This document is a training module for doctors and nurses on implementing pain as the 5th vital sign in a Malaysian hospital from 2008-2010. It discusses the importance of proper pain assessment and management. The objectives are to promote better communication between doctors/nurses and patients, improve patient satisfaction and care, and help manage pain more effectively. Guidelines are provided on assessing and documenting pain at regular intervals, using scales like numerical rating or Wong-Baker faces, and treating pain per the WHO analgesic ladder.

1. Malaysian 5 th Vital Sign Implementation: 2008-2010 5 th Vital Sign: Doctors’ training module: Intruduction DR LEE OI WAH PENGARAH HOSPITAL CHANGKAT MELINTANG

2. The purpose of module is to train doctors and nurses on pain assessment and pain management in order to implement pain as a 5th vital sign effectively in OUR hospital OBJECTIVE: 5 th Vital Sign: Doctors’ training module: Intruduction

7. Spectrum of Pain ACUTE PAIN CHRONIC PAIN ACUTE PAIN Healing NO PAIN CHRONIC PAIN Insidious onset post-surgical, post-trauma syndromes cancer 5 th Vital Sign: Doctors’ training module: Pain Physiology

8. Pain Pathway Free nerve endings Afferent nerve – ( A  / c) Spinal cord Sensory cortex Thalamus Descending inhibitory fibres Dorsal horn PAG / RAS Ascending ST tracts Courtesy of Prof Ramani Vijayan, MASP 5 th Vital Sign: Doctors’ training module: Pain Physiology

10. Malaysian 5 th Vital Sign Implementation: 2008-2010 PAIN ASSESSMENT METHODS (ADULT AND PAED)

14. Wong-Baker Faces Pain Rating Scale 5 th Vital Sign: Doctors’ training module: Pain Assessment

15. FLACC SCORE 5 th Vital Sign: Doctors’ training module: Pain Assessment

19. Observation Chart 5 th Vital Sign: Doctors’ training module: Pain Assessment Patient’s Name : RN : DOA : Age : Ward : DATE TIME BP PULSE RESP RATE TEMP PAIN SCORE ACTION TAKEN COMMENTS

20. 5 th Vital Sign: Doctors’ training module: Pain Assessment FLOWCHART FOR NURSES

21. FLOWCHART FOR DOCTORS

22. ANALGESIC LADDER: ACUTE PAIN MANAGEMENT 5 th Vital Sign: Doctors’ training module: Pharmacology

23. THANK YOU