Pain – The Fifth Vital Sign
January 11, 2016
When assessing patients, the four routine measurements of their status include their temperature, blood pressure, respirations and pulse. Pain has been recognized as the “fifth vital sign,” since it also reflects a patient’s status and needs. For our pediatric patients, pain is assessed along with routine vitals and also as dictated by a patient’s specific medical circumstances.
Our pediatric patients range in age from newborns to teenagers, and we use different pain scales for different age ranges:
- For very young patients, including those unable to communicate their pain level, we use the FLACC pain scale. This acronym stands for face, legs, activity, cry and consolability, which are used to measure a child’s pain level. This would mean, for example, that a baby who is kicking is perceived as having a higher pain level than a baby who is quiet and relaxed.
- For older patients, such as school-age children, we use the Faces pain scale. With this method, children can indicate how they feel using a pictorial scale of smiling to crying faces.
- Teenagers use a scale of 0 to 10, with 10 being the worst, to indicate their pain level.
In addition to the patient’s current pain level, we ask what level would be tolerable for the patient, as zero pain may not always be possible. We then use the pain scales to track not only the current level of pain, but also the patient’s response to interventions for pain. These could include distraction, heat, cold, medication and other methods.
Pain medications may be either “scheduled,” to be given at set times, or “as needed.” In the case of “as needed,” a certain length of time is needed between doses but the medication is not necessarily given if a patient is comfortable and can go without the next dose.
The method of administration also affects pain relief. Intravenous (IV) medications enter and leave the bloodstream faster than oral medications, which may take longer to address pain but provide longer-lasting relief. A hospitalized patient often will progress from IV medications to oral medications before being discharged.