Page 69 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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Pain assessment in children can be quite different than adults. The
following are principles to guide pain assessment in children using the
acronym $ % & ' (:

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A Ask the child and Assess pain score
B Use Behavioural and Biological measures
C Find the Cause
D Decide and Deliver treatment in a timely manner
E Evaluate outcome

Assessment and management of pain in children and infants are
different from adults due to: 112 Pain rating scale
Age
• Communication: Children have limited verbal and cognitive abilities.
FLACC
1 month to
Non-verbal cues and observation are essential approaches to
4 years
• Observe the child’s behaviour in 5 dimensions (Face,
assessment. Legs, Arms, Cry, Consolability) for 2 to 5 minutes, and
• Development: Children have a wide physiological, cognitive, and
assign a score (maximum 10)
developmental response to pain according to their age groups.
4 years to
Revised FACES
This has to be carefully assessed.
• Picture-based scale where the child selects 1 to 6 faces
7 years
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to represent their pain experience
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play therapy, distraction and other cognitive behaviour strategies.
Numerical rating scale
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• Dosage: Medication must be carefully adjusted according to age,
• Ask the child to assign a number to their pain, with ‘0’
weight and developmental understanding. Adolescent also has a
being no pain and ‘10’ being the worst imaginable pain
unique approach to cancer pain management. Healthcare workers
will require appropriate training for assessment and management.
• Parental involvement: Caregivers input is an essential component
and part of the assessment.
• Ethical consideration: Children are not able to give consent for any
Special
intervention and medical management. Consent must be taken
Pain rating scale
population
from legal caregivers or parents.
Neurological Revised FLACC
impaired
•
3DLQ $VVHVVPHQW 7RROV Incorporates individualised pain behaviours which is
unique to a child
The choice of a pain assessment tool should take into consideration: 112, 113
COMFORT-Behaviour scale and FLACC
Critically ill
• the child’s developmental age
• verbal ability Neonatal/Infant Pain Scale (NIPS)
Neonates
These are shown in 7DEOH and .
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