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Posts tagged ‘Pain’

Chapter #3 Part 9: RAT the PAIN

Assalamu`alaikum and greetings to all…


Recognize, Asses and Treat the Pain

Pain Free Hospital

Recently, I attended a Regional Training of Trainers for Pain Free Hospital in Sarawak. Pain Free Hospital (PFH) is a change in our concept and approach in pain management. It does not mean that patient will feel painless when they came to the hospital but they will have a good pain management. It is encompassing multi-disciplinary team not only anesthetist.

Pain is one of  main reason why patients are admitted to the hospital and unrelieved pain is the reason why patients refused to come to the hospital. It is neglected because of our own attitude.

  • Pain is unavoidable
  • Not considered priority
  • Medical staff lack of sufficient knowledge about pain
  • Barrier to the use if opioid analgesics
  • Post-op pain continues to be under-treated

Pain as the 5th vital sign (P5VS) is another concept that we want you to do it for patient’s benefit. We want to have an environment where we reach out and treat the pain rather than wait for it to be severe.

  • Acute pain : Sudden onset, short duration, resolves when the tissue heal
  • Chronic pain : Last for more than 3 months, cannot identify cause, pain persist


Recognize, Ask, Treat is a simple framework for managing pain. Pain cannot be seen. Therefore, we have to trust and believe what patient tell us.


Ask these 4 questions to make a pain diagnosis:

  • Acute pain or chronic pain?
  • Cancer or non-cancer?
  • Nociceptive or neuropathic?
    • Nociceptive : Pain because of injury, well localize, cause by definite nerve injury
    • Neuropathic : Nerve pathology, pain raise from injury of the nerve – burning, shooting, phantom limbs, pins, needles, numbness
  • Are there any other factors?
    • Physical factors (other illness)
    • Psychological and social factors – anxiety, anger, depression, lack of social supports


Measure the severity of pain during rest and movement by using:

  • Numerating scale 0 to 10
  • Wong-Baker faces scale
  • FLACC scale


Use both pharmacological and non-pharmacological treatment. The analgesic (PCM, NSAIDS, OPIOID) ladder provided by the Ministry of Health (MoH) Malaysia. We may add anti-neuropathic, anti-depressant (eg. amitriptyline) and anti-convulsant (eg. carbamazepine, gabapentin, pregabalin) in the treatment.

Training of Trainers (ToT)

Since it was a training of trainers workshop, the participant are expected to be an effective teacher and start in-house training of other medical staff about Pain Free Hospital. For adult learning, it must have 3 important components:

  • Structure
    • Beginning
    • Middle
    • End
  • Relevant
  • Interaction

In a nutshell, it involves a lot of commitment to make this vision into a reality. Do not be discourage. Just do it!

Dia (Ibrahim) berkata: “Apakah kamu memperhatikan apa yang kamu sembah? Kamu dan nenek moyang kamu terdahulu? Sesungguhnya mereka (apa yang kamu sembah) itu musuhku, kecuali Tuhan seluruh alam. (Iaitu) Yang telah menciptakan aku, maka Dia yang memberi petunjuk kepadaku. Dan Yang memberi makan dan minum kepadaku. Dan apabila aku sakit, Dialah yang menyembuhkan aku. Dan Yang akan mematikan aku, kemudian akan menghidupkan aku (kembali). Dan Yang sangat kuinginkan akan mengampuni kesalahanku pada hari kiamat.”

(Surah Al-Syu’ara’ 26: 75-82)

Until we meet again.

May peace be upon you.

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