neurologic disorders
Evaluation of Pain
Pain severity
Pain severity should be assessed before and after potentially painful interventions. In verbal patients, self-report is the gold standard, and external signs of pain or distress (eg, crying, wincing, rocking) are secondary. For patients who have difficulty communicating and for young children, nonverbal indicators (behavioral and sometimes physiologic) may need to be the primary source of information. Formal measures (see figure Some pain scales for quantifying pain as it is occurring ) include Verbal category scales (eg, mild, moderate, severe) Numeric scales The Visual Analog Scale (VAS) For a numeric scale, patients are asked to rate their pain from 0 to 10 (0=no pain; 10=“the worst pain ever”). For the VAS, patients make a hash mark representing their degree of pain on an unmarked 10-cm line with the left side labeled “no pain” and the right side labeled “unbearable pain.” The pain score is distance in mm from the left end of the line. Children and patients with limited literacy or known developmental problems may select from images of faces ranging from smiling to contorted with pain or from fruits of varying sizes to convey their perception of pain severity. When measuring pain, the examiner should specify a time period (eg, “on average during the past week”). For the Functional Pain Scale, examiners should clearly explain to the patient that functional limitations are relevant to the evaluation only if they are due to the pain being evaluated; treatment aims to relieve pain as much as possible, at least to a tolerable level (0–2). Adapted from the American Geriatrics Society (AGS) Panel on Chronic Pain in Older Persons: The management of chronic pain in older persons.Journal of the American Geriatrics Society46:635–651, 1998; used with permission; from Gloth FM III, Scheve AA, Stober CV, et al: The functional pain scale (FPS): Reliability, validity, and responsiveness in a senior population.Journal of the American Medical Directors Association2 (3):110–114, 2001; and from Gloth FM III: Assessment. InHandbook of Pain Relief in Older Adults: An Evidence-Based Approach, edited by FM Gloth III. Totowa (NJ), Humana Press, 2003, p. 17; used with permission; copyright © FM Gloth, III, 2000. 