Page 86 Guide to Pain Management in Low-Resource Settings

74 Richard A. Powell et al.

with the patient’s body and legs uncovered. If possible,
the patient is repositioned, with the health care provider
touching their body to assess for tenseness and tone.

ii) Touch Visual Pain (TVP) Scale
Th e 10-point TVP Scale, which uses touch and observa-
tion to assess not only a child’s pain but also any anxi-
ety or discomfort that may be experienced, is based on a Fig. 8. Wong-Baker FACES Pain Rating Scale. Used with permission.
(Wilson and Hockberry 2008.)
search for signs of pain and anxiety that can be assessed
either by looking at, or touching, an ill child. Signs of pain
and anxiety include an asymmetrical head, verbalizations describes the pain they feel, with the number assigned
of pain, facial tension, clenched hands, crossed legs, shal- to that face recorded by staff .
low breathing, and an increased or irregular heartbeat.
Children over 7 years old
On the fi rst assessment, the health care provid-
er assigns a score of 1 (for present) and 0 (for not pres- i) Pain thermometer
ent) across 10 items to establish a baseline score. De-
An adaptation of the VDS (Fig. 9), this tool aligns a
pending on the degree of pain and anxiety, medication thermometer against a range of words that describe
is administered when necessary. After 20–30 minutes,
varying levels of pain intensity. Th is scale was developed
the child is assessed once more using the TVP scale. for patients with moderate to severe cognitive defi cits,
If there is no positive change in these signs, a diff erent
or with diffi culty communicating verbally, but a sub-
approach to managing the child’s pain can be consid- sequent revised version (the Iowa Pain Th ermometer)
ered. Importantly, whilst the TVP has yet to be rigor-
has been shown to be useable among the young, too.
ously validated, it is being used in low-resource settings. Patients are shown the tool and asked to imagine that,
just as temperature rises in a thermometer, pain also
Children over 3 years old
increases as you move to the top of the scale. Th ey are
i) Wong-Baker FACES Pain Rating Scale then asked to indicate which descriptors best indicate

Th is scale (Fig. 8) comprises of six cartoon faces, with the intensity of their pain, either by marking the ther-
expressions ranging from a broad smile (representing mometer or circling the relevant words.
“No hurt”) to very sad and tearful (representing “Hurts Th e health professional documents the relevant
worst”) (Wilson and Hockberry 2008), with each be- descriptor and evaluates changes in pain over time by
coming progressively sadder. Th e health care provider comparing the diff erent descriptors chosen. Some re-
points to each face, using the words to describe pain in- searchers have converted the indicated descriptors into
tensity, and asks the patient to choose the face that best a pain score by attributing scores to each.

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Fig. 7. Touch Visual Pain Scale (Used with permission. Copyright, Dr Rene Albertyn, School of Child and Adolescent
Health, University of Cape Town, South Africa.)