In 1979, the International Academy of Pain (IASP) defined pain as an unpleasant sensation and emotional feeling that is accompanied by existing or potential tissue damage.In 1983, the American Pain Society (APS) promoted pain as the fifth vital sign of the body.In 1995, James Campbell, president of the American Pain Society, proposed the formal inclusion of pain as the In 1995, James Campbell, president of the American Pain Society, proposed that pain be officially recognized as the fifth vital sign. Adequate attention to pain and mastery of pain assessment tools will provide unprecedented relief to patients and will be a boon to pain patients. There are many different tools for pain assessment, and they are used by different people. It is well known that there are three general methods of measuring pain: self-report assessment, physiological assessment, and behavioral assessment. Self-report assessment is still the gold standard and the preferred method for pain assessment in clinical work. The following is a description of the specific pain assessment tools that are commonly used in clinical practice and those that are appropriate for different age groups.
I. Commonly used self-report assessment and behavioral assessment methods
1, visual analog scaling (VAS): also known as visual analog scaling method, there are two types of linear and facial charts, is the most commonly used pain assessment tools. The VAS card, supervised by the Pain Medicine Society of the Chinese Medical Association, is a linear chart, divided into 10 levels, the larger the number, the greater the pain intensity, and the pain intensity value is measured with a ruler during pain assessment; the other type is the face chart, based on the VAS scale, with a laughing or crying face next to the scale that is easy to understand for children, mainly suitable for children over 7 years old, It is suitable for the assessment of pain of various nature in children over 7 years of age with normal consciousness. Preoperative explanation of pain mechanisms, presentation and use, and accurate assessment of the patient’s pain is essential to help the provider understand the extent of the pain and to take appropriate measures to eliminate or reduce it in order to obtain the patient’s cooperation. The assessment method can be more accurate to grasp the degree of pain and facilitate the assessment of the effect of pain control.
2, numerical pain grading method (NRS): this method is composed of a total of 11 numbers from 0 to 10, the patient with anesthesia online http://www.csaol.cn September 2007 0 to 10 these 11 numbers to describe the intensity of pain, the greater the number of pain increasingly severe, this method is similar to the VAS method. The NRS has high reliability and validity, is easy to record, and is suitable for patients with relatively high literacy levels. However, the scale of NRS is abstract and it is difficult to explain the use of NRS to patients in clinical work, so it is not suitable for patients with low literacy or illiteracy.
3.Wong-Banker facial expression scale method (FPS-R)
This method has been used for clinical assessment since 1990, which uses six facial expressions ranging from smiling, sadness to pain.
It is based on the Facial Expression Pain Scale (FPS) (7 facial expressions), which was revised to express the pain level. The patient is asked to choose a face that best expresses his or her pain during the pain assessment. This method was initially used for pain assessment in children, but it has been shown to be suitable for all ages, especially for those over 3 years of age, with no specific cultural background or gender requirements, and is simple, intuitive, easy to grasp, and does not require any additional equipment. The FPS-R assessment method has been shown to be the best assessment scale among the four assessment methods, namely FPSCR, NRS, VDS and VAS, for the assessment of pain in the elderly.
4.Subjective Pain Rating Scale (VRS)
The VRS-5 is part of the Canadian McGill Pain Inventory, which is a specific grading of pain according to its impact on quality of life. It is divided into five levels: 0, 1, 2, 3, 4, and 5.
The four-point verbal rating scale (VRSs-4) classifies pain into 0, 1, 2, and 3 degrees. This method is the most
This method is the most convenient, but is influenced by the patient’s literacy level.
5.Verbal Pain Rating Scale (VDS)
This method consists of a series of adjectives describing pain, with the lightest pain being scored as 0 and each subsequent level increasing by 1, so each adjective has a corresponding score. The total pain level of the patient is the number represented by the most appropriate pain adjective for that patient. The scholar Melzeak used mild pain, severe pain, paroxysmal pain, terrible pain, and unbearable pain to assess the degree of pain. The words of this method are easy to understand, can be verbally expressed at any time, easy to communicate, and meet the psychological needs of patients, but it is greatly influenced by subjective factors and is not suitable for patients with language expression disorders.
