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Pain is one of the most common reasons for a patient to visit a clinician, and pain relief is one of the most consistently useful interventions clinicians make. With limited resources, the goal is to provide the best analgesia using the fewest and cheapest resources.

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To treat patients' pain, it is vital to assess it. There are several common methods to do this, including:

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  1. The 5-point pain scale using words, in which patients point to the word that best expresses their pain level (Fig. 13-1). However, to use this, the patient must understand each of the terms for gradations of pain. (The words in the figure are provided in several languages.)

  2. Faces pain scales (Figs. 13-2 and 13-3), which can be used by nonverbal patients or when language difficulties exist.1

  3. Pain Assessment for Children (Table 13-1) can be used for children <4 years old and for those children who are nonverbal or noncommunicative. It provides a rough guide to their discomfort level.

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Fig. 13-2.
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Faces pain scale: adult.

This scale can be used (a) with patients without language ability, (b) where a language barrier exists between the patient and health care provider, (c) with preverbal children, or (d) with those who are deaf. The numbers 1 to 10 on this scale correlate to those used on the other linear scales.

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Fig. 13-3.
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Faces pain scale: children.

This figure may work well with children.1 Explain to the child that each face is for a person who feels happy because he has no pain (hurt) or who feels sad because he has some or a lot of pain. Ask the child to point to the face that best describes how he is feeling. The numbers correlate to those used on the other linear scales.

  • Face 0 is very happy because he doesn't hurt at all.
  • Face 2 hurts just a little bit.
  • Face 4 hurts a little more.
  • Face 5 hurts even more.
  • Face 8 hurts a whole lot more.
  • Face 10 hurts as much as you can imagine, although you do not have to be crying to feel this bad.
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Table Graphic Jump Location
Table 13-1 Pain Assessment for Children <4 Years Old

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