Page 85 Guide to Pain Management in Low-Resource Settings

Pain History and Pain Assessment 73

Items* 0 1 2 Score
Breathing independent Normal Occasional labored breathing. Noisy labored breathing. Long
of vocalization Short period of hyperventilation period of hyperventilation.
Cheyne-Stokes respirations.
Negative Vocalization None Occasional moan or groan. Repeated troubled calling out.
Lowlevel speech with a negative Loud moaning or groaning.
or disapproving quality. Crying.
Facial expression Smiling or inexpressive Sad. Frightened. Frown. Facial grimacing.
Body language Relaxed Tense. Distressed pacing. Rigid. Fists clenched. Knees
Fidgeting. pulled up. Pulling or pushing
away. Striking out.

Consolability No need to console Distracted or reassured by voice Unable to console, distract
or touch. or reassure.
Total**
Fig. 5. Pain Assessment in Advanced Dementia Scale. Used with permission. Copyright, Elsevier.

can experience more pain or prolonged pain due to bally unable to report their pain. Each of the scale’s fi ve
its undertreatment. measurement categories—i.e. Face; Legs; Activity; Cry;
Th e tool consists of fi ve items (i.e. breathing, and Consolability—is scored from 0–2, which results
negative vocalizations, facial expressions, body language, in a total score per patient of between 0 and 10 (Merkel
and consolability), with each item assessed on a three- et al, 1997). Scores can be grouped as: 0 = Relaxed and
point score ranging in intensity from 0–2, resulting in comfortable; 1–3 = Mild discomfort; 4–6 = Moderate
an overall score ranging from 0 (meaning “No pain”) to pain; 7–10 = Severe discomfort/pain.
10 (meaning “Severe pain”). Before deciding upon a rating score, for patients
who are awake, the health care provider observes the pa-
Children’s pain tools tient for at least 2–5 minutes, with their legs and body
uncovered. Th e health care provider then repositions the
Children under 3 years old patient or observes their activity, assessing their body
i) Th e FLACC Behavioral Pain Scale for tenseness and tone. Consoling interventions are ini-

Th e FLACC Behavioral Pain Scale (Fig. 6) is a pain as- tiated if needed. For patients who are asleep, the health
sessment instrument for use with patients who are ver- care provider observes for at least 5 minutes or longer,

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Fig. 6. FLACC Behavioral Pain Scale (used with permission). Copyright 2002, Th e Regents of the University of Michigan.