Showing papers on "Pain assessment published in 1994"

Pain assessment: Global use of the Brief Pain Inventory.

Abstract: Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.

What is the maximum number of levels needed in pain intensity measurement

Abstract: An important issue that has yet to be resolved in pain measurement literature concerns the number of levels needed to assess self-reported pain intensity. An examination of treatment outcome literature shows a large variation in the number of levels used, from as few as 4 (e.g., 4-point Verbal Rating scales (VRS)) to as many as 101 (e.g., 101-point Numerical Rating scales (NRS)). The purpose of this study was to provide an empirically derived guideline for determining the number of levels needed. Chronic pain patients (n = 124) provided pre- and post-treatment measures of pain intensity using 101-point NRS for least, most, current, and average pain. The patients' responses to the measures were examined closely to determine the actual number of levels used. In addition, their responses to the 101-point scales were recorded to form 7 scales of varying levels (2- to 101-point scales). The sensitivity of the 7 recorded scales was examined. The results indicated that little information is lost if 101-point scales are coded as 11- or 21-point scales. Moreover, examination of the actual responses to the 101-point measure showed that almost all patients treated it as a 21-point scale by providing responses in multiples of 5 or 10, while a substantial number of patients treated it as an 11-point scale, providing responses in multiples of 10 only. The results suggest that 10- and 21-point scales provide sufficient levels of discrimination, in general, for chronic pain patients to describe pain intensity.

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.

Abstract: This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were randomly allocated to either cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of complete elimination of pain, lower levels of relapse at 6- and 12-month follow-up, and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC. After controlling for pretreatment levels of pain, children's active self-coping and mothers' caregiving strategies were significant independent predictors of pain behavior at posttreatment.

Self-efficacy and pain behavior among subjects with fibromyalgia.

Abstract: Given the lack of objective physical measures for assessing fibromyalgia syndrome (FS), the role of pain assessment is particularly important. The role of psychological factors is controversial among FS patients. This study was designed to better understand the relationship between pain behaviors and psychological variables. Specifically, this study (1) refined a pain behavior observation (PBO) methodology for use with FS patients, (2) determined whether stretching is a valid pain behavior, and (3) assessed whether psychological variables including self-efficacy and/or depression can predict pain behaviors after controlling for disease severity and age. The 73 FS subjects meeting the American College of Rheumatology classification system completed questionnaires measuring self-efficacy, depression, and pain. Trained physicians conducted tender-point examinations. Subjects were video-taped using a standardized procedure. Two trained raters independently coded all pain behaviors. Kappa coefficients and correlations among pain behaviors and self-reported pain indicated that the PBO method was both reliable and valid. However, the newly defined pain behavior 'stretching' was found to be negatively associated with self-reported pain. Hierarchical multiple regression (MR) analyses revealed that depression did not predict pain behavior over and above myalgic scores and age; however, in 3 separate MR analyses, self-efficacy for function, pain, and other symptoms each predicted pain behavior over and above myalgic scores and age. This study indicated that the original pain behavior scoring methodology is appropriate for use with the FS population and should not be modified to include the pain behavior 'stretching'. Self-efficacy was related to pain behavior while depression was not among this FS sample.

Factors influencing nurses' pain assessment and interventions in children

Abstract: Research is lacking on factors influencing nurses' decision-making directed at the diagnosis of pain in children and its related interventions. This paper reports on two studies, namely a qualitative study and its replication, in which we explored factors influencing nurses' pain assessments and interventions in children. Those factors found to influence nurses' decisions were: medical diagnosis, child's expressions, age, and parents, and the nurses' knowledge, experience, attitude and workload. Some of these factors seem to have more influence than others. For example, the presence of a medical diagnosis seems to legitimate being in pain. Furthermore, it is suggested that mainly vocal expressions, especially crying, influence nurses' decisions to administer analgesics. Finally, nurses' negative views on non-narcotic analgesics were striking. In this paper, the results of both studies and their relationship to information reported in the literature are further elaborated and discussed, and hypotheses on strength and direction of influence of factors on pain assessment and intervention are generated.

Refinement of animal use--assessment and alleviation of pain and distress.

Abstract: The refinement of experimental techniques represents an important opportunity to improve the welfare of laboratory animals. Objective methods for the assessment of pain and distress in animals are needed before procedures that are claimed to be refinements can be evaluated. The methods currently used for assessment of pain and distress are unsatisfactory, and are often based on uncritical anthropomorphic assumptions. Future developments may enable the establishment of well validated clinical scoring systems, or identification of biochemical or physiological indices of pain or distress. If reliable methods of pain assessment can be developed, then a critical evaluation of the methods available for the alleviation of pain and distress can be undertaken. This article reviews methods of clinical pain assessment in animals, with reference to the techniques used in man. Techniques for pain alleviation are briefly reviewed.

Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document.

Abstract: Pain is the most common presenting complaint heard in Emergency Medicine, yet it is poorly controlled. Evaluation of this pain should be with use of objective pain scales completed by the patient, not relying on physician impression. Treatment modalities available in the Emergency Department, a review of medications and their dosing as well as specifics to pediatric pain management are presented. The final section reviews situation or diagnosis specific pain control: headaches, renal colic, polytrauma victims, abdominal pain, soft tissue injury and acute arthritis. These recommendations are based on a Canadian Association of Emergency Physicians (CAEP) consensus conference held in April 1993. The literature was reviewed extensively and used as the basis for the consensus workshops and discussion. At the writing of the consensus paper, however, no specific ideas were borrowed from any one article. The appended bibliography is suggested reading, selected from the larger literature review. There are to date few controlled multi centre trials in overall pain management that would allow guidelines to be produced.

Measuring pain in neonates: evaluating an instrument and developing a common language.

Abstract: This paper describes the development and evaluation of the Pain Assessment Tool (PAT), a scoring system that was developed by a group of neonatal nurses to assess neonates' pain. To test the practical application of the tool and to compare the scoring system with nurses' subjective pain assessments, a pilot study was conducted with a sample of 20 neonates during the 24 hours following their surgery. The study found that PAT effectively quantified neonates' pain and that PAT scores reflected nurses' perceptions of the pain experienced by neonates. Based on the PAT scores, 15 babies experienced discomfort that required nursing comfort measures and eight babies needed both comfort measures and analgesia to relieve pain. Recommendations for future use of the Pain Assessment Tool are discussed.

Italian multicentric study on pain treatment with epidural spinal cord stimulation.

Abstract: A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% received noninvasive unsuccessful treatment (10 tensor acupuncture). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.

Observer Perceptions of Chronic Low Back Pain1

Abstract: This study examined the effects of three variables on perceptions of symptoms associated with chronic low back pain: (a) the presence or absence of supporting medical evidence, (b) the valence (positive/negative) of the relationship of an observer to the person in pain, (c) the degree of control (present/absent) of the person in pain over the circumstances of pain onset. The independent variables were manipulated in a (2 × 2 × 2) within-subjects design. Forty-eight undergraduate subjects were asked to estimate levels of pain intensity, emotional distress, and disability for the person in pain described in each of eight vignettes. Significant main effects, a two-way interaction, and a three-way interaction emerged, indicating that these contextual variables exerted substantial and complex effects on observer perceptions. The implications of these findings are discussed for matters such as pain assessment and disability determination.

Further validity testing of the Abu-Saad Paediatric Pain Assessment Tool.

Abstract: This paper reports on the results of two studies conducted to further validate the Abu-Saad Paediatric Pain Assessment Tool, a Dutch-language questionnaire developed to assess pain in school-age children. Children of 5 to 15 years of age reported in the first study their post-operative pain before and after the administration of analgesic medication using word descriptors of pain, the 10-cm scale, the Oucher, and a visual analogue scale (VAS). Lower mean pain scores at 4-hourly intervals post-analgesia supported the construct validity of the tool. Convergent validity was supported in both studies when scores on all concurrently administered measures positively correlated with the pain tool. In the second study, the correlations between pain and fear, a concurrently used measure with the pain instruments, were low, substantiating the discriminant validity of the pain tool. The significance of the results in relation to instrument development and multidimensional pain assessment in children are further discussed and elaborated.

Pain as a quality management initiative.

Abstract: A 320-bed surgical nursing department's pain management quality improvement initiative is presented. Clinical indicators were designed through literature review and consultation with pain management experts. Results for pain assessment compliance, patient perception of relief, and the perceived impact of pain on activity--analyzed by nursing care unit, physician service, and pain medication type--are detailed, as are selected strategies to improve pain management outcomes.

Reliability and Validity of Preverbal Pain Assessment Tools

Abstract: Pain assessments using three different observational pain assessment tools--the Post Operative Pain Score (POPS), the Nursing Assessment of Pain Intensity (NAPI), and the Pain Rating Scale (PRS)--were made on 98 preverbal children following surgery in an attempt to establish the reliability and validity of the three tools. Two observers (raters) scored pain intensity using each of the three instruments before and after administration of an analgesic. Interrater agreements were satisfactory on all three tools, with Interclass Correlations (ICC) ranging from .71 to .85. T tests supported the discriminant validity of all three tools at the p < .0001 level. The POPS and NAPI had internal consistency reliability alphas ranging from .79 to .88 for the POPS and .59 to .77 for the NAPI. Item analyses suggested specific revisions of the tools that might increase their reliability.

