Pain Management at The Surgery Center of Nacogdoches

The mission of The Surgery Center of Nacogdoches is to deliver ambulatory surgical care to our patients in an efficient, caring, timely and conservative manner and to assess and manage effectively any pain associated with this ambulatory care.  We believe every patient has the right to expect a rapid and effective response to a report of pain.

Acute pain is the symptom of a larger disease process, and is usually nocioceptive in nature.  This means that a noxious (unpleasant) event stimulates the intact nervous system to produce the sensation of pain.  An example is a surgical incision.

Examples of pain medications used according to severity are listed in the following table.

Analgesic (pain relief) Choice

Examples

Pain severity: Mild

(pain score 1-3)

Analgesic (pain relief) choice: Acetaminophen, nonsteroidal anti-inflammatory agents

Examples: Tylenol®, Ibuprofen (Motrin®), Naproxen (Naprosyn®)

Pain severity: Moderate

(pain score 4-6)

Analgesic (pain relief) choice: IV Ketorolac, oral acetaminophen/opioids combinations

Examples: Toradol®, Vicodin®, Tylox®, Tylenol® with Codeine #3

Pain severity: Severe

(pain score 7-10)

Analgesic (pain relief) choice: Opioid

Examples: Morphine, hydromorphone (Dilaudid®), Fentanyl

How to rate your pain

The pain scales used at the Surgery Center as based on a score or ranking of the intensity of your pain according to a numeric score of 0 to 10.  Zero (0) is considered no pain and 10 is the worse possible pain.  Another scale that may be used is the Wong-Baker Faces Pain Rating Scale.  The scales used are shown below.

Color Scale

This scale is a colored stripe in which color gradually changes from white (no pain) through shades of pink to dark red (worst possible pain). Ask the patient to point to the area on the scale that shows their level of pain. To obtain a number for documentation use the scale parallel to the color stripe to find the number corresponding to the area where the patient points.

Click here to view the Pain Rating Color Scale 

Wong-Baker FACES Pain Rating Scale

 Click here to view the Wong-Baker Pain Rating Scale

From Wong DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Ahmann E, DiVito-Thomas PA: Whaley and Wong’s Nursing Care of Infants and Children, ed. 6, St. Louis, 1999, Mosby, p. 1153.

This scale can be used with young children (sometimes as young as 3 years of age). It also works well for many older children and adults as well as for those who speak a different language. Explain that each face represents a person who may have no pain, some pain, or as much pain as imaginable. Point to the appropriate face and say:

(0) "This face is happy and does not hurt at all."
(2) "This face hurts just a little bit."
(4) "This face hurts a little more."
(6) "This face hurts even more."
(8) "This face hurts a whole lot."
(10) "This face hurts as much as you can imagine, but you don't have to be crying to feel this bad."

Ask the patient to choose the face that best matches how she or he feels or how much they hurt.

FLACC Scale

This is a behavior scale that has been tested with children age 3 months to 7 years. Each of the five categories (Faces, Legs, Activity, Cry, Consolability) is scored from 0-2 and the scores are added to get a total from 0-10. Behavioral pain scores need to be considered within the context of the child's psychological status, anxiety and other environment factors.

Face

0
No particular expression or smile

1
Occasional grimace or frown, withdrawn disinterested

2
Frequent to constant frown, clenched jaw, quivering chin

Legs

0
Normal position or relaxed

1
Uneasy, restless, tense

2
Kicking, or legs drawn up

Activity

0
Lying quietly, normal position, moves easily

1
Squirming, shifting back and forth, tense

2
Arched, rigid, or jerking

Cry

0
No cry
(awake or asleep)

1
Moans or whimpers, occasional complaint

2
Crying steadily, screams or sobs, frequent complaints

Consolability

0
Content, relaxed

1
Reassured by occasional touching, hugging or "talking to, distractible

2
Difficult to console or comfort

The FLACC is a behavior pain assessment scale
©University of Michigan Health System (can be reproduced for clinical or research use)