home Boiler room Methods for objectifying pain syndrome. Visual Analog Scale (VAS) Facial Pain Scale

Methods for objectifying pain syndrome. Visual Analog Scale (VAS) Facial Pain Scale

Verbal Rating Scale

The verbal rating scale allows you to assess the intensity of pain through a qualitative verbal assessment. Pain intensity is described in specific terms ranging from 0 (no pain) to 4 (worst pain). From the proposed verbal characteristics, patients choose the one that best reflects the pain they experience.

One of the features of verbal rating scales is that verbal characteristics of the pain description can be presented to patients in a random order. This encourages the patient to select a pain grade that is based on semantic content.

Verbal Descriptive Pain Rating Scale

Verbal Descriptor Scale (Gaston-Johansson F., Albert M., Fagan E. et al., 1990)

When using a verbal descriptive scale, you need to find out if the patient is experiencing any pain right now. If there is no pain, then his condition is assessed as 0 points. If painful sensations are observed, it is necessary to ask: “Would you say that the pain has gotten worse, or the pain is unimaginable, or is this the worst pain you have ever experienced?” If this is the case, then the highest score of 10 points is recorded. If there is neither the first nor the second option, then you need to clarify further: “Can you say that your pain is weak, average (moderate, tolerable, not strong), strong (sharp) or very (especially, excessively) strong (acute) "

Thus, there are six possible pain assessment options:

0 - no pain;
2 - mild pain;
4 - moderate pain;
6 - severe pain;
8 - very severe pain;
10 - unbearable pain.

If the patient experiences pain that cannot be characterized by the proposed characteristics, for example, between moderate (4 points) and severe pain (6 points), then the pain is rated as an odd number that is between these values (5 points).

The Verbal Descriptive Pain Rating Scale can also be used in children over seven years of age who are able to understand and use it. This scale can be useful for assessing both chronic and acute pain.

The scale is equally reliable for younger children school age, and older age groups. In addition, this scale is also effective in various ethnic and cultural groups, as well as in adults with minor cognitive impairments.

Faces Pain Scale (Bien, D. et al., 1990)

The facial pain scale was created in 1990 by Bieri D. et al. (1990).

The authors developed a scale to optimize the child's assessment of pain intensity by using changes in facial expression depending on the degree of pain experienced. The scale is represented by pictures of seven faces, with the first face having a neutral expression. The next six faces depict increasing pain. The child should choose the face that he thinks best demonstrates the level of pain he is experiencing.

The Facial Pain Scale has several features compared to other facial pain rating scales. Firstly, it is more of a proportional scale rather than an ordinal one. In addition, the advantage of the scale is that it is easier for children to correlate their own pain with a drawing of a face presented on the scale than with a photograph of a face. The simplicity and ease of use of the scale make it possible for its widespread clinical use. The scale has not been validated for use with preschool children.

, , , , , , ,

The Faces Pain Scale-Revised (FPS-R)

(Von Baeyer C. L. et al., 2001)

Carl von Baeyer and students from the University of Saskatchewan (Canada), in collaboration with the Pain Research Unit, modified the facial pain scale, which was called the modified facial pain scale. The authors, instead of seven faces in their version of the scale, left six, while maintaining a neutral facial expression. Each of the images presented in the scale received a digital rating ranging from 0 to 10 points.

Instructions for using the scale:

“Look carefully at this picture, where the faces are drawn, which show how much pain you can have. This face (show the leftmost one) shows a person who is not in pain at all. These faces (show each face from left to right) show people whose pain is increasing, increasing. The face on the right shows a person in unbearable pain. Now show me a face that indicates how much you are hurting at the moment.”

Visual Analog Scale (VAS)

Visual Analogue Scale (VAS) (Huskisson E. S., 1974)

On the reverse side of the ruler there are centimeter divisions, according to which the doctor (and in foreign clinics this is the responsibility of the nursing staff) notes the obtained value and enters it into the observation sheet. The undoubted advantages of this scale include its simplicity and convenience.

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 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.

