What's Pain?

1.1 PAIN
Pain is the most common symptom of disease. It is an unpleasant sensation or emotional experience
associated with actual or potential tissue damage. Any pain of moderate or higher intensity is
accompanied by anxiety and the urge to escape or terminate the feeling.
Diagnostic criteria
Self-report is the key to pain assessment. In non- or pre verbal children, facial expression is the most valid
indicator of pain; therefore use faces pain scale to assess severity. Pain should be assessed by:
- Duration
- Severity, e.g. does the patient wake up because of the pain
- Site
- Character, e.g. stabbing, throbbing, crushing, cramp like
- Persistent or intermittent
- Relieving or aggravating factors
- Accompanying symptoms
- Distribution of pain
- In children pain can be assessed by Childs’ crying voice, posture, movement and colour
1.1.1 HEADACHE
1.1.1.1 Acute Headache
Diagnostic criteria
- Secondary to fever and infection diseases
- Secondary to local inflammatory cause
For further actions refer to fever, eye, ear and oral sections.
Pharmacological Treatment
A: Paracetamol oral 1g every 8 hours for at least 3 days
OR
A: Ibuprofen, oral 400mg 8 hourly for at least 3 days
Children A: Paracetamol 15 mg/kg/dose 6 hourly when required to a maximum of 4 doses per
24 hours
If there is no relief to paracetamol give:
A: Ibuprofen oral, 5-10mg/kg/dose 8 hourly

Note: Ibuprofen shall be given with food

Chronic Headache
Diagnostic criteria
- Migraine
- Cluster headache
- Tension headache
Pharmacological Treatment:
Migraine
In acute attack give analgesics:
A: Paracetamol 1g immediately then every 4 hours; maximum dose 4g per day
2
OR
A: Acetylsalicylic acid 600mg 6 hourly.
AND
C: Metoclopramide (PO) 10mg 8 hourly.
OR
C: Metoclopramide IV 10mg 8hourly
In severe attack give:
C: Ergotamine tartrate 2mg 12 hourly. Not to be repeated at intervals less than 4 days.
For prevention purposes give:
A: Propranolol 40-80mg 12 hourly
OR
A: Amitriptyline 10-50mg at night
Cluster and Tension headache: Give analgesics as in acute headache (section 1.1.1)
1.1.2 CHEST PAIN
Differential diagnoses
- Angina
- Myocardial infections
- Reflux Esophagitis
- Lung infection
- Pericarditis
Non-Pharmacological and Pharmacological Treatments
Treat as for main disease as indicated in specific chapters.
1.1.3 ABDOMINAL PAIN
1.1.3.1 Upper Abdominal Pain
Differential diagnoses
Pain related to eating food:
- Dyspepsia
- Gastritis
Pain related to eating food but persisted for more than three months
- Peptic ulcers
Acute and recurrent pain in upper quadrant
- Gallbladder diseases
- Inflammatory bowel syndrome
- Chronic pancreatitis
- Diabetic autonomic neuropathy
Non-Pharmacological and Pharmacological Treatments
Treat as for main diseases
1.1 3.2 Lower Abdominal Pain
Diagnostic Criteria
Pain associated with diarrhoea or constipations
- Intestinal involvement
- Helminthes
Colicky pain in abdomen without diarrhoea or constipation
3
- Colitis
Pain just before or during menstruation
- Dysmenorrhoea
- Endometriosis
Pain over lower abdomen and back associated with excessive white discharge in women
- Pelvic inflammatory diseases
Pain during urination
- Urinary tract infections (UTI)
Non Pharmacological and Pharmacological Treatments
Treat as for main disease as indicated in specific chapters
1.1.4 OTHER PAINS
Other pains may include:
- Generalized body ache
- Joint pain
- Pain due to local infections
- Pains due to injury
- Eye pains
- Ear pains
Non-Pharmacological and Pharmacological Treatments
For generalized pain give analgesics as in section 1.1.1. Advise the patient to rest and make a follow-up.
For joint, infections, injury, eye and ear pains treat as for main disease.

CAUTION: Do not use aspirin for abdominal pain or if a patient is vomiting or has nausea and do not use aspirin in children. Patients with peptic ulcers should not be given acetic salicylic acid tablet.

Referral:
Refer patients to Regional and Tertiary care for:
- Children with moderate and acute severe pain
- No response to oral pain control
- Uncertain diagnosis
- All acute abdominal pain accompanied by vomiting and no passing of stool
- Pain requiring definitive treatment for the underlying disease
- Pain requiring strong opioids