Pain measurement and control. Pain scales for children Analogue pain scale is yours

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The simplest and most common way is to record the intensity of pain using rating scales.

There is a numerical ranking scale (NRS), consisting of a sequential series of numbers from 1 to 5 or to 10.

The patient must select a number that reflects the intensity of pain experienced.

The Verbal Rating Scale (VRS) contains a set of pain descriptor words reflecting the degree of pain increase, numbered sequentially from less severe to greater: no (0), mild pain (\), moderate pain (2), severe pain (3), very severe pain (4), unbearable (unbearable) pain (5). The visual analogue scale (VAS) is a straight line 100 mm long with or without millimeter units applied to it. starting point the line means no pain, the final line means unbearable pain.

The patient is required to mark the level of pain with a dot on the proposed straight line. For patients who have difficulty abstracting and representing pain as a number or a point on a line, a facial (facial pain scale) can be used. Variants of the listed scales most often used in clinical practice are shown in Fig. 1.

Rice. 1. Pain scales

The simplicity and high sensitivity of rank scale assessment methods make them very useful and sometimes irreplaceable in clinical practice, but they also have a number of disadvantages. The mathematical analysis of the results is based on the unlikely assumption that each rank is an equal psychological unit of measurement.

Pain is assessed unambiguously - by intensity, as a simple sensation that differs only quantitatively, while it has qualitative differences. Analogue, numeric and verbal scales provide a single, generalized assessment that reflects the largely unexplored process of integrating multidimensional pain experience.

For a multidimensional assessment of pain, R. Melzack and W. S. Torgerson (1971) proposed a questionnaire called the McGill Pain Questionnaire. There is also a known method of multidimensional semantic description of pain, which is based on the extended McGill questionnaire (Melzack R., 1975).

The extended questionnaire contains 78 pain descriptor words, introduced into 20 subclasses (subscales) based on the principle of semantic meaning and forming three main classes (scales): sensory, affective and evaluative.

The survey results can serve as a criterion for the mental state of patients. Numerous studies have verified the adequacy of the method for assessing pain, analgesia and diagnosis; it has now become a standard examination method abroad.

Similar work has been done in our country. V.V. Kuzmenko, V.A. Fokin, E.R. Mattis et al. (1986), using the McGill questionnaire as a basis, developed an original questionnaire in Russian and proposed a methodology for analyzing its results. In this questionnaire, each subclass consists of words that are similar in their semantic meaning, but differ in the intensity of the pain sensation they convey (Table 3).

Table 3. McGill Pain Questionnaire

What words can you use to describe your pain? (sensory scale)
1. 1. Pulsating 2. Grasping 3. Jerking 4. Quilting 5. Pounding 6. Chiseling	2. Similar 1. Electrical discharge, 2. Electric shock, 3. Shot	3. 1. Stabbing 2. Digging 3. Drilling 4. Drilling 5. Punching
4. 1. Spicy 2. Cutting 3. Striping	5. 1. Pressure 2. Compressive 3. Aching 4. Squeezing 5. Crushing	6. 1. Pulling 2. Twisting 3. Snatching
7. 1. Hot 2. Burning 3. Scalding 4. Scorching	8. 1. Itchy 2. Pinching 3. Corrosive 4. Stinging	9. 1 Dumb 2. Aching 3. Brainy 4. Aching 5. Splitting
10. 1. Bursting 2. Stretching 3. Rending 4. Tearing	11. 1. Spilled 2. Spreading 3. Penetrating 4. Piercing	12. 1. Scratching 2. Itching 3. Fighting 4. Sawing 5. Gnawing
	13. 1. Mute 2. Bridging 3. Chilling
What feelings does pain cause, what effect does it have on the psyche? (affective scale)
14. 1. Tiring 2. Exhausting	15. Calls 1. Feeling nauseous 2. Choking	16. Evokes a feeling 1. Anxiety 2. Fear 3. Horror
17. 1. Depressing 2. Annoying 3. Angry 4. Infuriating 5. Leads to despair	18. 1. Makes you weak 2. Blinding	19. 1. Pain is a hindrance 2. Pain is a nuisance 3. Pain - suffering 4. Pain is torment 5. Pain is torture
How do you rate your pain? (evaluative scale)
	20. 1. Weak 2. Moderate 3. Strong 4. Strongest 5. Unbearable

The subclasses form three main classes (scales): sensory, affective and evaluative (evaluative). Descriptors of the sensory scale (subclasses 1-13) characterize pain in terms of mechanical or thermal effects, changes in spatial or temporal parameters. The affective scale (14-19 subclasses) reflects the emotional side of pain in terms of tension, fear, anger or vegetative manifestations.

