Showing papers on "Pain assessment published in 1996"
TL;DR: Children were given significantly less medication than was prescribed, regardless of their reported pain level, and nurses, mothers, and ‘no‐one’ were frequently reported as helping with pain.
Abstract: Our knowledge of the prevalence and sources of pain within hospital is limited. The present study is an epidemiological investigation of pain in a pediatric hospital. All children who were inpatients in a tertiary care hospital (excluding Neonatal ICU and psychiatry patients) and one parent per child were potential subjects. Interviews were conducted on three weekdays. Parent interviews were used for children less than 5 years of age (n = 102); child interviews were used for children age 5 years and older (n = 98). Subjects reported the intensity and source of the worst, usual and current pain during the past 24 h, and help received for pain. Medical and demographic variables and analgesics prescribed and administered were obtained from the medical record. Forty-nine percent of subjects reported clinically significant levels of worst pain. Twenty-one percent of subjects had clinically significant levels of usual pain. Causes of pain were variable and included disease, surgery, and intravenous lines (I.V.). Pain intensity was not significantly related to age, gender, patient type (medical, surgical), or diagnostic category. Children were given significantly less medication than was prescribed, regardless of their reported pain level. Nurses, mothers, and 'no-one' were frequently reported as helping with pain. Medications and nonpharmacological methods were reported as helpful in managing pain. Many children endure unacceptable levels of pain during hospitalization. Pain prevention and management must be more aggressive. Pain assessment should be approached with the same attention as vital signs. Improvements in analgesic prescription and administration practices and non-pharmacological pain control methods are needed.
327 citations
TL;DR: In this paper, a prospective study of 2266 cancer patients, assessed localisations, aetiologies and pathophysiological mechanisms of the pain syndromes, and found that 30% of the patients presented with 1, 39% with 2 and 31% with 3 or more distinct pain disorders.
Abstract: Although pain assessment is a vital preliminary step towards the satisfactory control of cancer pain, data on the prevalence of different pain syndromes are rare. In a prospective study of 2266 cancer patients, we assessed localisations, aetiologies and pathophysiological mechanisms of the pain syndromes. Thirty percent of the patients presented with 1, 39% with 2 and 31% with 3 or more distinct pain syndromes. The majority of patients had pain caused by cancer (85%) or antineoplastic treatment (17%); 9% had pain related to cancer disease and 9% due to aetiologies unrelated to cancer. Pain could be classified as originating from nociceptors in bone (35%), soft tissue (45%) or visceral structures (33%) or otherwise as of an neuropathic origin (34%). In most patients, pain syndromes were located in the lower back (36%), abdominal region (27%), thoracic region (23%), lower limbs (21%), head (17%) and pelvic region (15%). The main pain syndrome was also coded according to the IASP Classification of Chronic Pain. Regions and systems affected by the main pain syndrome showed large variation depending on the site of cancer origin, whereas temporal characteristics, intensity and aetiology were not markedly influenced by the cancer site. The variety of pain syndromes evaluated in our patients confirms the importance of comprehensive pain assessment prior to treatment.
315 citations
TL;DR: Practical recommendations are presented for increasing nurses' knowledge about pain management; improving the quality and the consistency of the assessment, documentation and treatment of pain; and disseminating pain management information.
293 citations
TL;DR: The results suggest that, when clinicians or researchers wish to assess average pain among chronic pain patients, but cannot obtain multiple measures of pain over time, the most valid measure would be the arithmetic mean of patient‐recalled least and usual pain.
Abstract: This study examined the relative predictive validities of several measures of pain intensity. Forty chronic pain patients completed 6-14 days worth of hourly pain ratings, which were averaged to obtain a measure of actual average pain intensity. These patients then made ratings, on 101-point numerical rating scales, of worst, least, and usual pain during the previous 2 wks, and of their current pain. A series of correlation coefficients were computed and regression analyses were performed to determine the individual or composite measures that best predicted actual average pain intensity. Consistent with previous research, the best single predictor of actual average pain intensity was patient rating of least pain in the previous 2 wks. Of all possible composites of usual, least, worst, and current pain ratings, the arithmetic mean of least and usual pain had the strongest relationship to actual average pain. The inclusion of ratings of most pain or current pain in any composite score actually weakened the relationship between the composite score and actual average pain intensity. These results suggest that, when clinicians or researchers wish to assess average pain among chronic pain patients, but cannot obtain multiple measures of pain over time, the most valid measure would be the arithmetic mean of patient-recalled least and usual pain.
