The Clinical Institute Narcotic Assessment (CINA) Scale measures 11 signs and symptoms commonly seen in patients during narcotic withdrawal. This can help to gauge the severity of the symptoms and to monitor changes in the clinical status over time.
Parameters based on Questions and Observation:
(1) abdominal changes: Do you have any pains in your abdomen?
(2) changes in temperature: Do you feel hot or cold?
(3) nausea and vomiting: Do you feel sick in your stomach? Have you vomited?
(4) muscle aches: Do you have any muscle cramps?
Parameters based on Observation Alone:
(5) goose flesh
(6) nasal congestion
(7) restlessness
(8) tremor
(9) lacrimation
(10) sweating
(11) yawning
|
Parameter |
Finding |
Points |
|
abdominal changes |
no abdominal complaints; normal bowel sounds |
0 |
|
|
reports waves of crampy abdominal pain |
1 |
|
|
crampy abdominal pain; diarrhea; active bowel sounds |
2 |
|
changes in temperature |
none reported |
0 |
|
|
reports feeling cold; hands cold and clammy to touch |
1 |
|
|
uncontrolled shivering |
2 |
|
nausea and vomiting |
no nausea or vomiting |
0 |
|
|
mild nausea; no retching or vomiting |
2 |
|
|
intermittent nausea with dry heaves |
4 |
|
|
constant nausea; frequent dry heaves and/or vomiting |
6 |
|
muscle aches |
no muscle aching reported; arm and neck muscles soft at rest |
0 |
|
|
mild muscle pains |
1 |
|
|
reports severe muscle pains; muscles in legs, arms or neck in constant state of contraction |
3 |
|
goose flesh |
none visible |
0 |
|
|
occasional goose flesh, but not elicited by touch, not permanent |
1 |
|
|
prominent goose flesh, in waves and elicited by touch |
2 |
|
|
constant goose flesh over face and arms |
3 |
|
nasal congestion |
no nasal congestion or sniffling |
0 |
|
|
frequent sniffling |
1 |
|
|
constant sniffling, watery discharge |
2 |
|
restlessness |
normal activity |
0 |
|
|
somewhat more than normal activity, moves legs up and down, shifts position occasionally |
1 |
|
|
moderately fidgety and restless, shifting position frequently |
2 |
|
|
gross movement most of the time, or constantly thrashes about |
3 |
|
tremor |
none |
0 |
|
|
not visible but can be felt fingertip to fingertip |
1 |
|
|
moderate with patient's arm extended |
2 |
|
|
severe, even if arms not extended |
3 |
|
lacrimation |
none |
0 |
|
|
eyes watering; tears at corners of eyes |
1 |
|
|
profuse tearing from eyes over face |
2 |
|
sweating |
no sweat visible |
0 |
|
|
barely perceptible sweating, palms moist |
1 |
|
|
beads of sweat obvious on forehead |
2 |
|
|
drenching sweats over face and chest |
3 |
|
yawning |
none |
0 |
|
|
frequent yawning |
1 |
|
|
constant, uncontrolled yawning |
2 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 31
• The higher the score, the more severe the withdrawal syndrome.
percent of maximal withdrawal symptoms =
= (total score) / 31 * 100%
Specialty: Toxicology, Emergency Medicine, Critical Care