The evaluative scale (subclass 20) consists of five words expressing the patient’s subjective assessment of pain intensity and is a variant of the verbal ranking scale. When filling out the questionnaire, the patient selects words that correspond to his feelings at the moment in any of 20 subclasses (not necessarily in each, but only one word in a subclass).

Each selected word has a numerical indicator corresponding to the ordinal number of the word in the subclass. The calculation comes down to determining two indicators: the number of selected descriptors index (NSID), which is the number (sum) of selected words, and the rank pain index (RIB), which is the sum of the serial numbers of descriptors in subclasses. Both indicators are calculated for the sensory and affective scales separately and together (total index).

According to the International Association for the Study of Pain, “pain threshold (PT) is the minimum pain sensation that can be perceived.” An informative characteristic is also the level of pain tolerance (pain tolerance threshold - PTP), defined as “the highest level of pain that can be withstood.”

The name of the method of quantitative research of pain sensitivity is derived from the name of the algogenic stimulus used in it: mechanoalgometry, thermoalgometry, electroalgometry.

Most often, pressure is used as a mechanical effect and then the method is called tensoalgometry (dolorimetry). With tensoalgometry, PB is expressed in units of pressure force per unit area (kg/cm2). Depending on the location of the measurements, replaceable attachments are used: in the area of ​​the head and distal limbs with a diameter of 1.5 mm, and in the area of ​​massive skeletal muscles - 5 mm.

Tensoalgometry is carried out by smoothly or stepwise increasing pressure on the tested area of ​​the body. Painful sensation occurs at the moment when the force of pressure reaches values ​​sufficient to excite Ab-mechanoreceptors and C-polymodal nociceptors.

Determination of PB and PPB can provide important clinical information. A decrease in PB indicates the presence of allodynia, and a decrease in PB is a sign of hyperesthesia (hyperalgesia). Peripheral sensitization of nociceptors is accompanied by both allodynia and hyperalgesia, and central sensitization is manifested predominantly by hyperalgesia without concomitant allodynia.

R.G. Esin, O.R. Esin, G.D. Akhmadeeva, G.V. Salikhova

The duration of pain intensity measurement on a visual analogue scale takes less than 1 minute. Disadvantages of VAS include: Mandatory presence of paper, pen and ruler. As a result, this test cannot be administered orally or over the telephone. The use of the visual analogue scale may be limited in older patients with cognitive impairment or musculoskeletal problems. The Visual Analog Scale is a more difficult test than the Numeric Rating Scale ().

Source:

1. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2 (2): 175–184.

2. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011; 63 Suppl 11:S 240–252.

... objectification of pain is one of the intractable problems in the clinical practice of doctors of various specialties.

Currently, to assess the presence, degree, and location of pain in the clinic, (1) psychological, (2) psychophysiological and (3) neurophysiological methods. Most of them are based on a subjective assessment of their feelings by the patient himself.

Most in simple ways quantitative characteristics of pain are the ranking scale (Bonica J.J., 1990).

Numerical ranking scale consists of a sequential series of numbers from 0 to 10. Patients are asked to rate their pain sensations with numbers from 0 (no pain) to 10 (maximum possible pain). Patients can easily learn to use this scale. The scale is simple, visual and easy to fill out and can be used quite often during treatment. This allows you to obtain information about the dynamics of pain: by comparing previous and subsequent indicators of pain, you can judge the effectiveness of the treatment.

Verbal ranking scale consists of a set of words characterizing the intensity of pain. The words are arranged in a row, reflecting the degree of increase in pain, and are numbered sequentially from less severe to greater. The most commonly used series of descriptors is: no pain (0), mild pain (1), moderate pain (2), severe pain (3), very severe (4) and intolerable (unbearable) pain (5). The patient chooses the word that most closely matches his feelings. The scale is easy to use, adequately reflects the patient's pain intensity and can be used to monitor the effectiveness of pain relief. The verbal rating scale data compares well with the results of pain intensity measurements using other scales.