224 citations
TL;DR: Understanding the pain-depression relationship provides treatment implications and hypotheses for origins of chronic pain in SCI, and reduced pain will have a greater effect on reducing depression than reduced depression will have on pain.
191 citations
TL;DR: The Postoperative Pain Measure for Parents showed excellent sensitivity and specificity in selecting children who reported clinically significant levels of pain and as child‐rated pain decreased from Day 1 to Day 2, so did scores on the behavioral measure.
Abstract: Parents are now primarily responsible for the at home assessment and treatment of their children's pain following minor surgery. Although some research has suggested that parents underestimate their children's pain following surgery, no behavioral measure exists to assist parents in pain assessment. The Postoperative Pain Measure for Parents was developed based on cues parents reported using to assess their children's pain (e.g. changes in appetite, activity level). The purpose of the present study was to develop and validate this measure by examining the relation between parent-report of child behaviors and child-rated pain. Subjects were 110 children (56.4% male) aged 7-12 years undergoing day surgery at a tertiary-care children's hospital and their parents. Parents and children completed a pain diary for the 2 days following surgery. Children rated their pain and emotional distress and parents rated the presence or absence of specific behaviors from a checklist. Correlations were conducted between each of the 29 behavioral items and child-rated pain on Day 1; 14 items with correlations less than 0.30 were dropped. The remaining 15 items were subjected to a principal axis factor analysis. A one-factor solution was the best fit for the data. The items were then summed to yield a total score out of 15. Internal consistency reliabilities for the measure and correlations with child-rated pain were high on both days following surgery. Child-rated pain and emotional distress were moderately correlated. The Postoperative Pain Measure for Parents was also positively correlated with child-rated emotional distress on both days following surgery. As child-rated pain decreased from Day 1 to Day 2, so did scores on the behavioral measure. The Postoperative Pain Measure for Parents was successful in discriminating between children who had undergone no/low pain surgeries and children who had undergone moderate to high pain surgeries. There were no significant differences in scores on the behavioral measure for child age or sex. Using a cut-off score of six out of 15, the measure showed excellent sensitivity (> 80%) and specificity (> 80%) in selecting children who reported clinically significant levels of pain. This study provides preliminary evidence for the use of the Postoperative Pain Measure for Parents as a valid assessment tool with children between the ages of 7-12 years following day surgery. It is internally consistent and strongly related to child-rated pain. Future research should explore the use of this measure with a younger sample and children with developmental delays.
188 citations
TL;DR: The use of a pain tool, such as the Pain-O-Meter, could improve patient care by facilitating the documentation of pain and evaluation of pain relief measures.
165 citations
TL;DR: It is concluded that the VAT is a valid accurate, and clinically useful tool for measuring pain, suitable and effective for clinical use and as an outcome measure in clinical trials.
131 citations
TL;DR: It is concluded that HP thresholds obtained from a single session are of limited value, and should be carefully interpreted, and long‐term studies that use the HP threshold should take results from the second (or later) session as their baseline.
Abstract: Experimental heat pain transients were administered to 30 normal volunteers over four weekly sessions, measuring both heat pain (HP) threshold and suprathreshold magnitude estimation through VAS. Repeatability and bias for these two factors were evaluated. Heat pain thresholds measured through the method of limits were previously shown to have inter-session bias, presumably due to a practice effect. Existence of such a bias between first and second measurement sessions casts doubt on the usefulness of this parameter for pain assessment of individuals over time. In the present study, measurements of normal HP thresholds over four sessions showed that bias exists between the first and successve sessions, but not among sessions other than the first. It is concluded that (i) HP thresholds obtained from a single session are of limited value, and should be carefully interpreted. (ii) Long-term studies that use the HP threshold should take results from the second (or later) session as their baseline.