Pain assessment from patients with burns and their nurses.

Abstract: We investigated pain experienced during burn wound debridement. Forty-nine adult patients with burns and 27 nurses submitted 123 pairs of visual analog scale pain ratings for burn wound debridements. While patients' overall visual analog scale pain scores were found to be evenly distributed, worst pain scores yielded a bimodal distribution with groups centered around means of 2.0 (low pain group) and 7.0 (high pain group). Low and high pain groups did not differ in age, sex, or total body surface area burned. Patient and nurse pain ratings were found to be highly correlated. According to one researcher's criteria, 53% of nurse pain ratings were accurate. Accuracy of nurses' ratings was unrelated to nursing experience or educational level. Future strategies are presented for comparing high and low pain groups and increasing nurse pain rating accuracy.

Post‐operative pain in children after day case surgery

Abstract: Summary The increasing use of paediatric day case surgery requires assessment of the effectiveness of post-operative analgesia. A prospective epidemiological study of ninety-eight patients undergoing day case surgery looked at pain assessment using a self report Faces scale and a numerical rating scale for parents and nursing staff. An inpatient record was combined with a home questionnaire detailing pain assessment and analgesic use over a 48 h period. Patients undergoing circumcision with a penile ring block experienced significant degrees of post-operative pain, had high levels of use of paracetamol at home, and their first night of sleep was frequently disturbed. High levels of opioid use were found. Comparison between assessors indicated parents tended to score their child's pain higher than nursing staff in hospital. Minor paediatric surgical procedures, particularly circumcision, may be associated with considerable post-operative pain and assumptions must not be made about the effectiveness of analgesia, especially in the home.

Nurses’ assessment of pain intensity and choice of analgesic dose

Abstract: Under-treatment of all types of pain has been identified in many countries throughout the world. For example, the World Health Organization states that unrelieved cancer pain is an international problem. Lack of education of health care professionals, including nurses, is frequently cited as a major reason for under-treatment of pain. This survey of 517 Australian nurses suggests that they have some of the same educational needs as nurses in North America, such as how to assess pain intensity and how to select a dose of an opioid analgesic that is appropriate for the individual patient.

Multidimensional evaluation of craniomandibular dysfunction. II: Pain assessment.

Abstract: Summary To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about: (i) pain, (ii) other symptoms of craniomandibular dysfuntion (CMD), (iii) correlates of CMD, (iv) pychosocial factors, and (v) general health. The current study focuses on variables in Screen concerning pain reported somewhere in the head, neck and/or shoulders. This study was performed to assess whether subgroups of patients with signs and symptoms of CMD and a control group of dental patients with and without signs and symptoms of CMD can be characterized by differences in areas reported to be painful, in quantitative and qualitative characteristics of pain, and in factors exacerbating pain. Results indicate that several characteristics of pain as measured in Screen can be used to discriminate between: (i) subgroups of subjects with signs and/or symptoms of CMD and controls without signs or symptoms of CMD, (ii) subgroups of clinical cases and controls with signs or symptoms of CMD, and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. The results of logistic regression analysis indicate that four adverbs describing pain correctly classified 75% of patients with CMD-myo and patients with CMD-arthro. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with a mainly myogenous component and patients with CMD with a mainly arthrogenous component and the subjective treatment need for CMD. Implications for further research are discussed.

Effectiveness of documented assessment of postoperative pain.

Abstract: This article presents the results of a pilot study on the use of a numerical pain assessment chart for improving the care of patients with acute postoperative pain and increasing the effectiveness of nursing time and intervention. The study showed that the chart was effective and highlighted several areas that warrant further investigation.

A survey of pain assessment and management practices among critical care nurses

Abstract: BACKGROUND Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. PURPOSES To explore the relationship between two variables in pain assessment (length of time after surgery and ventilator status) and medication decisions made by critical care nurses, and to identify nurses' concerns about opioid use. METHODS A convenience sample of 71 critical care nurses participated in the survey. RESULTS Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.

Pain in the cancer patient

Abstract: In summary, the ACS has acknowledged the magnitude and severity of the cancer pain problem nationally and recognized that cancer pain can be relieved. It has identified cancer pain control as a priority and has devised programs that emphasize the importance of pain assessment, recognize the availability of pain relief programs, and encourage treatment to achieve optimum pain relief for the cancer patient.