Visual analogue scale(VAS) is a straight line 10 cm long, the beginning of which corresponds to the absence of pain - “no pain.” The end point on the scale reflects excruciating, unbearable pain – “unbearable pain.” The line can be either horizontal or vertical. The patient is asked to make a mark on this line that corresponds to the intensity of the pain he is experiencing at the moment. The distance between the beginning of the line (“no pain”) and the mark made by the patient is measured in centimeters and rounded to the nearest whole. Each centimeter on the visual analogue scale corresponds to 1 point. As a rule, all patients, including children over 5 years of age, easily learn the visual analogue scale and use it correctly.

The visual analogue scale is a fairly sensitive method for quantifying pain, and data obtained using the VAS correlates well with other methods of measuring pain intensity.

McGill Pain Questionnaire(McGill Pain Questionnaire). Pain is a complex, multidimensional feeling, which simultaneously reflects the intensity of pain, its sensory and emotional components, therefore, when using one-dimensional ranking scales, the doctor evaluates pain only quantitatively, without taking into account the qualitative features of pain. In the early 70s of the 20th century, R. Melzack developed the McGill Pain Questionnaire, in which all words (descriptors) describing the qualitative characteristics of pain are divided into 20 subclasses (Melzack R., 1975). The McGill Pain Questionnaire has been translated into many languages ​​and has proven highly effective in multidimensional pain assessment.

In our country, there are several versions of the questionnaire in Russian, but the most successful is the version prepared by employees of the Russian State Medical University, Moscow State University. M.V. Lomonosov and CITO named after. N.N. Priorov (Kuzmenko V.V. et al., 1986), which is given below.

MCGILL PAIN QUESTIONNAIRE

Please read all the definition words and mark only those that most accurately describe your pain. You can mark only one word in any of the 20 columns (rows), but not necessarily in each column (row).

What words can you use to describe your pain? (sensory scale)

(1) 1. pulsating, 2. grasping, 3. jerking, 4. constricting, 5. pounding, 6. gouging.
(2) similar to: 1. electric discharge, 2. electric shock, 3. shot.
(3) 1. stabbing, 2. biting, 3 drilling, 4. drilling, 5. piercing.
(4) 1. sharp, 2. cutting, 3. striping.
(5) 1. pressing, 2. squeezing, 3. pinching, 4. squeezing, 5. crushing.
(6) 1. pulling, 2. twisting, 3. tearing out.
(7) 1. hot, 2. burning, 3. scalding, 4. scorching.
(8) 1. itchy, 2. pinching, 3. corrosive, 4. stinging.
(9) 1. dull, 2. aching, 3. brainy, 4. aching, 5. splitting.
(10) 1. bursting, 2. stretching, 3. tearing, 4. tearing.
(11) 1. diffuse, 2. spreading, 3. penetrating, 4. penetrating.
(12) 1. scratching, 2. raw, 3. tearing, 4. sawing, 5. gnawing.
(13) 1. mute, 2. cramping, 3. chilling.

What feeling does pain cause, what effect does it have on the psyche? (affective scale)

(14) 1. tires, 2. exhausts.
(15) causes a feeling of: 1. nausea, 2. suffocation.
(16) causes feelings of: 1. anxiety, 2. fear, 3. horror.
(17) 1. depresses, 2. irritates, 3. angers, 4. infuriates, 5. drives into despair.
(18) 1. weakens, 2. blinds.
(19) 1. pain-interference, 2. pain-annoyance, 3. pain-suffering, 4. pain-torture, 5. pain-torture.

How do you rate your pain? (evaluative scale)

(20) 1. weak, 2. moderate, 3. strong, 4. strongest, 5. unbearable.

Each subclass consisted of words that were similar in their semantic meaning, but differed in the intensity of the pain sensation they conveyed. The subclasses formed three main classes: a sensory scale, an affective scale and an evaluative (evaluative) scale. Descriptors of the sensory scale (subclasses 1–13) characterize pain in terms of mechanical or thermal effects, changes in spatial or temporal parameters. The affective scale (14 – 19 subclasses) reflects the emotional side of pain in terms of tension, fear, anger or vegetative manifestations. The evaluative scale (20th subclass) consists of 5 words expressing the patient’s subjective assessment of pain intensity.

