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dr. Ken Wirastuti, MKes, Sp.

S Bagian Ilmu Penyakit Saraf Fakultas Kedokteran-Universitas Islam Sultan Agung

Pain: The Fifth Vital Sign


Pain should be considered the fifth vital sign Patients should be assessed for pain every time pulse, blood pressure, core temperature, and respiration are measured Healthcare professionals should recognize a report of unrelieved pain as a red flag
American Pain Society Quality Improvement Committee. JAMA. 1995;18471880.

Why is assessment important?


a reduced experience of pain increased comfort improved physiological, psychological and physical function increased satisfaction with pain management on treatment efficacy Pain is not a simple sensation that can be easily assessed and measured.

Basic Characteristics of Assessment Tools


Highly valid and reliable Allow for the comparison of the magnitude of changes in pain (ratio scale) Be relatively free of bias Be useful for assessing both experimental and clinical pain Allow for comparison with physiological measures in humans and animals Be relatively easy to use

The pain assessment involves


an overall appraisal of the factors that may influence a patients experience and expression of pain (McCaffery and Pasero 1999)

Assessing the Patient With Pain


Onset and duration Location/distribution Quality Intensity Aggravating/relieving factors Associated features or secondary signs/symptoms Associated factors mood/emotional distress functional activities Treatment response

Measuring pain
Pain should be measured using an assessment tool that identifies the quantity and/or quality of one or more of the dimensions of the patients experience of pain. This includes the: intensity of pain; intensity and associated anxiety and behaviour.

Pain assessment tools


The range of pain measurement tools is vast, and includes both uni-dimensional and multidimensional methods. Uni-dimensional tools measure one dimension of the pain experience, for example, intensity; are accurate, simple, quick, easy to use and understand; are commonly used for acute pain assessment;

Multi-dimensional pain assessment tools


provide information about the qualitative and quantitative aspects of pain; may be useful if neuropathic pain is suspected; require patients to have good verbal skills and sustained concentration, as they take longer to complete than unidimensional tools.

Pain assessment tools


Uni-dimensional measurement tools (selection): Visual analogue scales Verbal rating scales Graphic rating scales Numerical rating scales Verbal descriptor scales Body diagrams Computer graphic scales Picture scales Coin scales Multi-dimensional pain measurement tools (selection) McGill pain questionnaire (short and long) Brief pain inventory (short and long) Behavioural pain scales Pain/comfort journal Multidimensional pain inventory Pain information and beliefs questionnaire Pain and impairment relationship scale Pain cognition questionnaire Pain beliefs and perceptions inventory Coping strategies questionnaire Pain disability index Hospital anxiety and depression questionnaire (HAD scale) Neuropathic signs and symptoms ( Leeds assessment of neuropathic symptoms and signs (LANSS) (Bennett, 2001). Cognitively impaired/dementia pain scales

The various methods to measure pain

1. Subjective Report 2. Spontaneous Behavioural Responses 3. Physiological Measures

Pain Intensity Rating Scales


Pain Faces Scale
0 No hurt 2 Hurts just a little bit 4 Hurts a little bit more 6 Hurts even more 8 Hurts a whole lot 10 Hurts as much as you can imagine

Brief Pain Inventory


Shade areas of worst pain
Put an X on area that hurts most

(Cleeland, 1991; Wong et al, 2001)