1. Measurement of pain Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio) Mahatma Gandhi medical college and research institute, puducherry – India

2. Why this topic ? Pain is not simple Subjective Multi dimensional Sensory, emotional etc…etc… Day, age, drugs etc, etc ….

3. The first man So simple Keele, Lancet, 1948 Measured pain as Mild, moderate, severe Unfortunately or fortunately, it still remains

4. Rotter scale and locus of control The Locus of Control is a 13 item questionnaire People with an internal locus of control believe that their own actions determine the rewards those with an external locus of control believe that their own behavior doesn't matter much Scores range from 0 to 13. A low score indicates an internal control while a high score indicates external control. But why we need it ??

5. Nurse or PCA Internal ------ External --------

6. In the post op ward Pulse BP Temperature Respiration And pain as the fifth vital sign

7. So how do we measure pain ?? Pain is a separate language Subjective Multidimensional So very difficult

8. Visual analog scale 3.5

9. Advantages Extremely simple Sensitive Reproducible Quick Cheap Can also use for nausea, patient satisfaction Both vertical and horizontal scales are available

10. Disadvantages Patient understanding Resting and movement Unidimensional

11. Numerical rating scale similar to VAS 0- 10 numbers 0 = least pain 10 = maximum pain

12. Simple, VAS and NRS

13. Mcgill pain questionnaire Melzack- Torgerson (1971) Sensory Affective and emotional components of pain addressed

14. Mcgill pain questionairre Crushing Throbbing Cramping Splitting Cutting Shooting Etc etc

15. Mcgill pain questionnaire

16. Mcgill pain questionairre 102 word descriptors into 20 subclasses For each subclass – patient has to tell the description To tell the score

17. Three things in MPQ PRI Summation of Scores of each class NWC number of words chosen PPI 1 to 5 (mild to very severe

18. Advantages - Disadvantages Wholesome Data analysis All components Assessment of therapy Very lengthy Frustrated Repetition not possible Knowledge of patients

19. Short form MPQ Instead of 20 – 15 Instead of 102 - 15 * 4 = 60 VAS PPI is there. Less vast and less frustrating

20. Short form

21. MPQ and all painful conditions 50 Causalgia 40 amputation LBA,cancer, PHN primi Arthritis 30 multi toothache 20 fracture, bruise, cut 10 sprain 0

22. Nonverbal adults

23. Paediatric pain assessment

24. Problems in children Pain can be measured by self-report (what children say), biological markers (how their bodies react), and behavior (what children do). Because pain is a subjective event, self-report is best if it is available. behavioral or biological measures Cry, vocalization HR,BP,autonomic NS Faces

25. It may vary Stranger Fearing child Injection

26. Regular techniques VAS NRS Acceptable over 8 years Faces Pain Scales Faces pain scales comprise a series of line diagrams of faces with expressions of increasing distress

27. OUCHER The OUCHER is a poster developed for children to help them communicate how much pain or hurt they feel. There are two scales on the OUCHER: a number scale for older children and a picture scale for younger children.

28. Wong baker faces rating scale

30. CHEOPS Children’s Hospital Eastern Ontario Pain Scale

31. Body outlines and colouring

32. So many scales Manchester scale Pieces of hurt scale The Bieri Faces Pain Scale Face, Legs, Activity, Cry, Consolability Scale (FLACC)

33. Poker chips

34. Neonate The Neonatal Facial Action Coding System consists of 10 facial actions that coders identify from videotapes. Facial movements observed in response to heel lance were: brow bulge, eye squeeze, nasolabial furrow and lip part, taut tongue, mouth stretch, and chin quive

35. AGE and pain assessment coding hurt Faces VAS NRS 0 2 4 6 8 1 0 12

36. Special Considerations for the Cognitively Impaired Child What are the Barriers to effective pain management in the cognitively impaired ? the complexity of pain assessment in those who cannot verbalize their pain outdated beliefs that these children have altered or blunted pain perception limited evidence for the safety and efficacy of analgesic regimens an exaggerated concern regarding opioid side effects

37. The University of Wisconsin Pain Scale for Preverbal and Nonverbal Children Cry, Faces Behaviour Posture Sleep And the FLACC scale

38. Summary Pain measurement – multidimensional SDS, VAS, NRS Mcgill - long and short forms Paediatric pain Codes, hurt, faces, VAS, NRS

39. The pain ends - Thank you all