When filling out the questionnaire, the patient selects words that correspond to his feelings at the moment in any of 20 subclasses (not necessarily in each, but only one word in a subclass). Each selected word has a numerical indicator corresponding to the ordinal number of the word in the subclass. The calculation comes down to determining two indicators: (1) index of the number of selected descriptors, which is the sum of the selected words, and (2) pain rank index– the sum of the ordinal numbers of descriptors in subclasses. Both measures can be scored for the sensory and affective scales separately or together. The evaluative scale is essentially a verbal ranking scale in which the selected word corresponds to a certain rank. The obtained data is entered into a table and can be presented in the form of a diagram.

McGill Questionnaire allows you to characterize in dynamics not only the intensity of pain, but also its sensory and emotional components, which can be used in the differential diagnosis of diseases.

Age factor in assessing pain in children. Children aged 8 years and older can use the same visual analogue scales as adults to assess pain severity - this scale is plotted on a ruler, which should be positioned horizontally.

For children from 3 to 8 years old, when self-assessing the severity of pain, you can use either facial scales (faces in photographs or drawings are lined up in a row, in which the facial expressions of distress gradually intensify) or scales with a color analogy (rulers with increasing brightness of red color, indicating the severity of pain) . A high degree of agreement was reported in pain severity measures using the Photographic Portrait Scale and the Color Analogy Scale in children aged 3 to 7 years after surgery.

The use of child behavior scales is the main method for assessing pain in newborns, infants and children aged 1 to 4 years, as well as in children with developmental disorders. In such scales, pain is assessed by facial expression, motor responses of the limbs and trunk, verbal responses, or a combination of behavioral and autonomic changes. In some of these techniques, the term “distress” reflects not only pain, but also fear and anxiety. Behavioral scales may underestimate the severity of long-term pain when compared with self-report measures.

During surgery and in critical care settings, it is prudent to document physiological responses to pain, although these responses may be nonspecific. For example, tachycardia can be caused not only by pain, but also by hypovolemia or hypoxemia. Hence, ( !!! ) it can be difficult to assess the severity of pain in newborns, infants and children aged 1 to 4 years, as well as in children with significant developmental disorders. If the clinical picture does not allow definite conclusions to be drawn, stress-levelling measures should be resorted to, which include creating comfort, nutrition and analgesia, and the effect can be used to judge the cause of distress.

Quantitative assessment of pain sensitivity refers to integrative indicators that reflect general state the body and its response to physiological or psycho-emotional stress, therefore measuring pain thresholds is a very useful method in a comprehensive examination of patients. The threshold of pain sensitivity is taken to be the minimum value of the stimulus that is perceived by the test subject as a painful sensation.

Pain threshold determined using instrumental methods, in which various mechanical, thermal or electrical stimuli are used as stimuli (Vasilenko A.M., 1997). The threshold of pain sensitivity is expressed in (1) units of stimulus strength when using methods with increasing intensity, or in (2) units of time when a stimulus is applied with constant force. For example, when measuring pain sensitivity using a strain gauge, which provides a gradual increase in pressure on the skin, the pain threshold is expressed in units of the ratio of pressure force to tip area (kg/cm2). In thermoalgometry with a constant thermode temperature, the threshold of pain sensitivity is expressed in seconds - the time from the beginning of exposure to the onset of pain.

Using methods for quantitative assessment of pain sensitivity, it is possible to (1) detect zones of hyperalgesia in pathology internal organs, (2) trigger points for myofascial pain syndromes, (3) monitor the effectiveness of analgesics, and in some cases (for example, with psychogenic pain syndromes) (4) determine therapeutic tactics.

Electrophysiological methods. Electrophysiological methods are also used in clinical studies to assess patients' pain sensitivity and monitor the effectiveness of pain relief. The most widely used method for recording the nociceptive withdrawal reflex, or RIII reflex.

