Pain is a biopsychosocial feeling. The International Association for the Study of Pain has defined pain as an undesirable and displeasing sensory and emotional incident related to a definite or potential tissue injury or reported with reference to such an injury. The only reliable way to know about pain is to ask the patient. Therefore, what the patient says about pain is very important because the perception of pain is different for different people. Assessment of pain is essential to improve understanding of the disease, to devise a suitable method to alleviate pain and evaluate the success of a treatment given for any disease.
What Is an Acute Pain Assessment Tool?
Pain is a many-sided symptom. It's important to determine the location, nature, duration, time, course, and magnitude of pain. Pain is not only an objective measurement but also subjective. It is impacted by physical, environmental, and mental factors. Pain is described as acute when it is sudden, sharp, and severe and of shorter duration with a specific underlying cause. Any well-grounded tool or scale used to measure acute pain is called acute pain measurement tool.
What Are the Types of Acute Pain Assessment Tools?
Pain assessment tools can be unidimensional or multidimensional.
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Unidimensional Pain Assessment Tool:This tool measures only one dimension of pain which is the intensity of pain. The most commonly used pain assessment tools by clinicians are as follows.
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Numerical Scale (NRS):
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It is the most commonly used pain assessment tool.
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It is used for patients older than 9 years.
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It measures pain with numerical values.
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The level of pain is numbered from 0 to 10 with 0 representing no pain and 10 representing the worst pain one can experience.
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The patient is asked to number the intensity of the ongoing, the best, and the worst pain experienced in the past 24 hours.
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Then the average of these three values is measured as the pain experienced by the patient for the past twenty-four hours.
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This tool can be used before the beginning of treatment or during the treatment.
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Visual Analog Scale (VAS):
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This tool is a scoring sheet used by the patient to convey the level of pain they are experiencing.
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On a piece of paper, a straight line of 10 centimeters with two end points marked.
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One endpoint is marked as “no pain” and the other end is marked as “the worst pain”.
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The patient is asked to mark the pain level by marking ‘X’ on the line.
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The doctor will measure the distance from the endpoint ‘no pain’ to the ‘X’ point marked by the patient to give a pain score.
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It is used for children older than 8 years.
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Categorical Scales:
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This scale measures pain through words and pictures.
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The patient is asked to define the pain severity using words like ‘mild’ ‘moderate’, ‘severe’, ‘unbearable’, ‘excruciating’, ‘extremely painful’, and other words like that.
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This will give an idea about the pain level.
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And for children, it is difficult to communicate and convey the exact feeling of pain so a pictorial representation to describe the intensity of pain is used.
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A child’s face with different facial expressions of increasing scale of pain is presented. The child chooses the face which matches the best with the pain the child is undergoing at present.
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Verbal descriptor scale (VDS).
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An example tool is the Wong-Baker FACES pain rating scale used for children above 3 years. It has six faces numbered from 0 to 10. The face with no pain is happy and smiling and the face with the worst pain is a crying face.
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Multidimensional Pain Assessment Tool: This tool measure the intensity, nature, and location of the pain as well.
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Brief Pain Inventory (BPI):
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This tool is a like question paper with few questions and a 0 to 10 numerical rating scale.
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This scale measures the magnitude of pain and also how it interferes with other daily activities for the past 24 hours.
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It explores pain during situations like walking, sleep cycle, daily physical activities, working, mood, and relationships with others.
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McGill Pain Questionnaire (MPQ):
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This tool is in form of a questionnaire with different words describing the types of pain.
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It has a list of words like lacerating, crushing, Searing, tingling, and freezing.
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The patient has to mark the words that best describe their pain.
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Then a numerical score is given according to the number of words marked by the patient.
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FLACC Pain Scale: Acute pain assessment tools for patients who can not communicate
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It is an observational tool used by doctors to evaluate children and others who can not convey their exact emotions.
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It assesses five behavior, that is facial expression, leg movements, activity, cry, and consolability.
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And under each behavior, a score of 0,1, and 2 denoting mild, moderate, and severe levels of pain is provided for marking.
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It is used from age of 2 months to 7 years old.
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The score will help to determine the need for analgesia according to the score.
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CRIES Pain Scale:
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It is used especially for fetuses as old as 32 weeks to newborns of 6 months old.
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It measures pain using five parameters -crying, oxygen saturation, crucial functions like heart rate and blood pressure, facial expression, and sleeplessness.
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Each parameter is scored from 0 to 2 with 0 being no sign and 2 being the presence of severe pain. The total score will be from 0 to 10.
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DATE/TIME |
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Crying- the high-pitched cry is present 0-Absence of a cry or a cry that is low-pitched 1-High-pitched cry but the baby is easily pleasable 2-High-pitched cry but the baby is unpleasable |
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Requires O2 for SaO2 <95%-Babies having pain show reduced oxygenation. Consider other causes of hypoxemia e.g. oversedation, atelectasis, pneumothorax 0-No requirement of oxygen 1-oxygen requirement < 30% 2- oxygen required >30% |
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Increased vital signs(BP and HR)-BP to be measured at last to avoid awakening baby making other assessments easy 0-Both HR and BP remain same or less than baseline 1-Increse in BP or HR but increase in <20% of baseline 2-Increase in BP or HR which is >20% over baseline |
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Expression-Grimaceis the most common facial expression. A grimace may be characterized by brow lowering, eyes pressed out, enhancing nasolabial furrow or open lips and mouth 0-Grimace is absent 1-Only grimace is present 2-Grimace and no sobbing vocalization grunt is present |
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Sleep -Scored based upon baby’s state during the hour before this recorded score 0-Child has been sleeping throughout 1-Child has awakened at constant intervals 3-Child has not slept at all |
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TOTAL SCORE |
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COMFORT Pain Scale:
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This type of pain scale is for children who are under ventilation, adults who are intellectual disabilities, unconscious patients, and patients in intensive care units.
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The variable observed are nine totally-alertness, calmness, respiratory discomfort, crying, physical movement, muscle tone, facial tension, blood pressure, and heart rate.
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Each has a score from 1 to 5. So, the total score would be from 9 to 45 depending on the severity.
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The score reveals the necessary treatment for the patient.
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Tools Used in Geriatic Patients:
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Pain assessment in advanced dementia (PAINAD)
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Pain assessment checklist for seniors with limited ability to communicate (PACSLAC)
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Abbey pain scale
Conclusion
There are many other types of pain assessment tools for acute as well as chronic pain. Even though organized scales to measure pain are available, there are a few challenges faced like communication problems, the inability to assess pain who have with impaired cognitive skills, and unconscious patients. Always self-report by a patient is the standard methodology in the assessment of pain.
