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As defined by International Association for the Study of Pain: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”

“The most reliable indicator of the existence and intensity of acute pain” is the patient's self-report (Emerg Med Clin North Am 2005;23:393).

  • For nonverbal or cognitively impaired children, use behavioral and physiologic indicators or scales.
  • Pain intensity and response to treatment must be continually monitored and reassessed regularly.
  • Pain assessment should be individualized, taking into account age, race, gender, culture, emotions, development, expectations, and prior experiences.
  • Pain prevention is better than treatment; anticipate procedure-related pain and prepare patient and parents.
  • Poorly controlled pain can have short- and long-term physical and psychological consequences.
  • Adequate pain prevention and control can have short- and long-term benefits.
  • Unexpected intense pain, especially if associated with altered vital signs, should be evaluated for other possible diagnoses.
  • World Health Organization Analgesic Ladder: Physical measures, nonopioid analgesics, oral opiates, and IV opiates may be used in a stepwise manner.
  • Other adjuncts, including local anesthetics, anxiolytics, antidepressants, muscle relaxants, anticonvulsants, and cognitive/behavioral therapies should be used with analgesics for an integrated approach to pain management.
  • The goal is to reduce pain to acceptable levels while considering the possible adverse reactions and side effects of each medication.

Physiologic parameters: Tachycardia, vasoconstriction, diaphoresis, pupil dilatation, increased minute ventilation, hypertension

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Age Group



0–10 scale; 0 = no pain, 10 = worst pain you could ever imagine

Children who understand the concepts of numbers, rank, and order; generally older than 8 years of age

Beiri and Wong-Baker scales


Six faces that range from no pain to the worst pain you can imagine

Younger children who have difficulty with numeric scale; cognitive age, 3–7 years


Behavioral observer

Five categories: face, legs, activity, cry, and consolability; range of total scores is 0–10; score ≥7 is severe pain

Nonverbal children older than 1 year of age


Behavioral observer

Rates a set of standard criteria and gives a score

Nonverbal infants younger than 1 year of age

*FLACC is an acronym derived from the categories assessed by the scale: face, legs, activity, cry, and consolability.

CRIES is an acronym for Crying, Requires O2 (for SpO2 <95%), Increased vital signs (BP and HR compared to resting baseline), Expression, and Sleeplessness.

NIPS, Neonatal Infant Pain Scale; PIPP, Premature Infant Pain Profile.

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Score 0

Score 1

Score 2


No particular expression or smile

Occasional grimace or frown, withdrawn, disinterested

Frequent to constant frown, clenched jaw, quivering chin


Normal position or relaxed

Uneasy, restless, tense

Kicking or legs drawn up


Lying quietly, normal position, moves easily

Squirming, shifting back and forth, tense

Arched, rigid, or jerking



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