The Visual Analog Scale (VAS) is considered the ‘gold standard’ for assessment of clinical and suprathreshold experimental pain, and changes in VAS score are regarded as significant evidence of individual response to treatment, placebo, or experimental manipulation. Although its overall group accuracy and precision have been examined for both clinical and experimental pain, and found adequate (Price 1988), the VAS has not been rigorously assessed for repeatability. Stimuli at three pain levels, 1.5, 3 and 4.5°C above each individual's heat pain threshold as determined at each session, were given. Several models of analysis of the VAS were tested and repeatabilities (r) obtained from these analyses demonstrate poor precision for each of the tested analysis models. For example, inter-session repeatabilities for the three individual pain levels ranged from r = 2.8–4.7, effectively providing a confidence interval of 7.6–9.4 for any VAS reading on a 0- to 10-point scale. An examination of intra-session VAS provided somewhat better results. Thus, use of the VAS in similar experimental settings is called into question. The use of the VAS in clinical settings, where individual assessments are necessary, is also called into question, but remains to be specifically tested.
123 citations
Journal Article•
TL;DR: As the use of warm CO2 gas leads to significant reduction of pain, technical and mechanical parameters should be changed accordingly.
Abstract: The temperature of the gas used for insufflation during laparoscopy has a significant influence on postoperative shoulder and subphrenic pain according to a prospective randomized study of 103 female patients who filled out a standardized pain assessment questionnaire with a visual analogue scale from 0 to 10. Women in group B (n = 53), who had been insufflated with warm CO2 gas during laparoscopy, had significantly less pain than women in the control group (group A; n = 50). The declared value for shoulder pain at the first postoperative day was 3.6 with cold gas versus 2.5 with warm CO2 (p = 0.013). The strongest pain was found following long operations (5.4 vs. 4, respectively) and following high CO2 gas use (5.5 vs. 2.3); in both cases, a significant advantage was noted for the group treated with warmed CO2. Further research is needed regarding the etiology and possible prevention of postoperative pain following laparoscopy. As the use of warm CO2 gas leads to significant reduction of pain, technical and mechanical parameters should be changed accordingly.
95 citations
TL;DR: The findings suggest that pain behavior observation is a valid assessment tool in the elderly and observation of elders during performance of activities of daily living may be a more sensitive and valid way of assessing pain behavior than observing pain behavior during sitting, walking, standing, or reclining.
Abstract: Pain evaluation typically relies upon the use of self-report instruments. The validity of these tools is questionable in many older adults, however, particularly those with cognitive impairment. Rating of pain behavior (e.g. grimacing, sighing) by an objective observer represents an alternative pain assessment strategy which has been validated in subjects of heterogeneous ages. The purpose of this study was to examine, in a group of community-dwelling elderly with low back pain and lumbosacral osteoarthritis, the concurrent validity of observational pain behavior rating techniques as compared with self-report instruments and the degree to which pain and pain behavior relate to disability. Thirty-nine cognitively intact subjects, age >65 years, without depression, other sources of pain, or other known spinal pathology underwent the following measures: (1) pain self-report using the verbal 0–10 scale, vertical verbal descriptor scale, Arthritis Impact Measurement Scales and McGill Pain Questionnaire; (2) pain behavior was sampled during two protocols, one, identical to that used by Keefe and Block (Behav. Ther., 13 (1982) 363–375), that required subjects to sit, stand, walk, and recline for 1–2 minute periods (which we have labelled the traditional protocol), and a second, more demanding protocol that was designed to simulate activities of daily living that place a premium on axial movement (the ‘ADL’ protocol); (3) disability was assessed using the Roland questionnaire, a 6 month global disability question and the Jette Functional Status Index; and (4) radiographic evaluation of the lumbosacral spine; osteoarthritis was quantitated using a previously validated scoring system. Interrelationships among pain, pain behavior and disabilityv measures were tested using canonical correlations. Self-reported pain was associated with pain behavior frequency; the association was stronger when the ADL protocol was used, as compared with the traditional protocol. The association between pain and disability was modestly strong with both self-report instruments and pain behavior observation when the ADL protocol was used, but not when the traditional protocol was used. Our findings suggest that pain behavior observation is a valid assessment tool in the elderly. In addition, it seems that observation of elders during performance of activities of daily living may be a more sensitive and valid way of assessing pain behavior than observing pain behavior during sitting, walking, standing, or reclining.
