dr. Ken Wirastuti, MKes, Sp.

S
Bagian Ilmu Penyakit Saraf
Fakultas Kedokteran-Universitas Islam Sultan Agung
 Pain: The Fifth Vital Sign
• Pain should be considered the “fifth vital
sign”
• Patients should be assessed for pain
every time pulse, blood pressure, core
temperature, and respiration are
measured
• Healthcare professionals should
recognize a report of unrelieved pain as
a “red flag”
American Pain Society Quality Improvement Committee. JAMA. 1995;1847–1880.
Why is assessment important?
• a reduced experience of pain
• increased comfort
• improved physiological, psychological
and physical function
• increased satisfaction with pain
management  on treatment efficacy
• Pain is not a simple sensation that can
be easily assessed and measured.
Basic Characteristics of Assessment
Tools
• Highly valid and reliable
• Allow for the comparison of the magnitude of
changes in pain (ratio scale)
• Be relatively free of bias
• Be useful for assessing both experimental
and clinical pain
• Allow for comparison with physiological
measures in humans and animals
• Be relatively easy to use
The pain assessment involves

• an overall appraisal of the factors

that may influence a patients
experience and expression of pain
(McCaffery and Pasero 1999)
Assessing the Patient With Pain
• Onset and duration
• Location/distribution
• Quality
• Intensity
• Aggravating/relieving factors
• Associated features or secondary signs/symptoms
• Associated factors
– mood/emotional distress
– functional activities
• Treatment response
 Measuring pain
Pain should be measured using an
assessment tool that identifies the
quantity and/or quality of one or more of
the dimensions of the patients’
experience of pain. This includes the:
• intensity of pain;
• intensity and associated anxiety and
behaviour.
 Pain assessment tools
The range of pain measurement tools is vast,
and includes both uni-dimensional and multi-
dimensional methods.
Uni-dimensional tools
• measure one dimension of the pain
experience, for example, intensity;
• are accurate, simple, quick, easy to use and
understand;
• are commonly used for acute pain
assessment;
Multi-dimensional pain assessment tools

• provide information about the qualitative

and quantitative aspects of pain;
• may be useful if neuropathic pain is
suspected;
• require patients to have good verbal
skills and sustained concentration, as
they take longer to complete than uni-
dimensional tools.
 Pain assessment tools
• Uni-dimensional
measurement tools
(selection):
• Visual analogue scales
• Verbal rating scales
• Graphic rating scales
• Numerical rating scales
• Verbal descriptor scales
• Body diagrams
• Computer graphic scales
• Picture scales
• Coin scales
• Multi-dimensional pain measurement
tools (selection)
• McGill pain questionnaire (short and long)
• Brief pain inventory (short and long)
• Behavioural pain scales
• Pain/comfort journal
• Multidimensional pain inventory
• Pain information and beliefs questionnaire
• Pain and impairment relationship scale
• Pain cognition questionnaire
• Pain beliefs and perceptions inventory
• Coping strategies questionnaire
• Pain disability index
• Hospital anxiety and depression
questionnaire (HAD scale)
• Neuropathic signs and symptoms ( Leeds
assessment of neuropathic symptoms and
signs (LANSS) (Bennett, 2001).
• Cognitively impaired/dementia pain scales
The various methods to measure pain

1. Subjective Report
2. Spontaneous Behavioural
Responses
3. Physiological Measures
Pain Intensity Rating Scales
• Pain Faces Scale

0 2 4 6 8 10
No Hurts Hurts a Hurts Hurts a Hurts as
hurt just a little bit even whole much as
little bit more more lot you can
imagine
• Brief Pain Inventory
Shade areas of worst pain
Put an X on area that hurts most

(Cleeland, 1991; Wong et al, 2001)