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Pain Scales
http://hacking-medschool.com/who-analgesic-ladder
**** Error Clinician’s Guide to the Best Adult Pain Measures Medscape Nov 2011
Simple Numeric Scale
0 no pain 1 slight 2 moderate 3 severe
Or 1 2 3 4 5 6 7 8 9 10
0 = no pain 10 = the worse pain ever
Linear (Likhart) Visual Analog Scale
Mark the position on a line
No pain ——————– Worst Pain
Wong-Baker FACES pain rating scale Wong DL 2001 Essentials of Paediatric Nursing St Louis
Referred Pain
| Site of pain | organ | nerve root |
|---|---|---|
| Neck Left Jaw Left Arm Upper Back | heart | |
| Left Shoulder | Lungs Diaphragm | |
| Right Shoulder Right Side | Liver | |
| Left Sided Back Pain | spleen | |
| Epigastrum Middle of Back | Stomach | |
| R/L flanks | Kidney | |
| Left Hypochondrum LUQ | Pancreas | |
| Umbilicus | Gall Bladder | |
| R/L Groins/Inguinal Regions | Ovaries ureters | |
| R Groin RIF | Appendix | x |
Analgesics
hacking-medschool/who-analgesic-ladder
Paracetamol / Ibuprofen
http://hacking-medschool.com/paracetamol-ibuprofen-kids
Ibuprofen alone gives better pain relief than paracetamol Source: Annals of the Rheumatic Diseases 2011;70:1521-1522
Combining paracetamol and ibuprofen to treat pain is illogical, according to this clinical trial of analgesia for osteoarthritis of the knee. There is no evidence that the combination is more effective than either product alone, and the risk of side effects is greater with two drugs than one. Both drugs are COX 2 inhibitors, which block formation of prostaglandin E2, which causes pain. The accompanying editorial comments that the enzyme can be blocked only once. Ibuprofen 400 mg three times a day should do the trick.
One of the medicines management KPIs is to reduce the quantity of soluble paracetamol prescribed due to its cost and high salt content which is especially an issue in our patient population. As a guide the cost of one months regular paracetamol treatment is:
Tablets £3.49
Capsules £6.78
Liquid 250mg/5ml £14.33 (Sugar free) or £14.43
Soluble £16.08
If a patient has minor swallowing difficulties then a trial of the capsules may be worthwhile, or else liquid is the next most cost effective option. Please be careful when choosing the formulation, we should only be prescribing the 250mg/5ml either sugar free or normal. The 500mg/5ml is a special and we have been charged £700 a bottle in the past for prescribing this in error.
I have added a direction code to Vision paraliquid which will bring up “take 10mls (500mg) to 20mls (1000mg) every four to six hours when required for pain or fever. Do not take more than 80mls in 24 hours”
Neuropathic pain
NICE CG96 Neuropathic pain Mar 2010
http://www.thepainweb.com/doclib/topics/000081.htm
Chronic pain
| Acute versus chronic pain (nursing facts Lippincott) |
Physiological evidence | Behavioural Evidence |
|---|---|---|
| Acute | increased resps increased pulse increased bp dialted pupils sweating |
restlessness distraction worry distress |
| Chronic | Normal resps pulse BP and pupil size no sweating | reduced or absent physical activity despar depression hopelessness |
CADTH Rapid Review: Efficacy and safety of nabilone for chronic pain management
- Wong-Baker FACES pain rating scale Wong DL 2001 Essentials of Paediatric Nursing St Louis ↵