Assessing pain and mood in a poorly resourced country in a post-conflict setting

Context. Accurate pain assessment is important but presents problems in poorly resourced countries. A civil war in Sierra Leone resulted in civilian casualties with pain from deliberate amputation and other injuries.

Objectives. To examine the quality of simple pain and mood scales.

Methods. Within a pain treatment project, pain was assessed using numerical and verbal descriptor scales, and mood using visual analogue and verbal descriptor scales. The relationships between these scales (translated where necessary) were examined by comparison of pairs of measures.

Results. The overwhelming majority (99%) used the scales consistently. The verbal pain scale showed substantial discrimination between the pain words mild/small, moderate/half and half, and severe/serious (F = 41.80, P < 0.001). Numerical and verbal pain scales were related at a modest level (Kendall's tau-b = 0.39, P < 0.001, n = 272) and not dependent on the level of education. A smaller sample (n = 30) provided pain data across three assessment occasions, and both pain scales appeared sensitive to change. The 5-point verbal mood scale collapsed into three categories, with reasonable distinction between mood words (F = 14.75, P < 0.001). The visual analogue scale proved difficult to explain to civilian casualties in this setting.

Conclusion. Verbal pain and mood scales and numerical pain scales appeared to yield useful information in a post-conflict situation. This suggests that adapting these established rating scales for pain, and for mood, was useful to clinicians and acceptable to patients.