Nociceptive withdrawal reflex(NRO), or nociceptive flexor reflex, is a typical defensive reflex. This type of protective reflexes, which occur in both animals and humans in response to painful stimulation, was first described by Sherrington in 1910 and has been used clinically since 1960 to objectify pain (Kugekberg E. et al., 1960). Most often, NPO is recorded in response to electrical stimulation of n. suralis or plantar surface of the foot (Vein A.M., 2001; Skljarevski V., Ramadan N.M., 2002). At the same time, NPO can be recorded during painful stimulation of the fingers (Gnezdilova A.V. et al., 1998) and even with heterosegmental stimulation (Syrovegina A.V. et al., 2000).

When recording NPO, two components are distinguished in EMG activity – RII and RIII responses. The RII response has a latent period of 40–60 ms and its appearance is associated with the activation of thick low-threshold A-fibers, while the RIII response occurs with a latent period of 90–130 ms at an intensity of stimulation exceeding the excitation threshold of thin A-fibers. It is believed that the NRO is polysynaptic, the reflex arc of which closes at the level spinal cord.

However, there is evidence indicating the possibility of involvement of supraspinal structures in the mechanisms of NRA occurrence. Direct confirmation of this is studies that compared the characteristics of changes in NPO in intact and spinal rats (Gozariu M. et al., 1997; Weng H.R., Schouenborg J., 2000). In the first study, the authors found that in intact rats, the preservation of supraspinal pain control mechanisms counteracts the development of an increase in NPO amplitude under conditions of prolonged painful stimulation, in contrast to spinal animals. The second paper provides evidence of an increase in NPO inhibitory reactions to heterotopic nociceptive stimuli under conditions of spinalization of animals.

Understanding the fact that supraspinal structures of the brain are involved in the formation of NPO not only expands the diagnostic capabilities of the method, but also allows its use in the clinic for an objective assessment of the severity of pain not only during homotopic stimulation, but also during heterosegmental pain stimulation.

Method of exteroceptive suppression of voluntary muscle activity in m. masseter. To study the mechanisms of development of headaches and facial pain, the clinic also uses the method of exteroceptive suppression of voluntary muscle activity in the m. masseter (Vein A.M. et al., 1999; Andersen O.K. et al., 1998; Godaux E., Desmendt J.E., 1975; Hansen P.O. et al., 1999). This method is essentially a variation of the nociceptive withdrawal reflex.

It has been established that perioral electrical stimulation causes two successive periods of inhibition in the tonic EMG activity of the masticatory muscles, designated ES1 and ES2 (exteroceptive suppression). Early period inhibition (ES1) occurs with a latency of 10 -15 ms, late (ES2) - has a latency period of 25 - 55 ms. The degree of exteroceptive suppression in the masticatory muscles is enhanced by homotopic nociceptive activity in trigeminal afferents, which is used clinically to quantify pain in patients with headaches and facial pain.

The exact mechanisms of development of ES1 and ES2 are unknown. It is believed that ES1 is associated with oligosynaptic activation by trigeminal afferents of interneurons of the nuclei of the trigeminal complex, which have an inhibitory effect on motoneurons of the masticatory muscles, while ES2 is mediated by polysynaptic reflex arc, involving neurons of the medullary part of the spinal trigeminal nucleus (Ongerboer de Visser et al., 1990). At the same time, there is evidence that ES2 can be recorded during heterotopic pain stimulation, and electrical stimulation of the fingers reduces ES2 in the masticatory muscles (Kukushkin M.L. et al., 2003). This suggests that the mechanisms of ES2 development are more complex and are realized with the participation of supraspinal centers through the spinocorticospinal recurrent loop.

Method for recording somatosensory evoked potentials. Over the past two decades, somatosensory evoked potentials (SSEPs) have been widely used to measure clinical and experimental pain in humans. There is extensive research on this issue research material, summarized in a number of review articles (Zenkov L.R., Ronkin M.A., 1991; Bromm B., 1985; Chen A.C.N., 1993). It is believed that the early SSEP components (N65-P120) reflect the intensity of the physical stimulus used to evoke pain, while the amplitude of the late SSEP components (N140-P300) correlates with the subjective perception of pain.

