KELOMPOK 6

1.NUR AULIYA
2.SAPARI 3.SAFITRI
4.SEPINAWATI
Pain
SOURCES OF PAIN
 Cutaneous Pain
 Somatic Pain
 Visceral Pain
 ReferredPain
 Neuropathic Pain
 Breaktrhough pain
 Phantom limb sensation
 Psychogenic Pain
 FACTORS AFFECTING PAIN
 Perception of Pain
 Socio Cultural Factors

 Age

 Gender

 Meaning of Pain

 Anxiety

 Past experience with Pain

 Based on the time is lasts,
pain can be divided into

Acute Pain
Pain that comes
suddeny or suddenly

Chronic Pain
Pain that has been around for
3-6 mounths or years.
Example:
Burns, bruises, feractures
Psychogenic
pain
Pain that is influenced
by psychological
factors
 PAIN
ASSESSMENT
 WHY MEASURE PAIN?
❖ For documentation

❖ Produces abaseline to assess therapeutic

interventions e.g. administration of analgesic drugs

❖ Facilitates
communication between staff looking
after the patient
CLINICAL TECHNIQUES FOR MEASUREMENT OF PAIN

 Self reporting by the patient (best method)

 Observer assessment
Observation of behaviour and vitalsigns
Functional assessment
 PAIN MEASUREMENT
 Multidimensional scales
Brief Pain Inventory (BPI)
Unidimensional scales McGill Pain Questionnaire
Numerical Rating Scale (MPQ)
(NRS) Memorial Pain Assessment
Verbal Analogue Score Card
(VAS)
Categorical Scale or
Scales used in children / infants
Verbal rating scale
 Wong Baker Faces Scale (> 3-7 years)
 FLACC scale (paediatric patients 1
month to 3 years old)
 Observational scale
 Functional scale
WHEN SHOULD PAIN BE MEASURED?

 At
Rest
 Movement, coughing and deep breathing

Frequency of assessment should be

increased if the pain is poorly controlled or
if the pain stimulus or treatment
interventions are changing
 HOW TO ASSESS PAIN:
 Important to :
listen and believe the patient

 Takea pain history :

“Tell me about your pain…”
 HOW TO ASSESS PAIN IN ADULT
P : Place or site of pain
 “Where does it hurt?”
(a body chart might help describe
their pain)
A : Aggravating factors
 “What makes the pain worse?”
I : Intensity (NRS or VAR)
 “How bad is the pain?”
N : Nature and neutralizing
factors
 “What does it feel like” “What makes the
pain better?”
 Numeric rating scale

“On a scale of ‘0’ – ‘10’ (show the pain scale), if ‘0’ = no pain and ‘10’ =
worst pain you can imagine, what is your pain score now?”
•Patient is asked to slide the indicator along the scale to show the severity of
his/her pain.
•Nurse records the number on the scale (zero to 10)
 DETAILED HISTORY
 Goal is to characterize pain by location, intensity, and etiology
 Listen to descriptive words about quality, location, radiation
 Evaluate intensity or severity, aggravating factors (have patient
keep a log)
 Impact on activity, mood, mentation, sleep, functioning in daily
activities
 Previous episodes, relation to physical or stress-related etiological
factors
 Previous diagnostics and findings

 Previous treatment and its effects

 Concurrent medical problems (cardiac, respiratory, anxiety,

depression)
ASSESSING PAIN IN CHILDREN
Q Question the child

U Use pain rating scales

Evaluate behavioural and
E physiological changes

S Secure the parents’ involvement

Take the cause of pain into
T account

T Take action and evaluate results

 WONG-BAKER FACES PAIN RATING SCALE
 This scale can be used with young children (sometimes as young as 3 years of age). It also works well for many
older children and adults as well as for those who speak a different language. Explain that each face represents a
person who may have no pain, some pain, or as much pain as imaginable. Point to the appropriate face and say:
 (0) "This face is happy and does not hurt at all."
(2) "This face hurts just a little bit."
(4) "This face hurts a little more."
(6) "This face hurts even more."
(8) "This face hurts a whole lot."
(10) "This face hurts as much as you can imagine, but you don't have to be crying to feel this bad."
 FLACC Scale
This is a behavior scale that has been
tested with children age 3 months to 7
years. Each of the five categories (Faces,
Legs, Activity, Cry, Consolability) is
scored from 0-2 and the scores are
added to get a total from 0-10.
Behavioral pain scores need to be
considered within the context of the
child's psychological status, anxiety and
other environment factors.
 2
0 1
Frequent to
No particular Occasional grimace or
Face constant frown,
expression or frown, withdrawn
clenched jaw,
smile disinterested
quivering chin
0 2
1
Legs Normal position or Kicking, or legs
Uneasy, restless, tense
relaxed drawn up
0
1 2
Lying quietly,
Activity Squirming, shifting back Arched, rigid, or
normal position,
and forth, tense jerking
moves easily
2
0 1
Crying steadily, screams
Cry No cry (awake Moans or whimpers,
or sobs, frequent
or asleep) occasional complaint
complaints
1
2
Consola 0 Reassured by occasional
Difficult to console
bility Content, relaxed touching, hugging or "talking
or comfort
to, distractible
PAIN SIGNS IN COGNITIVELY IMPAIRED

 Facial expressions
 Verbalizations
 BodyMovement
 Change in Interaction
 Change in Activity or Routine
 Mental Status Changes
 WHEN SHOULD PAIN BE ASSESSED ?
1. At regular intervals – as the 5th vital sign during routine observation of BP, heart
rate, respiratory rate and temperature).
This can be 4 hourly, 6 hourly or 8 hourly
2. On admission of patient
3. On transfer-in of patient
4. At other times apart from scheduled
observations:
- Half to one hour after administration of analgesics and nursing intervention for
pain relief
- During and after any painful procedure in the ward e.g. wound dressing
- Whenever the patient complains of pain
 A Typical Pain
Management Technique

• Rest, Ice, Ompression, and Elevation (Rice)

• A simple method of ease with patients in the home
Drugs. The use of a pain reliever is the most common method for pain control
Thank you
for
your attention