Angela tells Nurse Moffat that her headache is on the right side of her head, that it started when she had her stroke but is worse now. Nurse Moffat also notices that Angela seems quite drowsy.
Nurse Moffat decides to assess Angela’s pain using a pain assessment scale. The unit uses either a vertical Visual Analogue Scale (VAS) or a Faces Pain Scale depending on the patient’s impairments. There isn’t an ideal scale for stroke patients but these can be used with patients who have stroke-related visual and communication impairments.
Pain scales are usually visual analogue scales used to try to quantify the patient’s subjective feeling of pain.
However stroke disease often affects language and cognition and stroke patients with these impairments cannot complete visual analogue scales reliably (Price et al)
Patients with milder clinical stroke subtypes (‘lacunar strokes’) use the scales more effectively than patients with more severe strokes do.
Patients with right hemisphere strokes in general perform poorly when using these scales but the vertical visual analogue scale is the preferred scale for this group. It is also more reliable for patients with visual field deficits (Dixon et al).
Patients with left hemisphere stroke appear to use the Faces Pain Scale (Benaim et al) more reliably.
All of the above scales are more reliable than a 1 – 10 point verbal rating scale in stroke patients (Benaim et al)
References
Can stroke patients use visual analogue scales? Price CIM, Curless RH and Rodgers H. Stroke 1990; 30 : 1357-1361
Reproducibility along a 10 cm vertical visual analogue scale. Dixon JS and Bird HA. Annals of the Rheumatic Diseases 1981; 40 : 87-89
Use of the Faces Pain Scale by left and right handed hemispheric stroke patients. Benaim C, Froger J, Cazoltes C, Gueben D, Porte M, Desnuelle C, Pelissier J. Journal of the International Association for the study of pain. 2007; 128 (1); 52-58
