What is the adult equivalent of the Face, Legs, Activity, Cry, Consolability (FLACC) score?

The Adult Equivalent of the FLACC Score: ALGOPLUS

For adult patients who cannot self-report pain, the ALGOPLUS scale is the recommended adult equivalent of the FLACC (Face, Legs, Activity, Cry, Consolability) score used in children. 1

Understanding Pain Assessment Scales

FLACC Scale Overview

The FLACC scale is a validated observational pain assessment tool designed for:

• Children from 2 months to 7 years of age 1
• Non-communicating children up to 18 years 1
• Children with cognitive impairment who cannot self-report pain 2, 3

The FLACC scale evaluates five behavioral categories:

• Face
• Legs
• Activity
• Cry
• Consolability

ALGOPLUS Scale for Adults

The ALGOPLUS scale is specifically designed for elderly and non-communicating adult patients:

• It consists of 5 simple behavioral items (similar to FLACC's approach)
• A score of 2/5 or greater allows for the diagnosis of pain with 87% sensitivity and 80% specificity 1
• It is particularly useful in acute care settings for elderly patients who cannot self-report pain

Clinical Application

When to Use ALGOPLUS vs. Other Adult Pain Scales

• Use ALGOPLUS: For non-communicating adults, particularly elderly patients
• Use Numerical Rating Scale (NRS): For communicating adults who can self-report pain
• Use Critical-Care Pain Observation Tool (CPOT): May be considered for critically ill adults (though research on its use in pediatrics suggests potential broader applicability) 4

Implementation Tips

1. Assess the patient's ability to self-report pain first
2. If self-reporting is not possible, use ALGOPLUS for adults
3. Document baseline scores and reassess after interventions
4. Monitor for changes in pain scores after analgesic administration to evaluate effectiveness

Evidence Quality and Considerations

The recommendation to use ALGOPLUS as the adult equivalent of FLACC comes from expert consensus guidelines published in Anaesthesia in 2019 1. This represents a strong expert agreement based on clinical experience and available evidence.

The FLACC scale itself has been extensively validated:

• High interrater reliability (ICC 0.67-0.95) 5
• Excellent internal consistency (Cronbach's alpha = 0.882) 5
• Strong correlation with other pain assessment tools 5, 6, 2

Common Pitfalls to Avoid

• Don't assume adults can always self-report pain: Cognitive impairment, critical illness, and language barriers may necessitate observational tools
• Don't use pediatric scales for adults: Although FLACC is well-validated for children, ALGOPLUS is specifically designed for adults
• Don't assess only once: Pain is dynamic and requires regular reassessment, especially after interventions
• Don't ignore individualized behaviors: Consider patient-specific pain expressions that may not be captured in standardized scales

By using the appropriate pain assessment tool for each patient population, clinicians can better identify, quantify, and manage pain, ultimately improving patient outcomes and quality of life.