Page 84 Guide to Pain Management in Low-Resource Settings

72 Richard A. Powell et al.

0 1 2 3 4 5 6 7 8 9 10
0 1 2 3 4 5 6 7 8 9 10
No Mild pain Moderate Severe Very Worst
No Worst
pain pain pain (mild) pain pain severe pain
imaginable (discom- (distres- (horrible) (excruci-
Fig. 2. Numerical rating scale. forting) sing) ating)
Fig. 3. Verbal descriptive scale
iii) Verbal descriptor scale
When using this scale, the health care provider describes pain, but do not focus exclusively on pain. Th e health
the meaning of pain to the patient (e.g., signifi cant feel- care provider interviews patients and their carers us-
ings of unpleasantness, discomfort, and distress, and the ing a 10-item scale over four time periods on a scale
signifi cance of the experience for the individual). of 0–5 that can also be completed using the “hand
Th en either verbally or visually, the patient is scale.” Promoted by the WHO, the hand scale ranges
asked to choose one of six descriptors (i.e. “No pain,” from a clenched hand (which represents “No hurt”) to
“Mild pain,” “Moderate pain,” “Severe pain,” “Very severe fi ve extended digits (which represents “Hurts worse”),
pain,” and “Worst pain possible”) that best represents with each extended digit indicating increasing levels of

the level of pain intensity he or she is experiencing. pain. A pediatric version of the APCA African POS is
Sometimes (as in Fig. 3), numbers are also used to ease currently being developed.
the recording of the results.
v) Pain Assessment in Advanced Dementia
iv) African Palliative Outcome Scale (PAINAD) Scale
Th e APCA African POS is a simple and brief multi- The PAINAD is an observational tool that assesses
dimensional outcome measure, specifi cally for pallia- pain in patients who are cognitively impaired with
tive care, that uses patient-level indicators that include advanced dementia, who as a result of their condition

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Fig. 4. APCA African Palliative Outcome Scale (used with permission). Copyright 2008, the African Palliative Care Association.