The idea that the amplitude of late SSEP components may reflect the subjective perception of pain was based on studies that showed a positive relationship between a decrease in the amplitude of the N140-P300 SSEP components and the administration of various analgesics. At the same time, the variability of the amplitude of late SSEP components is well known, which depends on a number of psychological factors, such as attention, memory, emotional condition(Kostandov E.A., Zakharova N.N., 1992), which can be significantly changed not only by analgesics, but also by the research procedure itself. In addition, recent publications on this problem (Syrovegin A.V. et al., 2000; Zaslansky R. et al., 1996) indicate a low connection between subjective pain perception and the amplitude of late SSEP components.

!!! The most reliable among electrophysiological methods for monitoring the magnitude of subjective pain sensation remains the nociceptive withdrawal reflex (NRE).

Functional mapping of neuronal activity of brain structures. Recently, methods of functional mapping of neuronal activity of brain structures in acute and chronic pain have been increasingly introduced into clinical practice (Coghill R.C., et al., 2000; Rainville P. et al., 2000). The most famous of them are: (1) positron emission tomography and method (2) functional magnetic resonance. All functional mapping methods are based on recording a local hemodynamic reaction in brain structures, which has a positive correlation with the electrical activity of neuron populations.

Using functional mapping methods, it is possible to visualize in three-dimensional spatial coordinates (millimeters in humans and micrometers in animals) changes in neuronal activity in response to presented nociceptive influences, which makes it possible to study the neurophysiological and neuropsychological mechanisms of pain.

Everyone Have a good day. Lately, we have been talking very often about remission, a decrease in disease activity, about activity in general, activity indices, etc.

Today and tomorrow we’ll talk about how to measure this activity and how to interpret the result. Let's look at it using an example; if you are interested in other activity indices, just let us know.

So, today we will look at the pain scale, which is often used by rheumatologists and is used to calculate disease activity indices. Pain rating scales are designed to determine the intensity of pain (for any disease). These scales allow you to assess the subjective pain experienced by the patient at the time of the study. The Visual Analogue Scale (VAS) was introduced by Huskisson in 1974.

This method of subjective pain assessment involves asking the patient to mark a point on a non-graduated 10 cm line that corresponds to the severity of pain. The left border of the line corresponds to the definition of “no pain at all,” the right border corresponds to “the most intense pain imaginable.” As a rule, a paper, cardboard or plastic ruler 10 cm long is used. On the back of the ruler there are centimeter divisions, according to which the doctor notes the obtained value and enters it into the medical history or outpatient card. Also, to assess the intensity of pain, you can use a modified visual analogue scale, in which the intensity of pain is also determined by different shades of colors.

The undoubted advantages of this scale include its simplicity and convenience, and the ability to monitor the effectiveness of therapy.

During dynamic assessment, the difference between the VAS value and the previous one by more than 13 mm is objective and significant.

• The disadvantage of the VAS is its one-dimensionality, i.e., on this scale the patient notes only the intensity of pain.
• The emotional component of the pain syndrome introduces significant errors into the VAS score.
• The subjectivity of the VAS is also its main drawback. The patient, in pursuit of his goals, may deliberately underestimate or overestimate the values. When? For example, the patient does not want to offend (stress, bother) his doctor, and even in the absence of a result and the pain syndrome remains at the same level, he underestimates the value. Yes, there are such things) Or the patient wants to get a disability, wants to become a candidate for expensive treatment, etc., and deliberately sets the score significantly higher than the previous result. Well, don’t forget that we are all different: some will endure and even smile, while others with the same pain will not even be able to get out of bed.

Plus, the doctor also needs to be attentive and actively communicate (no, don’t push!!!) with the patient. For example, offering him options for comparison. Let's say a woman walks into the office quite cheerfully, but on a scale she puts it at 10 out of 10, all accompanied by a story about how terrible she feels. You ask: “Have you given birth? Does it hurt as much? “Oh, no, doctor, when I gave birth, did you think I was going to die?” After this, the value decreases to 5. That is why VAS is only one of the tools for calculating the activity index by the doctor himself, who uses objective methods for assessing the patient’s condition. Here you can remember Dr. House and his ironclad “Everyone lies,” but you and I are well-mannered people and will not express ourselves so categorically😄

In conclusion, I just want to say one thing: please be honest with your doctor. If you feel better, talk about it, if you feel worse, again tell the doctor about it. There is no need to deliberately fake or hide anything. If the doctor doesn’t hear you, doesn’t want to hear you, then it’s simply not your doctor. Tomorrow we will discuss DAS-28 and what is considered remission.