Assessment of cancer pain: a continuous challenge

Abstract: A comprehensive assessment of cancer pain is the first and perhaps most important step toward pain relief. Yet, this assessment is frequently neglected in patients with cancer pain. This paper addresses five important aspects of cancer pain assessment: (1) What constitutes cancer pain assessment? (2) Why is it important? (3) Why is it frequently overlooked? (4) How can a cancer pain assessment program be implemented? (5) What changes can be expected as a result of routine cancer pain assessments? The fundamental assumptions underlying this discussion are that health-care providers must understand the intensity of their patients' pain and the likely etiology of that discomfort to direct an appropriate diagnostic evaluation and to initiate and evaluate the success of therapy. Instituting a routine pain assessment program need not be difficult. The recommended procedures must be simple, quantifiable, relevant, and recorded in the medical record. Routine pain assessment will promote a heightened sense of awareness and responsibility about cancer pain issues in health-care providers, improved communication between the patient and the healthcare provider, the development of cancer pain quality-assurance programs, and improved care for patients with cancer and pain.

The family experience of cancer pain management in children.

Abstract: This study describes the family perspective of cancer pain management in pediatric patients. Family caregiver knowledge and attitudes regarding pain, caregiver burden associated with pain, and caregiver moods were identified. This study was conducted in a children's hospital (n = 31) and a community hospice (n = 8) with family caregivers of pediatric cancer patients as the participants. Pain intensity was rated by children and family caregivers using pain assessment scales applicable to children with cancer. Differences in pain ratings were reported. The Family Pain Questionnaire was used to identify parents' knowledge and attitudes about pain and its management. Areas for family teaching were identified with the questionnaire. Understanding the pain experience from the perspective of family caregivers and their role in pain management can assist healthcare providers in relieving pain in children with cancer.

Prevalence and characteristics of pain in persons with terminal‐stage AIDS

Abstract: A retrospective chart review was undertaken to collect and report data on the prevalence and characteristics of pain in persons with terminal-stage AIDS. A convenience sample consisting of 50 patient charts at a residential AIDS hospice was utilized. Data were collected from the McCaffery Initial Pain Assessment Tool (IPAT) (1983) which was completed at the time of each hospice admission. The IPAT is composed of 10 sections that collectively describe the patient's pain experience. Demographic and AIDS-related pathology data were also collected. Data were analysed using descriptive statistics to examine the incidence and characteristics of pain. Pain was experienced by a majority of the subjects in the sample. Pain levels for 'present pain', 'worst pain gets', 'best pain gets' and 'acceptable level of pain' are reported. Characteristics of pain including location, causal factors and verbal descriptors are reported. Implications for nursing practice and suggestions for further research are discussed.

[A comparison between the pain relief effect of electroacupuncture, regional never block and electroacupuncture plus regional never block in frozen shoulder].

Abstract: Background Frozen shoulder is a kind of spontaneous, progressive peri-arthritis over the shoulder joint. The etiology is not yet clear. Traditional treatments for frozen shoulder included conservative medical therapy, physical therapy, nerve block and acupuncture and so on. The purpose of our study is to determine the pain relief effect of electroacupuncture (EAP), regional nerve block (RNB) and the combination of EAP + RNB for frozen shoulder. Materials & methods One hundred and fifty patients with fresh frozen shoulder were, randomly divided into 3 groups. Group I patients (n = 50) had RNB with stellate ganglion block and suprascapular nerve block by 1% xylocaine 10 ml. Group II patients (n = 50) had EAP with local acupoint--Chien-Yu, Chien-Ching, Chien-Nei-Ling, Ah-Shih Hsueh treatment and Group III (n = 50) patients had RNB+EAP performed with acupuncture first, then followed by the regional nerve block. Six vectors of movements were checked in all methods. Four graded Bromage score was used for pain assessment, Grade 1 means complete painless; Grade 2 means slight pain (i.e. pain on motion); Grade 3 means moderate pain (i.e. pain on silence); Grade 4 means severe pain (i.e. need analgesics). The range of shoulder joint was also recorded. Patients were requested for second treatment if pain recurred. The onset (time from injection to maximal pain relief), duration (time from injection to grade 3) Bromage score and side effects were recorded. Results The results showed that the combined EAP and RNB method had significant high pain control quality, longer duration, and better range of movement of the shoulder joint than that of EAP or RNB performed alone.

Nurses' attitudes towards management of pain.

Abstract: This research was carried out to discover nurses' attitudes towards and perceptions of post-operative pain management; knowledge of pain assessment; awareness of different methods of pain relief; and view of the necessity for education in post-operative pain management. The major findings of the research correlated with the authors' observations while undertaking audit. That is, that there is a need for conformity of pain assessment and pain scoring. It also showed a need for a focused education programme in postoperative pain management.