TL;DR: Examination of how health-care providers in U.S. teaching hospitals assess and manage children's pain found that the effectiveness of pain assessment and management was lower for infants and younger children.
TL;DR: The most salient recommendations arising from these findings are that nurses should be provided with education about pain assessment and management, and be empowered by policies that allow them to sensitively and effectively respond to children in pain.
TL;DR: In this article, the authors examined the relationship between children's ratings of their pain and the nurses' ratings of the children's pain in a Danish hospital and found that nurses tended to overestimate the effect of analgesics.
TL;DR: The results show that increasing the volume from 0.5 to 1.0 mL increases the pain significantly, which should be considered when injection preparations for subcutaneous administration are formulated.
Abstract: OBJECTIVE:To compare injection pain after subcutaneous administration of four different solution volumes.DESIGN:Double-blind, randomized, prospective, multiple crossover study.SETTING:Steno Diabetes Centre, Gentofte, Denmark.PARTICIPANTS:Eighteen healthy volunteers, 9 women and 9 men, aged 21-30 years.METHODS:The subjects were injected with four different volumes (0.2, 0.5, 1.0, 1.5 mL) of NaCl 0.9%. The study was performed on 2 days with a 1-week washout period between the study days. On each study day the subjects received four injections in each thigh. To evaluate the validity of our pain assessing model the subjects received eight injections of 0.5 mL on one of the study days. Pain assessment was done immediately after each injection using both a 10-cm visual analog scale (VAS) and a six-item verbal rating scale (VRS).RESULTS:A significant difference in pain score on both the VAS (p < 0.05) and the VRS (p < 0.01) was seen between the four injection volumes. The pain was significantly increased with vo...
TL;DR: Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.
TL;DR: The total pain score was less and the SIP showed modest improvement for laparoscopic herniorrhaphy but this did not reach statistical significance.
Abstract: Background: Laparoscopic herniorrhaphy is controversial and deserves critical evaluation. Methods: In a randomized prospective study transabdominal preperitoneal laparoscopic herniorrhaphy (n= 24) was compared in patients to the tension-free Lichtenstein repair (n= 29) utilizing validated and reliable pain and activity assessment tools. The Sickness Impact Profile (SIP) was used to compare preoperative normal activity to postoperative activity. A Pain-O-Meter (visual analogue scale plus affective and sensory pain descriptors) assessed intensity of pain. The total pain assessment score and SIP were compared across time (postoperative day 1–42). Analgesic medication was used as a covariate. Results: The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance. Similarly, the SIP showed modest improvement for laparoscopic herniorrhaphy. No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization. Conclusion: Further investigation of laparoscopic herniorrhaphy is warranted.
TL;DR: The lack of significant difference in scores between junior and senior residents suggest that adequate cancer pain management is not being effectively taught in postgraduate training programs.
Abstract: Pain control for cancer is a significant problem in health care, and lack of expertise by clinicians in assessing and managing cancer pain is an important cause of inadequate pain management. This study was designed to use performance-based testing to evaluate the skills of resident physicians in assessing and managing the severe chronic pain of a cancer patient. Thirty-three resident physicians (PGY 1–6) were presented with the same standardized severe cancer pain patient and asked to complete a detailed pain assessment. The residents then completed questions related to management of the cancer pain patient. In the cancer pain assessment, residents did well in assessing pain onset (70%), temporal pattern of pain (64%), and pain location (73%). However, only 33% and 45% physicians adequately assessed the pain description and pain intensity, respectively, and assessment of pain-relieving factors, previous pain history, and psychosocial history was done poorly or not at all by 70%, 88%, and 94% of residents. Only 58% of the residents were judged to be competent in this clinical cancer pain assessment. In the cancer pain management section, opioid analgesic therapy was prescribed by 98% of residents, and 91% used the oral route. However, only 18% of prescriptions were for regular use and 88% of residents did not provide analgesics for breakthrough pain. A significant number of graduated physicians were judged to be not competent in the assessment and management of the severe pain of a standardized cancer patient. Opioids and NSAIDs were the analgesics of choice; however, most were prescribed on a PRN basis only. Co-analgesics were rarely prescribed. Few physicians managed persistent, severe cancer pain according to the WHO guideline of increasing the opioid dose. The lack of significant difference in scores between junior and senior residents suggest that adequate cancer pain management is not being effectively taught in postgraduate training programs.
