of pain to assess a
patient’s experience of pain.
• It can be used in children aged between 3 and 18 years of age,
depending upon their cognitive ability.
How to use Wong-Baker faces?
• Explain to the patient that each face helps us understand how much
pain they have, and how this makes them feel.
• Face 0 is very happy because he doesn't hurt at all (ie has no pain).
• Face 2 hurts just a little bit.
• Face 4 hurts a little more.
• Face 6 hurts even more.
• Face 8 hurts a whole lot.
• Face 10 hurts as much as you can imagine, although you don't have to
be crying to feel this bad.
• Ask the person to choose the face that best describes how he is
feeling
FLACC - Face, Legs, Activity, Cry
and Consolability.
• The FLACC is a pain assessment tool that uses that patient’s
behaviour to assess pain experience.
• It can be used for children aged between 2 months and 18 years of
age, and up to 18 years of age in children with cognitive impairment
and/or developmental disability.
• It can be difficult to assess pain in children with cognitive
impairment/developmental disability and in patients who are non-
verbal.
• Ask the parent or carer to help you explain their child’s pain behaviour
to facilitate a more accurate pain assessment.
How to use FLACC:
• Each category (Face, Legs etc) is scored on a 0-2 scale, which results in
a total pain score between 0 and 10.
• The person assessing the child should observe them briefly and then
score each category according to the description supplied.
Physiological Indicators
• Physiological indicators of pain can be helpful to
determine a patient’s experience of pain. These
include:
• heart rate may increase
• respiratory rate and pattern may shift from
normal ie: increase, decrease or change pattern
• blood pressure may increase
• oxygen saturation may decrease
Considerations
• Assess pain using a developmentally and cognitively appropriate pain
tool
• Reassess pain after interventions given to reduce pain (eg. Analgesia)
have had time to work
• Assess pain at rest and on movement
• Investigate higher pain scores from expectation
• Document pain scores
• Use parent/guardian pain behaviour knowledge for children with
cognitive impairment.
THANK YOU…..
