Instructions:1- The patient is asked: What number on a 0 to 10 scale, where 0 means no pain and 10 as worst pain, would you give your current pain intensity?2- When the question above is not understood by the patient, it is sometimes helpful to further explain or conceptualize the Numeric Rating Scale in the following manner:0 = No Pain1-3 = Mild Pain (nagging, annoying, interfering little with ADLs)4–6 = Moderate Pain (interferes significantly with ADLs)7-10 = Severe Pain (disabling; unable to perform ADLs)3 - The interdisciplinary team in collaboration with the patient/family (if appropriate), can determine appropriate interventions in response to Numeric Pain Ratings
Instructions:1- Explain to the patient that each face is for a person who feels happy because he has no pain (hurt or, whatever word the patient uses) or feels sad because he has some or a lot of pain.2- Ask the patient to point to each face using the words to describe the pain intensity. Face 0 doesn’t hurt at all. 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.3- The interdisciplinary team in collaboration with the patient/family (if appropriate), can determine appropriate interventions in response to Faces Pain Ratings
Instructions:1- Each of the five (5) categories is scored from 0-2, which results in a total scorebetween 0 and 10.2- The interdisciplinary team in collaboration with the patient/family (if appropriate), can determine appropriate interventions in response to FLACC Scale scores.
Interpretation:minimum score: 0 maximum score: 7 0 No pain1 – 2 Mild discomfort2 – 4 Mild to moderate pain 4 – 7 Moderate to severe painLimitations: A falsely low score may be seen in an infant who is too ill to respond or who is receiving a paralyzing agent.
Instructions:1- Each of the five (5) categories is scored from 0-2, which results in a total score between 0 and 10.2-The interdisciplinary team in collaboration with the patient/family (if appropriate), can determine appropriate interventions in response to CRIES Scale scores.
Each of the nine (9) categories is scored from 1-5, which results in a total scorebetween 9 and 45.The interdisciplinary team in collaboration with the patient/family (if appropriate), can determine appropriate interventions in response to COMFORT Scale scores.Thank you Ahmad Thanin
Prepared & Presented by
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage.
Most common reason for seeking health care.
Pain is considered the 5th vital sign.
Pain Management – is a process of assessing,
treating and re-assessing pain utilizing non-
pharmacologic and pharmacological method.
among Elderly and Nurses
Pain is unavoidable.
Pain is a punishment.
Asking for pain medication is too
demanding and means I’m not a
Pain medication are addictive.
Taking pain medications means
I’ll lose my independence and
Pain is not harmful.
Nurses don’t have the time to
give extra medication.
Elderly patients have
decreased sensations of pain.
Elderly patients who are
cognitively impaired don’t feel
A sleeping patient is not in
Elderly patients complain more
about pain as they age.
Narcotics will hasten death.
Potent analgesics are
Potent pain meds will cause
Should be as automatic as taking
pulse and BP.
Pain is the 5th vital sign
Pain threshold: amount of pain
stimulation a person requires
before feeling pain.
Pain tolerance: the highest
intensity of pain that the
person is willing to tolerate.
The categories of pain:
Cancer – Related
Effects of acute pain:
Neuroendocrine response to stress
Increased metabolic rate
Increased cardiac output
Impaired insulin response
Increased retention of fluids
Increased risk for physiologic disorders
Decreased deep breathing and mobility
Effects Chronic Pain:
Suppressed immune function
Resultant increased tumour growth
Depression and lack of motivation
What alternative therapies can
close the gate?
Distraction of any sort
Ice and heat therapies
Alternative therapies which may
close the gate:
Cutaneous stimulation and massage
Transcutaneous electrical nerve
Let’s try an experiment….
Have each attendant take pen
and place over nail bed and push.
Describe sensation to neighbor.
All the same?
Now try counting backwards
from 10 while holding pressure on
nail bed. Is the pain as bad?
Selection of appropriate drug, dose, route
Aggressive titration of drug dose
Prevention of pain and relief of
Use of coanalgesic medications
Prevention and management of side
Analgesic ladder in action:
Step 1: non-opioid analgesics (Paracetamol
and Aspirins, NSAIDS)
Step 2: mild opioid is added (not
substituted) to step 1
Step 3: Opioid for moderate to severe pain
is used and titrated to effect
Use extra (rescue) doses of opioids.
Use the immediate-release form of same
opioid they are on.
Rescue dose 5-15% of the 24-hour dose.
If 3 or more rescue doses needed/24 hrs—
need to titrate routine drug to effect (25-
100% current dose).
Pain management through
medication and/or neurosurgery
PCA (Patient-controlled analgesia)
Cordotomy: division of certain tracts of the cord.
Rhizotomy: A lesion is made in the dorsal root to
destroy neuronal dysfunction and reduce nociceptive input.
Universal Side Effect
Nausea and Vomiting.
Placebo – HMG Policy
Placebo (e.g. normal saline) should not be
given to treat pain even with written medical
Using placebo to diagnose or treat pain is
considered unethical and violating patient
right to have optimal pain relief
Assessment tools used at Dr. Sulaiman Al Habib Hospital
Numeric Pain Rating Scale.
Wong-Baker Face Pain Rating Scale.
NIPS Pain Scale.
CRIES Pain Scale.
Critical Care Pain Observation Tool or
Comfort Pain Scale
Why have a pain scale?
Sometimes hard to put words to pain
Pain is multi-faceted (How long? Where?
How intense? What kind feeling?
Visual scales help us understand where
Faces help us understand how pain
makes patient feel.
Numeric scales help quantify pain using