6.Chinese Cancer Pain Assessment Tool (CCPAT):
In 1996, Dr. Willy Chung of the Department of Nursing and Medicine, Hong Kong Polytechnic University, began to develop a multidimensional pain assessment tool suitable for the Chinese cultural
The Chinese Cancer Pain Assessment Tool (CCPAT) was introduced in 1998.
In 1998, she introduced the Chinese Cancer Pain Assessment Tool (CCPAT), which consists of six domains: physical functioning, medication use, psychosocial, pain beliefs, emotions, and pain intensity, with a total of 56 indicators, each with a score of 5, 4, 3, 2, or 1.
7.Prince-Aenry scoring method
It is mainly applicable to the determination of pain intensity after open-heart and abdominal surgery, and is relatively sensitive, but it is only applicable to patients over 7 years old and is greatly influenced by the patient’s literacy level.
8.Color simulation assessment method (CAS)
Bulloch B suggested the use of facial expressions and color simulation to assess pain in pediatric patients in the emergency department. In contrast, Gordon et al. found that burn patients preferred the facial expression method and the color simulation method for assessing pain compared to the visual analog assessment and descriptive assessment methods.
9. McMillan pain assessment scale
This method uses a visual pain scale (0-10 points) to mark the degree of pain, using a pre-printed frontal surface of the human body.
This method uses a visual pain scale (0-10 points) to mark the degree of pain, a pre-printed front and back view of the human body to mark the site of pain, and a question and answer format for the patient to give a specific description of pain, including the onset and triggering factors of pain, the nature and duration of pain, aggravating and relieving factors, previous experience in dealing with pain, the accompanying symptoms of pain, the impact of pain on function, etc. This method is suitable for assessing acute pain, chronic pain, cancer pain, involved pain, visceral pain, acute pain, etc. It is not suitable for people with cognitive dysfunction and speech impairment.
10.POCIS (Pain Observation Criteria for Children)
This criterion was first proposed by Boelen and colleagues in 1998 and was developed at the University of Amsterdam in the Netherlands. It is used for the assessment of postoperative pain in children aged 1 to 4 years, but can also be used for transient or chronic pain, acute or chronic pain. The main indicators include facial expression, crying, breathing, tension, tension in the arms and fingers, tension in the legs and toes, and arousal. The measurement can be completed within 1 minute, but for chronic pain, when the child is fatigued pain response will be reduced.
11.MOPS (Modified Objective Pain Score) criteria
This criterion is used to evaluate postoperative pain, applicable to ages 2 to 11 years, and the patient’s parents can complete the pain assessment first, but the assessment score is often greater than the physician’s assessment score. The main indicators include crying, activity, mood, posture, and verbal expression.
12. MBPS (Modified Behavioral Pain Score for Children) criteria
This criterion is used to assess children’s pain due to routine operations, such as planned immunizations, intramuscular injections, lumbar punctures, intravenous infusions, etc. It should be assessed once before the procedure is performed as a baseline. The main indicators include facial expression, crying, and movement.
13.DAN (acute pain score) standard
This standard is used for neonatal pain assessment. The main indicators include facial expression, physical activity, verbal expression (without intubation) and verbal expression (with intubation) of the response.
14.CHEOPS (Eastern Ontario Children’s Hospital Pain Score) criteria
This standard is used to evaluate postoperative pain in children aged 1 to 5 years, and can also be used in adolescents but with reduced accuracy. The main indicators include crying, facial expression, verbal expression of pain, tension, response to painful points, and leg movement.
15.RIPS (Riley Pain Score) criteria
This standard was developed by RILEY Children’s Hospital in the United States and is used for children without verbal expression. The main indicators include facial expressions, body movements, sleep status, verbal expressions, comfortability, and response to activities or touching.
16. Neonatal Pain Assessment Scale (NIPS):
The NIPS was developed by the Children’s Hospital of Eastern Ontario, Canada, to assess preterm and term infants for operative pain, such as venipuncture. It includes six items: facial expression, crying, type of breathing, upper extremity, leg, and arousal status. The limitation of this assessment tool is that children on inotropic agents or those with severe disease may receive lower scores.
