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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.


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

  1. The five-point pain scale using words, in which patients point to the word that best expresses their pain level (Fig. 14-1). 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. 14-2 and 14-3), which can be used by nonverbal patients or when language difficulties exist.1

  3. Pain Assessment for Children (Table 14-1) can be used for children <4 years old and for children who are nonverbal or noncommunicative. It provides a rough guide to their discomfort level.

FIG. 14-1.

Five-point pain scale using words.

FIG. 14-2.

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.

FIG. 14-3.

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.

TABLE 14-1Pain Assessment for Children <4 Years Old

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