Pain is normally expressed through the changes in facial expression. Pain requires attention, recovery, and healing and for one to receive help, effective communication of the pain has to be expressed. According to research, there is a difference in facial expression of pain from a young age to an old age which is noticed by the observers. In many healthcare facilities, the facial expression of pain is incorporated with verbal and non-verbal vocal activity, movement, and posture which are categorized as pain behaviors.
Children aged five years and older can give self-reports of their pain intensity if they are trained to do so. School-aged children are more accurate in expressing their pain. By the age of 8 years, children can adequately communicate their pain intensity and the position of the pain. School-aged children are also able to control themselves; they are experiencing pain. They may fail to express pain to show their bravery. Children expressing their pain may be affected by their thoughts about the consequences of their pain rating (Holley et al., 2016). Children are afraid of needles, and whenever they think they will receive an injection after reporting their pain, they may suppress their self-report on their pain. On the other hand, in older adults, pain is frequent from both short standing and longstanding painful disease, and when there are comorbidities, they have to take several pain medicines (Holley et al., 2016). Compared to the child population, there is a little investigation done in assessing pain for adults and most geriatric patients.
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Pain can be described as temporal depending on its characteristic duration. It can also be classified according to its intensity, its location, and quality. In the temporal features of pain, it can either be acute, chronic or recurrent. Acute pain is characterized by an onset that was recent and does not stay longer than two weeks. On the other hand, chronic pain is one that is longstanding with an insidious onset and mostly has unknown duration. Pain intensity can be mild moderate or severe. In older children and adults, their intensity of pain can be investigated by asking the patients to grade the pain in a scale of zero to ten, with ten being the maximum intensity of pain that can be felt (Gallo et al., 2018). Pain characterized by its location can be diffuse, localized, deep or superficial. Diffused pain is also termed generalized, and one cannot pinpoint a specific area where the pain is elicited. Localized pain has a specific location while deep pain is mostly from visceral organs, unlike superficial pain which originates from injuries to the skin and other superficial organs.
In an article on Pain Assessment and Measurement , four points are considered in assessing pain. That is its history, location, intensity and the patient's cognitive pain understanding. Patients are assessed by documenting pain scores both before and after receiving pain treatments. Three ways of assessing pain include reporting which are the goal standard, behavior and the observation of the patient clinically. In children between aged 3 and 18, there is pain observation tool with an acronym –FLACC- standing for face, leg, activity, cry and consolability with each having a point (The Royal Children's Hospital Melbourne, 2019). According to Moyle (2015), pain is considered one of the vital signs. The author discusses both unidirectional and multidimensional pain assessment tools. Unidirectional tools involve using one characteristic of pain such as its intensity and using it on different scales such as the visual, verbal descriptor and verbal reading scales. Multidimensional tools give a more detailed description of pain. They include McGill pain questioner and a pain inventory.
Leonardi (2013) insists that only one assessment method is not enough. Combining the use of great rapport and communication with patients and repeating attempts if the patient is in delirium to ensure that good communication is established are some of the ways to ensure good assessment of pain. Moreover, in older children, the pain scale of 0-10 may be used. Assessment of vital signs could also be a good indicator in patients who cannot communicate. A face pain tool is used to assess pain in patients with mental and intellectual impairment.
In the comparison of acute and chronic pain, acute pain is of more sudden onset and is not longstanding as compared to chronic pain. Most of the causes of acute pain are external most likely trauma or sudden tissue damage that resolves within hours, days or weeks. Acute pain is a protective physiological process against toxins; indicate pathology for quick intervention or a symptom to a particular illness (Gallo et al., 2018). Medications play a huge role in relieving of acute pain as well as the host self-characteristics. On the other hand, chronic pain is more insidious in onset with duration of pain extending even to months. It has internal causes that are non-specific, most likely from a longstanding illness. Unlike acute pain that is physiologically protective, chronic pain is pathological. Persons inflicted with chronic pain suffer in futility. While acute pain happens to the patient, chronic pain happens in the patient.
In pain management, there's pharmacologic management and non-pharmacologic management of pain. Pharmacologic interventions include giving patients drugs such as NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, acetylsalicylic acid among others (Gallo et al., 2018). The non-pharmacologic methods include verbal therapy during periods of pain, use of vibratory stimulators, and use of elastic separators for example in orthodontistry. Psychotherapy has also been shown to be an effective way to relieve pain, that is, biofeedback, family psychotherapy, and group psychotherapy among others. Exercise and nerve stimulation therapy has also been shown to be effective physical therapies that deal with pain.
References
Gallo, R. B. S., Santana, L. S., Marcolin, A. C., Duarte, G., & Quintana, S. M. (2018). Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial. Journal of Physiotherapy , 64(1), 33-40.
Holley, A. L., Wilson, A. C., Noel, M., & Palermo, T. M. (2016). Post ‐ traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research. European Journal of Pain, 20(9), 1371-1383.
Leonardi, B. C. (2013). Best practices for assessing pain . Retrieved from https://www.rn.com/nursing-news/best-practices-for-assessing-pain/
Moyle, S. (2015, November 20). Pain as the fifth vital sign– Pain assessment & management. Retrieved from https://www.ausmed.com/articles/pain-assessment/
The Royal Children's Hospital Melbourne. (2019). Pain assessment and measurement. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Pain_Assessment_a nd_Measurement/
