Question

I. Read Chapters 29 to 30

II. Pain Assessment and management in children.

a) Write a description and interpretation of the several pain assessment scales

FLACC

CHEOPS

TPPPS, PPPRS, PPPM

COMFORT

FACES ( FPS-R and Wong-Baker)

OUCHER

Numerical rating scale (NRS)

Visual analog scale(VAS)

NCCPC-PV

NIPS

CRIES

PIPP

NPASS

I. Read Chapters 29 to 30 for Quiz # 7 ( Next Week) II. Pain Assessment and management in children. a) Write a description and interpretation of the several pain assessment scales FLACC CHEOPS TPPPS, PPPRS, PPPM COMFORT FACES ( FPS-R and Wong-Baker) OUCHER Numerical rating scale (NRS) Visual analog scale(VAS) NCCPC-PV NIPS CRIES PIPP NPASS

Answer 1

FLACC:

FLACC is a behavioral pain assessment scale used for nonverbal or preverbal patients who are unable to self-report their level of pain.

Criteria	Score 0	Score 1	Score 2
Face	No particular expression or smile	Occasional grimace or frown, withdrawn, uninterested	Frequent to constant quivering chin, clenched jaw
Legs	Normal position or relaxed	Uneasy, restless, tense	Kicking, or legs drawn up
Activity	Lying quietly, normal position, moves easily	Squirming, shifting, back and forth, tense	Arched, rigid or jerking
Cry	No cry (awake or asleep)	Moans or whimpers; occasional complaint	Crying steadily, screams or sobs, frequent complaints
Consolability	Content, relaxed	Reassured by occasional touching, hugging or being talked to, distractible	Difficult to console

0 = Relaxed and comfortable
1-3 = Mild discomfort
4-6 = Moderate pain
7-10 = Severe discomfort/pain

Note:This is to understand how the scaling works. As only description and interpretation is asked, the following only provides those.

CHEOPS:

The CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) is a behavioral scale for evaluating postoperative pain in young children. It can be used to monitor the effectiveness of interventions for reducing the pain and discomfort.

Interpretation:
• minimum score: 4(no pain)
• maximum score: 13(worst pain)

TPPPS:

The Toddler-Preschooler Postoperative Pain Scale: an observational scale for measuring postoperative pain in children aged 1-5. Pain behavior items ranging from 0.53 to 0.78.

PPPM;

To confirm the psychometric properties of a behavioural measure of postoperative pain developed to assist parents with pain assessment in children aged 7-12 years following day surgery.Scores on the PPPM were successful in discriminating between children who had undergone low/moderate and high pain surgeries. Global ratings of pain (r's=0.53-0.72).

COMFORT:

The COMFORT Scale is a pain scale that may be used by a healthcare provider when a person cannot describe or rate their pain. The COMFORT Scale provides a pain rating between nine and 45 based on nine different parameters.

FACES:

Faces Pain Scale (FPS-R) is a self-report measure of pain intensity developed for children.

OUCHER

Oucher permits older children (from 8 to 12 years old) to rate their pain intensity by picking the number from 0 (“no hurt”) to 10 (“the biggest hurt you could ever have”)

NRS:

In Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, 0 and 20 or 0 and 100 that fits best to their pain intensity [1]. Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible'.

VAS:

The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between “no pain” and “worst pain.

NCCPC-PV;

NCCPC-PV scores were dichotomized to define presence or absence of pain (≤10 no pain or mild pain; >10 moderate to severe pain) and the percentage of the concordant evaluations was calculated .

NIPS;

The Neonatal Infant Pain Scale (NIPS) is a behavioral scale and can be utilized with both full-term and pre-term infants.

0-2 = mild to no pain

3-4 = mild to moderate pain

>4 = severe pain

CRIES;

The tool is a ten point scale similar to the APGAR score. It is an acronym of five physiological and behavioural variables previously shown to be associated with neonatal pain. C--Crying; R--Requires increased oxygen administration; I--Increased vital signs; E--Expression; S--Sleeplessness(for infants > than or = 38 weeks of gestation). Maximal score of 10 is possible. If the CRIES score is > 4, further pain assessment should be undertaken, and analgesic administration is indicated for a score of 6 or higher.

PIPP:

The premature infant pain profile (PIPP) is a validated pain scoring system for preterm neonates.

Score 0-6 - no action
Score 7-12 - comfort measures
Score >12 - Pharmacological intervention

NPASS;

The N-PASS is a reliable assessment tool for neonatal pain and sedation. Internal consistency for pain varied from 0.31 at low pain scores, to 0.82 at high pain scores.