Oucher scale

Eland Body Tool

Hand scale

Poker Chip tool

Step by step guide WHO on the use and interpretation of the pain scale

Special scales are used to assess pain. To use them effectively, you need to select scales depending on the age of the child. For newborns, children up to 3 years old, from 3 to 7 years old, for teenagers developed different instruments

When assessing pain, non-verbal signs on the part of the patient, his level of development and intelligence are taken into account. When filling out the scale in verbal patients over 3 years of age, you need to focus on what the child says about his pain. However, it is worth remembering that if a child does not talk about pain, this does not mean that it does not exist. Perhaps he is afraid of consequences, for example, injections, or, on the contrary, he believes that denying pain is a manifestation of strength and courage.

Slightly older children can describe the intensity of their pain and localize it. If this is a child aged 1.5-2 years, he may not use the word “pain”, using words that are close to him (for example, “bo-bo”). Children over 8 years of age are able to describe pain in the context of their experience, and adolescents are able to talk in detail about the causes of pain and describe their painful sensations in detail.

It is always necessary to ask about pain not only the child, but also those who are nearby, see the child every day and can assess his condition over time. Moms and dads, caregivers, nannies or nurses can really give important information: did the child eat today, did he refuse to drink, does he talk today, how can you evaluate his posture and how natural it is for him.

When filling out the scale, it is necessary not only, but also to identify the cause of the pain in order to eliminate it, if possible, and anesthetize the child.

It is important to say that there are no ideal scales for assessing pain. They do not always give us an objective situation, and we need to treat them as indicative methods. But despite this, they must be used, as this makes it possible to assess the intensity of pain.

Important

You need to choose one technique for the patient and use it constantly.

NIPS – Neonatal Infant Pain Scale

And used to assess pain in children under 1 year of age.Parents can fill out the scale, focusing on the child’s facial expression, crying, breathing, position of the upper and lower extremities, and state of consciousness. A score above three indicates the presence of pain.

FLACC (Face, Legs, Activity, Cry, Consolability)

This behavioral scale is used for children under 3 years of age. It takes into account the child's facial expression, the position or movement of the legs, the nature of the cry, and how reassuring the child is. Pain is rated on a ten-point scale. The higher the score, the more severe the pain and the worse the child feels.

Source: Charitable Foundation "Children's Palliative"

Wong-Baker scale (Face scale)

Used for children aged 3 to 7 years. When working with this rating scale, the child must choose one of the drawn faces that corresponds to his state of health. Sometimes, when using this scale, a child may focus more on his emotions than on pain. 0– happy, no pain, 5– crying, unhappy, experiencing unbearable pain. Therefore, this scale is not always adequate for assessing pain.

Oucher scale

Analogue of the previous scale– ten-point scale Oucher, which shows photographs of children's faces with and without increasing pain.

Source: www.oucher.org

Eland body tool

Also for children of this age, coloredÖland scale ( Eland body tool). The child determines the intensity of pain using color: severe pain – red, moderate pain – orange, mild pain – yellow. The scale also allows you to determine the location of pain.

Hand scale

A five-point scale that shows fluctuations in pain using one hand. A hand clenched into a fist means no pain, a fully open palm– unbearable pain. Suitable for children over 3 years old.

Poker Chip tool

In some countries, according to WHO, for pain assessment in children 3-12 years olda scale with poker chips is used (Poker Chip tool). However, its use requires confidence that the child has developed the skill of sorting by size. Among the disadvantages is the need to wash chipsafter each use, the risk of losing chips and a limited number of answer options from 0 (no pain) to 4 - severe pain. The scale is available with translations into English, Arabic, Spanish and Thai. When using it, be sure that your healthcare provider can also use this scale.

Visual analogue scale (VAS)

Suitable for children over 7 years of age who understand the meaning of numbers. On a vertical scale with numbers from 0 to 10, the child must move the bar up or down (or point with his finger) to the height of the scale with which he associates his pain sensations. An analogue of such a scale– Numerology Rating Scale (NRS).

Touch Visual Pain – TVP scale

It was created for HIV-infected children with multiorgan pathology. Pain assessment involves touching and observing the child. Pain is assessed on a ten-point scale: 0 – no pain, 10 – unbearable pain.