MEASURING PAIN
As pain is an emotional sensation, it is hard to measure. But, there are scales to measure the severity and intensity of pain perceived by patients such as self-reported pain scales, which are more common than observational (behavioral), or Wong Baker FACES Wong Baker FACES Pain Rating Scale is ideal for children (older than 3 years) and adolescents as it consists of graphical illustrations of faces. Each facial expression demonstrates the severity of the pain. The scoring system ranges from 0 (no pain at all) to 5 (most severe pain )[15] .
physiological pain scales, which are easy to comprehend and administer. There are specific pain scales for newborns, infants, children, and adults. See Figure 2 for some of the pain scales that are frequently used.
Figure 2: Wong Baker FACES Pain Rating Scale
Note. Image adapted from: http://www.health.gov.au/internet/main/ publishing.nsf/Content/387970CE723E2BD8CA257BF0001DC49F/$F ile/Triage%20Quick%20Reference%20Guide.pdf
Visual Analog Scale (VAS) The Visual Analog Scale is a 100 mm line. The left end is marked as 0, which indicates “No pain,” and the right end is marked as 10, which denotes “Severe pain”. Refer to Figure 3 for more clarification in marking the VAS. The patient is asked to mark the level of pain he/she perceives on the straight line [15] . This scale is useful for adolescents and adults.
Figure 3: The Visual Analog Scale
Note. Image adapted from: http://www.health.gov.au/internet/main/ publishing.nsf/Content/387970CE723E2BD8CA257BF0001DC49F/$F ile/Triage%20Quick%20Reference%20Guide.pdf
Abbey Pain Scale The Abbey Pain Scale can be used for the patients who cannot speak and/or comprehend. The healthcare professional has to observe the person and fill in the boxes appropriately (as shown in Figure 4) [15] . On completion of the questions, Total Pain Score has to be obtained by adding the scores of all six questions.
The scoring system is: 0 - 2 No pain
8 - 13 Moderate
3 - 7 Mild
14+ Severe
Figure 4: Abbey Pain Scale How to Use Scale: While observing the patient, score questions 1 to 6. Q1. VOCALISATION eg: whimpering, groaning, crying Absent 0 Mild 1
Q1
Moderate 2
Severe 3
Q2. FACIAL EXPRESSION
Q2
Absent 0 Mild 1
Moderate 2
Severe 3
eg: looking tense, frowning grimacing, looking frightened
Q3. CHANGE IN BODY LANGUAGE
Q3
Absent 0 Mild 1
Moderate 2
Severe 3
eg: fidgeting, rocking, guarding part of body, withdrawn
Q4. BEHAVIORAL CHANGE
Q4
Absent 0 Mild 1
Moderate 2
Severe 3
eg: increased confusion, refusing to eat, alteration in unusual patterns
Q5. PHYSIOLOGICAL CHANGE
Q5
Absent 0 Mild 1
Moderate 2
Severe 3
eg: temperature, pulse or blood pressure outside of normal limits, perspiring
Q6. PHYSICAL CHANGES
Q6
Absent 0 Mild 1
Moderate 2
Severe 3
eg: skin tears, pressure areas, arthritis, contractures, previous injuries
Total Pain Score
Add scores for 1 - 6 and record here
Note. Image adapted from: http://www.health.gov.au/internet/main/publishing.nsf/Content/387970CE723E2BD8CA257BF0001DC49F/$File/ Triage%20Quick%20Reference%20Guide.pdf
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