17. Preterm Infant Pain Profile (PIPP):
The PIPP was developed by Toronto and McGill Universities in Canada for the assessment of acute pain in preterm and term infants. It consists of 3 behavioral indicators: frown, eye squeeze, nasolabial fold; 2 physiological indicators: heart rate and oxygen saturation; 2 related indicators: behavioral status, gestational week, and 7 indicators in total.
18.CRIES scale:
Developed by Missouri University, it is used to assess postoperative pain in newborns above 32 gestational weeks, and is named after the initials of 5 indicators, namely crying, need for oxygen to achieve SaO2 of 95% or more, rising vital signs (heart rate and blood pressure), expression, insomnia, where vital signs are measured at the end to avoid waking the child, and insomnia is based on observations recorded 1 h before.
19. Neonatal Facial Coding System (NFCS):
The NFCS was developed by the British Columbia Children’s Hospital and University in Canada to assess pain in preterm and newborn infants and is the most reliable and valid method of neonatal pain assessment. The NFCS has 10 indicators: frown, squeezed eyes, deepened nasolabial folds, open mouth, vertical stretching of the mouth, horizontal stretching of the mouth, cupped tongue, jaw fluttering, “O” shaped mouth, stretched tongue (only used to assess preterm infants). The NFCS was originally used to assess operant pain, but was only used in research because of the need for video. Peters et al. showed that the NFCS was reliable, valid and feasible in the assessment of postoperative pain. Reducing the NFCS to five items: frown, eye squeeze, deepening of the nasolabial folds, horizontal extension of the mouth and cupping of the tongue improved the specificity of the pain assessment, but did not change its validity or sensitivity.
20. Infant Body Coding System (IBCS): assessment of infant gross motor scores by hand, foot, upper arm, leg, head, and trunk
The IBCS is used to assess the gross motor activity of infants through motor scores of hands, feet, upper arms, legs, head and trunk, and is used in conjunction with the NFCS.
21.CHIPPS scale (CHIPPS): It consists of cry, facial expression, trunk posture, lower limb posture,
The CHIPPS scale is composed of 5 behavioral indicators, and is suitable for postoperative pain assessment.
The above assessment methods all require the assessor to be strictly trained, and the observation results of different observers on the same observation index should have good consistency, because the clinical dynamic assessment of pain, comprehensive assessment is often not done by the same assessor, so as to ensure the credibility of the assessment results, and the accuracy of the assessment results.
Second, the commonly used indicators of physiological behavior observation
The human body is a very perfect system, any damage to the body will affect the body’s defense system and immune system, and a series of physiological changes. Pain is mainly characterized by excitation of the sympathetic nervous system and the adrenal system, which can cause changes such as increased heart rate, increased blood pressure, increased respiratory rate, increased body temperature, painful expressions, muscle tension, sweaty palms, changes in skin color, and decreased pulse rate oxygen saturation. However, the variability in these aspects varies greatly from child to child, which may lead to inaccurate assessment. Therefore, a comprehensive assessment should be conducted together with behavioral assessment method, and a multifaceted assessment should be conducted.
Common errors in pain assessment
Many clinical workers do not understand that pain assessment is a dynamic and comprehensive assessment, and often incorrectly or inappropriately assess the patient’s true pain level, resulting in wrong guidance for clinical pain treatment and a series of side effects and complications of pain treatment. The main manifestations are:
1. incorrectly applying assessment tools that are only applicable to the assessment of acute pain to patients with chronic pain;
2. Lack of awareness of the fact that different pain patients often have different behavioral and expression changes for the same level of pain;
3.It is wrong to think that the physiological behavior and vital signs of patients with chronic pain and severe pain are absolutely abnormal;
4.Judging the degree of pain only according to behavior and expression;
5.The self-reported pain score is the gold standard of pain assessment, but ignore the comprehensive assessment from physiology, action, function and other aspects;
6.The pain assessment only assesses the pain classification when the patient is at rest, but not when the patient is moving, coughing, or breathing deeply.
4.The significance of pain assessment
Pain assessment is the first step of pain treatment, accurate and timely pain assessment can provide the necessary guidance and help to clinical treatment, which is an essential step of pain treatment. Pain relief can help patients to improve their quality of life, regain the meaning of life and confidence in overcoming the disease, which is very significant.