Face, Legs, Activity, Cry, Consolability (FLACC) Scale The FLACC Scale (see Figure 5) can be used for infants 2 months or more. It is also considered to be a gold standard of measuring pain in intubated patients in intensive care units. The healthcare professional should observe the patient with legs and body adequately exposed for about 2 to 5 minutes or more, then ask the patient to perform a movement if he/she is awake (or else reposition the patient)to assess the apprehension (i.e., tenseness) and tone of the body [15] . Consoling interventions can be started after this test if the patient is compliant.
The scoring system for this behavioral scale is: 0 Relaxed and comfortable 4-6
Moderate pain
1-3 Mild discomfort
7-10 Severe discomfort/pain
Figure 5: Face, Legs, Activity, Cry, Consolability Scale. 0 1
2
Face
No particular expression or smile.
Occasional grimace or frown, withdrawn, disinterested.
Frequent to constant quivering chin, clenched jaw.
Legs
Normal position or relaxed.
Uneasy, restless, tense.
Kicking or legs drawn up. Arched, rigid or jerking.
Activity
Lying quietly, normal position, moves easily.
Squirming, shifting back and forth, tense. Moans or whimpers; occasional complaint. Reassured by touching, hugging or being talked to, distractible.
Cry
No cry (awake or asleep).
Crying steadily, screams, sobs, frequent complaints. Difficult to console or comfort.
Consolability Content, relaxed.
Note. Image adapted from: http://www.health.gov.au/internet/main/publishing.nsf/Content/387970CE723E2BD8CA257BF0001DC49F/$File/ Triage%20Quick%20Reference%20Guide.pdf OVERVIEW OF STRATEGIES OF PAIN MANAGEMENT
Pain management has many aspects. The main goal of pain management is to reduce suffering caused by an illness or injury and improve the quality of life of the affected patient. The strategies of pain management differ according to the Acute vs. chronic pain management Management of pain may vary according to the time since the onset of the pain. Pain persisting for less than 6 months is acute pain, whereas pain continuing for more than 6 months is chronic pain [16] . Very often, the causes for acute pain are identifiable. For example, the pain caused by a recently sprained ankle is an acute pain. The reasons for chronic pain may vary extensively. For instance, a dull, aching pain continuing for a long time in the small joints of the hands is chronic pain. This can be either due to a known reason (e.g., rheumatoid arthritis) or due to an unidentifiable cause.
characteristics of pain such as type, duration, and/or location, as well as available medicinal and alternative techniques. There are two distinctive strategies of managing pain. They are: 1. Acute vs. chronic pain management. 2. Pharmacological vs. non-pharmacological pain management. The main objective of acute pain management is to aggressively alleviate pain and avoid pain persisting as a chronic pain. In chronic pain management, the objective is to treat the pain continuously, lessen the frequency of pain, and thereby improve the patient’s quality of life. In pain management, acute pain is generally treated with medications, while chronic pain can be treated through a variety of therapeutic strategies including medications, physical therapy, and alternative therapeutic medicine. This is not always the case, but as physical therapy and other alternative therapies take some time to show results, medication is the best option to see rapid pain relief, especially in acute pains. medications may have negative effects on the kidneys and liver; the two main protectors of the body, but physical therapy and other alternative therapies do not harm these organs. When considering the side effects, non-pharmacological strategies have no side effects, though many drugs do. There is no risk of overdosing on alternative therapies, unlike drugs, which do have a maximum dosage and can lead to overdose. In terms of cost effectiveness, the pharmacological approach is more costly due to the complexity of the drug preparation process, but the rates of therapeutic sessions may vary. For example, a session of physical therapy may charge more or less than a session of acupuncture.
Pharmacological vs. non-pharmacological pain management The other most common classification of pain management includes pharmacological and non-pharmacological approaches. Pharmacological pain management involves drugs and medication. Analgesics (i.e., painkillers) are used to control pain. Non-pharmacological pain management comprises a variety of therapeutic techniques. Cryotherapy, physical therapy, manipulative techniques, Pilates, reflexology, acupuncture, yoga, and meditation are some of the commonly used alternative therapeutic strategies to overcome pain. Pharmacological and non-pharmacological strategies of pain management have their own advantages and disadvantages. As the drugs act faster, they give a sudden pain relief comparative to any of the non-pharmacological strategies. However,
MEDICATION USED FOR PAIN MANAGEMENT
Pharmacological pain management has evolved over the years. The drugs used in pain relief are called analgesics . The Three- Step Pain Ladder developed by the World Health Organization (WHO) (shown in Figure 6) has addressed how mild, moderate, and severe pain should be medicated [17] . Initially, this pain ladder
was created to help health care professionals relieve persistent pain in cancer patients. Later, this concept was expanded into other areas of pain medicine as well.
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