Objective Nonself Report Pain Assessment

Physiologic changes from pain include tachycardia, tachypnea, crying, sweating, blood pressure elevation, decreased oxygen saturation, pupil dilation, flushing or pallor, nausea, and muscle tension. These parameters can be muted in persistent pain and can be confounded by fear, anxiety, or fever. Specific behaviors associated with pain include withdrawal of the painful part, pulling ears, or refusing to use a body part. The characteristic facial features of an infant in pain have been described: brows—lowered, drawn together; forehead—bulge between brows, vertical furrows; eyes—tightly closed; cheeks—raised; nose—broadened, bulging; mouth—open, squarish.

A number of objective numeric scores have been developed and validated for the assessment of pain intensity for infants and nonverbal toddlers. The CRIES scale was developed for the assessment of postoperative pain in neonates, or those 32 to 60 weeks of gestation, with a score of 4 or more requiring intervention (see Table 130-1). The CHEOPS score, a 13-point behavioral score for infants, which ranges from 4 (no pain) to 13 (worst pain) (see Table.130-2), is reliable in children under 5 years of age.

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