The Face, Legs, Activity, Cry and Consolability (FLACC) scale is used by medical professionals to determine pain levels in young or uncommunicative patients. The scale assigns a score of zero, one, or two for each category, with the sum being the patient’s pain score. Other pain scales include the Wong-Baker Faces pain graph and the CRIES test.
Doctors, physical therapists and chiropractors regularly use pain scales to determine how much a patient is in pain and then adjust treatment plans to manage symptoms most effectively. Some of these charts are specifically geared towards young children and other people who are unable to fully articulate their levels of discomfort. The Face, Legs, Activity, Cry and Consolability (FLACC) scale is used when even the iconic face-based pain scale is too advanced for the patient. For each segment of this comfort scale, the clinician assigns the patient a score of zero, one, or two. The sum of each section is the patient’s pain score, from zero for no pain to 10 for excruciating.
The FLACC scale is specific and observational, it does not require any interaction with a young or otherwise uncommunicative patient. Each of the five categories has three easy-to-characterize classifications into which to group the patient. All categories are specific to the particular part of the patient’s condition being assessed.
In the Face category of the FLACC scale, the doctor gives the patient a zero if he smiles or shows no effort. One is given for an erratic frown or aloof demeanor, and a three is given if the jaw is clenched or the chin is shaking. Likewise for the legs, zero is for a relaxed position, one is for tension or restlessness, and two is for legs that are constantly kicking or are tight at the chest.
The rest of the categories follow the same path. For Activity, the FLACC scale ranges from a calm demeanor to stiffness. The Crying section transitions from sleep or no crying to constant whining. Finally, the Consolability component refers to how much the patient’s pain is relieved by parental comfort, ranging from easily relieved to completely inconsolable.
If children are verbal and have learned to express basic feelings such as sadness, joy, and discomfort, a clinician is inclined to favor the FLACC scale in favor of the Wong-Baker Faces pain graph found in exam rooms around the world. This chart, which doesn’t even require a shared language between doctor and patient, classifies pain with six faces, presented in order from happy to crying. Below the faces is a numerical scale from “it doesn’t hurt” at zero to “it hurts the worst” at 10.
In addition to the FLACC, faces, and number scales, the National Institutes of Health’s Pain Consortium considers a few other tests helpful in determining patients’ pain levels. A CRIES test is particularly useful. This test evaluates the patient’s “crying”, “need” for supplemental oxygen, whether vital signs are “increased”, the “expression” on the patient’s face, and how “sleepless” the patient has been.
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