Journal Article•
TL;DR: Pain assessment using the multidimensional pain model showed that 186Re-etidronate is an effective agent in the treatment of metastatic bone pain in prostate cancer and warrants further placebo-controlled studies.
Abstract: Rhenium-186-etidronatehas been developed for pain reliefof bone metastases and has previously been studied with regard to toxicity, pharmacokinetics and dosimetry. Its palliating effect on bone pain has not been studied extensively. To justify further efficacy investi gations, patients participating in two toxk@ity studies were studled using a strict pain assessment methodology. Methods Forty-three patients entered the study, 37 of whom were evaluable for pain assessment. Administereddosages ranged from 1295 MBq (35 mCi) to 3515 MBq (95 mCi) lesRe@etidronate. Pain relief was assessed using a handwritten diary containing questions reflecting the multidimensional character of chronic pain. The diary was marked twice dailyfora maximum of 10 wk(2 wk priorto and 6/8 wk after the injection). A response was determined using a specdlc decision rule, in which pain intensity, medication index and daily actMties were core determinants. Resutts A response was reached in 54% (20 of 37) of the patients and varied from 33% (n = 6) in the “35-mCi†group to 78% (n = 7) in the “50/65-mCi†group to 70% (n = 7) in the “80/95-mCi†group. Conclusion: Pain assessment using the multidimensional pain model showed that lesRe@etidr@ onate is an effective agent in the treatment of metastatic bone pain in prostate cancer and warrants further placebo-controlled studies.
TL;DR: Abstract [Todd KH: Pain assessment and ethnicity].
TL;DR: Patient-administered analgesia with oral methadone appears to be a simple, cheap and relatively safe technique for controlling cancer pain, permitting individualization by the patient him- or herself and avoiding the risk of accumulation.
TL;DR: Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia.
Abstract: Summary
An audit project was designed to assess and improve the provision of postoperative analgesia in a children's hospital. Pain assessment for all children and analgesia standards for our institution were introduced prior to data collection. Data were collected on consecutive samples of 316 and 325 children undergoing surgery as inpatients during 10-week periods. Change was initiated between the two periods in response to our findings; our action plan involved education, changes to documentation, the widespread use of diclofenac in children over 2 years of age and recommendations far the prescription of analgesia. The initial prescription of analgesia increased from 95% to 98% (p = 0.019), administration of analgesia to children experiencing bad or severe pain increased from 57% to 71% (p = 0.032) and the number of children experiencing severe pain reduced from 17% to 11% (p = 0,050). Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia.
Journal Article•
TL;DR: The mother/child dyad showed significant relationships at observations 1 and 2; these correlations were higher than other correlations at each observation, and assessments of children's pain may need to integrate more data pertaining to developmental level.
Abstract: Purpose To identify whether nurses and mothers of pediatric patients accurately assess the child's pain intensity as determined by the child Method A descriptive correlational design examined the perception of pain from a nonrandom convenience sample of 20 postoperative school-aged children, their mothers, and their nurses A 100 mm visual analogue scale was completed by all participants at 3 separate observations Pearson's Product Moment Correlation was used to analyze relationships between the dyads Findings The mother/child dyad showed significant relationships at observations 1 and 2; these correlations were higher than other correlations at each observation There were significant relationships for the child/nurse dyad at observations 1 and 2, and for the mother/nurse dyad at observation 1 Conclusions Mothers may be a valuable source of information in assessing their child's pain The use of pain assessment tools may need to be examined and incorporated into nurses' practice, and assessments of children's pain may need to integrate more data pertaining to developmental level
TL;DR: It was discovered that in general, pain after ESS was less severe than expected and the type of anesthetic used did not significantly affect postoperative pain; pain score changes and use of analgesics were similar between the two anesthesia groups.
