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Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for
individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is
the responsibility of the treating physician, or health care provider, to determine the best course of treatment for the patient. Treat the
Pain and its partners assume no responsibility for any injury or damage to persons or property arising out of or related to any use of these
materials, or for any errors or omissions. Last updated on January 12, 2015
Objectives
2
Measuring pain
Palliative Care for HIV/AIDS and Cancer Patients in Vietnam, Basic Training Curriculum: Harvard Medical School, Centre for
Palliative Care (2007); Beating Pain, 2nd Ed. APCA (2012) 3
Pain scales
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Numeric pain rating scale
No pain Mild pain Moderate pain Severe pain Very severe pain Worst possible pain
0 1 2 3 4 5 6 7 8 9 10
Palliative Care for HIV/AIDS and Cancer Patients in Vietnam, Basic Training Curriculum: Harvard Medical School, Centre for
Palliative Care (2007) 5
Three ways to assess pain in children
Palliative Care for HIV/AIDS and Cancer Patients in Vietnam, Basic Training Curriculum: Harvard Medical School, Centre for
Palliative Care (2007) 7
FLACC scale
Use in children less than 3 years of age or older children who cant talk
Use it like an APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score,
arriving at a score out of 10
Category Score
Face
Pain intensity FLACC score
Legs
Relaxed and comfortable 0
Activity
Mild discomfort 1-3
Cry
Moderate pain 4-6
Consolability
Severe discomfort/pain 7-10
Total
10
Detailed pain assessments
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PQRST assessment
Quality
How would you describe the pain? What does it feel like?
Radiation
Is the pain in one place or does it move around your body?
tingling
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References
African Palliative Care Association. Beating Pain: a pocketguide for pain management in
Africa, 2nd Ed. [Internet]. 2012. Available from:
http://www.africanpalliativecare.org/images/stories/pdf/beating_pain.pdf
African Palliative Care Association. Using opioids to manage pain: a pocket guide for
health professionals in Africa [Internet]. 2010. Available from:
http://www.africanpalliativecare.org/images/stories/pdf/using_opiods.pdf
Amery J, editor. Childrens Palliative Care in Africa [Internet]. 2009. Available from:
http://www.icpcn.org/wp-content/uploads/2013/08/Childrens-Palliative-Care-in-Africa-
Full-Text.pdf
Kopf A, Patel N, editors. Guide to Pain Management in Low-Resource Settings [Internet].
2010. Available from: http://www.iasp-
pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Guide_to_Pain_Manag
ement_in_Low-Resource_Settings.pdf
The Palliative Care Association of Uganda and the Uganda Ministry of Health.
Introductory Palliative Care Course for Healthcare Professionals. 2013.
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