During dynamic assessment, a change in pain intensity is considered objective and significant if the current VAS value differs from the previous one by more than 13 mm.

Numerical Pain Scale (NPS)

Numeric Pain Scale (NPS) (McCaffery M., Beebe A., 1993)

Based on the principle stated above, another scale was built - a numerical pain scale. The ten-centimeter segment is divided by marks corresponding to centimeters. According to it, it is easier for the patient, in contrast to the VAS, to assess pain in digital terms; he determines its intensity on the scale much faster. However, it turned out that during repeated tests the patient, remembering the numerical value of the previous measurement, subconsciously reproduces an intensity that does not really exist

pain, but tends to remain in the region of the previously mentioned values. Even with a feeling of relief, the patient tries to recognize a higher intensity, so as not to provoke the doctor to reduce the dose of opioids, etc. - the so-called symptom of fear of recurrent pain. Hence the desire of clinicians to move away from digital values and replace them with verbal characteristics of pain intensity.

Pain scale by Bloechle et al.

Pain scale of Bloechle et al. (Bloechle C., Izbicki J. R. et al., 1995)

The scale was developed to assess pain intensity in patients with chronic pancreatitis. It includes four criteria:

Frequency of pain attacks.
Pain intensity (pain rating on a VAS scale from 0 to 100).
The need for analgesics to eliminate pain (the maximum severity is the need for morphine).
Lack of performance.

NB!: The scale does not include such characteristics as the duration of the pain attack.

When using more than one analgesic, the analgesic requirement for pain relief is equal to 100 (maximum score).

If there is continuous pain, it is also assessed at 100 points.

The rating on the scale is made by summing the ratings for all four characteristics. The pain index is calculated using the formula:

Overall scale rating/4.

The minimum score on the scale is 0, and the maximum is 100 points.

The higher the score, the more intense the pain and its impact on the patient.

Observational ICU Pain Rating Scale

Critical Care Pain Observation Tool (CPOT) (Gelinas S., Fortier M. et al., 2004)

The CPOT scale can be used to assess pain in adult patients in the ICU. It includes four signs, which are presented below:

Facial expression.
Motor reactions.
Muscle tension in the upper limbs.
Speech reactions (in non-intubated) or resistance to the ventilator (in intubated) patients.

Painful sensations are always unpleasant. When they occur frequently, most patients immediately consult a doctor. However, pain can have not only a different nature, but also an unequal degree of intensity. Currently, there is no device that would most accurately determine the severity of discomfort in a patient. That is why visual analogue scale pain (VAS). With its help, doctors can determine whether the patient is able to endure the pain or whether it is unbearable. To date, several methods have been developed to determine the intensity of unpleasant sensations. But the visual analog pain scale still remains the most informative.

Abbreviation

A method for determining the intensity of discomfort was developed in 1974 by an American scientist. The method immediately became widely used in medical practice. It was decided to designate it with the abbreviation VAS, which stands for Visual Analogue Scale. In Russia, it is customary to use the abbreviation VAS - visual analogue scale.

The essence of the method

The VAS is a subjective way of assessing the pain a patient is currently experiencing. For example, in some conditions a person feels one degree of discomfort, in others - another. The most common situation is when the patient experiences increased pain in the affected area at night, and during the day his quality of life remains virtually unchanged.

The VAS visual analogue scale is a way to identify the degree of discomfort while a person is seeing a doctor. In this situation, the patient must only indicate to the specialist that the intensity of pain increases, for example, at night or in the evening.

The doctor invites the person to mark a point on a non-graduated line, which, in his opinion, will reflect the severity of the discomfort. In this case, the specialist informs the patient that the left border corresponds to the absence of pain, and the right indicates its presence, and it is of such an unbearable nature that it is practically incompatible with life.

In practice, a plastic, cardboard or paper ruler is most often used. Its length is 10 cm.

Application in medical practice

The visual analogue pain scale is rarely used in therapy. For a generalist, in most cases it is enough to know that discomfort exists in principle. In addition, information regarding what hours they are bothered and what their nature is is important for the therapist.

The pain intensity rating scale is widely used in oncology and anesthesiology. This is due to the fact that in some cases doctors must quickly obtain the most complete information regarding the presence of unpleasant sensations without any prompting. IN last years in practice, VAS began to be used by rheumatologists.

Modified scale

It's no secret that colors affect people differently. Doctors, knowing this property, decided to slightly modify the visual analogue scale. The essence of the method remains the same. The changes affected the line directly. The regular scale is presented in black. The modified one has a line whose color changes from green to red. Doctors are convinced that such a new formation will reduce the likelihood of obtaining unreliable data, since patients on a subconscious level better associate their sensations with colors.

How the research is carried out

Despite the fact that VAS is most popular in anesthesiology and oncology, it can be used in any field of medicine. The research algorithm is as follows:

The doctor examines the patient. Already on at this stage he can guess how much pain a person is experiencing.
The doctor offers the patient a 10 cm long ruler on which he must place a dot. You need to point to the area that, in the opinion of the patient, corresponds to the degree of intensity of the pain that is bothering him. In this case, it is imperative to take into account that the left side of the ruler means the complete absence of discomfort, the right side, accordingly, its presence.
Centimeter divisions are applied on the other side of the product. The doctor evaluates the test results, taking into account other nuances. For example, he may ask whether the patient is engaged in physical activity, what is the duration and quality of his sleep. This information provides an opportunity to confirm the reliability of the study.

Using a visual analogue scale, the doctor is able to track the dynamics and evaluate the success of the prescribed treatment. The best option development of events is one in which at each subsequent appointment the patient indicates a point located closer to the left edge.

Interpretation of results

As mentioned above, the visual analog pain scale is a non-graduated 10-cm line. It can be standard or modified. The corresponding marks are shown on the reverse side, that is, the patient does not see them during the test.

The interpretation of the results (meanings and their interpretation) is as follows:

0. This is the absence of pain, a person does not feel it at all.
1. Discomfortable sensations are extremely mild. People practically don’t think about them. The presence of mild pain does not affect the quality of life.
2. Unpleasant sensations are mild. But at the same time, the pain periodically has a paroxysmal character and can sometimes intensify. When a person experiences unpleasant sensations, he most often becomes irritated.
3. The pain bothers me regularly, the patient is constantly distracted by it. But at the same time, a person easily gets used to it and is able to carry out any type of activity in its presence.
4. Moderate pain. If the patient is very immersed in some activity, he may not notice it for some time. However, the rest of the time she bothers him, and it is quite difficult to distract himself from her.
5. The pain is moderately severe. You can ignore it for a maximum of a few minutes. Uncomfortable sensations are a constant concern. However, if a person makes an effort, he will be able to do some work or take part in a public event.
6. The pain is still moderately severe. But it already greatly interferes with normal daily activities. It becomes extremely difficult to concentrate on anything.
7. The pain is severe. It literally subjugates all other sensations. In addition, it significantly interferes with communication with other people and the performance of daily activities. A person has difficulty sleeping at night due to pain.
8. The sensations are intense. Physical activity is extremely limited. Maintaining communication requires significant effort.
9. The pain is excruciating. The person is not even able to talk. Sometimes he makes uncontrollable moans.
10. The pain is unbearable. The patient is bedridden and often delirious. Pain of this nature is practically incompatible with life.

Based on the results of the study, the doctor can judge not only the intensity of the sensations, but also the course of the pathology as a whole.

Error

The specialist must draw conclusions about the patient’s health condition, taking into account not only the obtained visual analogue scale indicator. It is necessary to rely on error. For example, some patients do not experience relief after therapy, but for some reason do not want to offend the doctor. In this regard, they consciously reduce the pain indicator.

Some people, on the contrary, are prone to exaggeration. For example, women may indicate excruciating pain. Moreover, if you ask them about what sensations they experienced during the process of childbirth, most of them will point to pain that is practically incompatible with life. In such situations, it is necessary to halve the resulting indicator.

Thus, the doctor should focus not only on VAS, but also carefully monitor the patient’s condition. The most revealing criteria are speech and facial expressions.

Advantages

The doctor, focusing on the visual analogue scale, can relieve pain using the most effective means. For example, if the sensations are weak, taking non-narcotic drugs such as Ibuprofen, Paracetamol, Diclofenac is indicated. If the pain is unbearable, the administration of strong medications is required. In addition, in many cases it is advisable to carry out a blockade or alcoholization.

Another advantage of the VAS scale is its simplicity and ease of use. It is indispensable in cases where the doctor needs to find out the severity of pain, but the patient for some reason cannot speak or does so with great difficulty.

Flaws

The main disadvantage of the visual analogue scale is its one-dimensionality. In other words, a person can only indicate the intensity of the pain.

In addition, the emotional component of the syndrome often leads to unreliable results. As mentioned above, many patients deliberately underestimate the severity of pain or, on the contrary, significantly increase it. In such situations, the further development of events depends on the literacy and attentiveness of the doctor.

Finally

The visual analogue scale (VAS) is a simple way to determine the intensity of pain in a patient. It is a non-graduated 10 cm line. It can be either black or colored. The patient points to a point on the line that, in his opinion, corresponds to the intensity of the pain. The severity of sensations increases from left to right. Based on the test results, the doctor can select the most suitable drugs and assess the dynamics of treatment. In addition, he gets the opportunity to analyze the course of the disease as a whole.

With this simple test, you can more objectively assess the severity of the pain syndrome and its dynamics as a result of the treatment, as well as receive simple recommendations that will help you cope with back and joint pain.

Test instructions:

Sit back and relax.
Below is a visual analog pain scale. At the top are images showing pain, and below them are descriptions of pain. Click on the image that corresponds to your pain sensations (in the back and joints) at the moment. Write down or remember the pain level in points. When re-evaluating, compare this indicator with the pain severity indicator before treatment.
Read on for tips to help you cope with back and/or joint pain.

No pain
Mild pain
Moderate pain
Strong pain
Intolerable
pain

No pain

Your joints and back are in good condition. It is recommended to eat foods that are good for your joints and do daily exercise to help keep your back and joints healthy. More detailed information can be found in our articles and useful tips.

Mild pain

Local therapy using drugs (Viprosal B® ointment, Capsicam®, Valusal® gel) is recommended for the treatment of pain in the back and joints (1-2 times a day, for a maximum of 2 weeks), daily performance of a complex of therapeutic exercises for the back and joints. More detailed information can be found in our articles and useful tips.

Moderate pain

It is recommended to regularly use local medications with analgesic and anti-inflammatory effects (Viprosal B® ointment or Capsicam® ointment or Valusal® gel) 2-3 times a day for 10-14 days. If the effect is insufficient, change the external drug (repeated course for 10-14 days). Will help you decide on a remedy

It is recommended to consult a specialist who may prescribe you a short course (5-7 days) of non-steroidal anti-inflammatory drugs for oral administration (diclofenac, ibuprofen, nimesulide, etc.) or select a comprehensive treatment regimen.

Strong pain

Depending on the location of the pain: if back pain - Capsicam® ointment (2-3 times a day for up to 10 days), if muscle pain - Valusal® gel (2-3 times a day for up to 10 days), if joint pain - Viprosal B® ointment (1-2 times a day for up to 14 days). Will help you decide on a remedy

As an “ambulance”, you can take an anesthetic tablet orally, available from a pharmacy without a doctor’s prescription.

A consultation with a specialist is indicated, who may prescribe you a short course (5-7 days) of non-steroidal anti-inflammatory drugs for oral administration (diclofenac, ibuprofen, nimesulide, etc.) and select a comprehensive treatment regimen.

A doctor's help is needed.

Before the doctor arrives, take a horizontal position in order to... You may need to rest in bed for 2-3 days.

As an “ambulance”, you can take an anesthetic tablet orally, available from a pharmacy without a doctor’s prescription (up to 2-3 times a day).

Complex therapy and the optimal course of treatment using drugs from various pharmacological groups can only be prescribed by your attending physician.

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.

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.