Abstract: This prospective study was conducted to examine pain after endoscopic sinus surgery (ESS). The hypothesis was that a long-acting anesthetic agent would result in patients experiencing less pain in the 24-hour postoperative period and therefore needing fewer oral analgesics. We randomized 100 patients undergoing ESS to receive either lidocaine (1% or 2%) with epinephrine or bupivacaine (0.25% or 0.5%) with epinephrine as an anesthetic and for a sphenopalatine block. Postoperative pain was assessed with a standard numeric pain assessment scale at baseline and at 2, 6, and 24 hours after surgery. The use of analgesics during this period was also documented. We compared the results between patients receiving bupivacaine and those receiving lidocaine, as well as between patients who required nasal packing and those who did not. We discovered that in general, pain after ESS was less severe than expected. We further found that the type of anesthetic used did not significantly affect postoperative pain; pain score changes and use of analgesics were similar between the two anesthesia groups. Postoperative pain was also similar between the "packing" and "no packing" groups. Although patients receiving packing had consistently lower increases in pain (and in fact many patients in this group had decreases in pain from baseline), none of the differences between group means was statistically significant.
TL;DR: The pain assessment and disability score was statistically significant postoperatively and at the time of the follow-up in relation to the preoperative score.
Abstract: Background This study was designed to determine the efficacy of laparoscopy on patients with a history of recurrent and chronic abdominal pain longer than 3 months, of unknown origin. Methods From September 1990 to May 1994, we performed 66 laparoscopic treatments on 59 patients. The assessment of life quality ensured the disability score, the McGill pain questionnaire, and the visual analogue pain scale, which were completed preoperatively, then on the day of discharge, and finally at a mean period follow-up of 75.3 weeks. Laparoscopy provided diagnosis on 53 of 59 patients (89.8%). Results All 66 attempted laparoscopic procedures were completed successfully, no conversion to laparotomy was necessary, and no postoperative complication occurred. Five out of 59 patients (8.5%) revealed no improvement of pain postoperatively, and 6 out of 56 (10.7%) still suffer from pain at the time of the follow-up. Conclusions The pain assessment and disability score was statistically significant postoperatively and at the time of the follow-up in relation to the preoperative score.
TL;DR: Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain.
Abstract: BACKGROUND: Acute pain is a significant problem in critical care patients. Although many barriers to successful assessment and management of pain in critical care patients have been noted, little is known about how critical care nurses make clinical judgments when assessing and managing patients' pain. OBJECTIVE: This qualitative analysis is part of a pilot study evaluating nurses' use of a pain assessment and intervention notation algorithm in patients in critical care areas who have limited communication abilities after abdominal or thoracic surgery. METHOD: Transcribed audiotapes of nurse participants' "thinking aloud" while using the pain assessment and intervention notation algorithm were analyzed by using interpretive phenomenology. The interpretive account is based on 31 tape recordings of 14 nurses caring for 41 patients (12 patients in the ICU and 29 patients in the postanesthesia care unit). FINDINGS: The two domains of clinical judgment found were (1) assessing the patient and (2) balancing interventions. CONCLUSIONS: Many nurses' reports showed that they accurately assessed their patients' needs for analgesics. Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain. Additionally, nurses had to balance analgesic administration against the patients' hemodynamic and respiratory conditions, medical plan and prescriptions, and the desires of the patients and the patients' families.
TL;DR: The standard of nurses' assessment is discussed and the factors suggested to influence nurses' Assessment of pain are looked at.
Abstract: The report of the Royal College of Surgeons and College of Anaesthetists has stimulated much interest in the relief of pain following surgery. Despite the development of new techniques such as patient controlled analgesia, pre-emptive analgesia and complementary techniques that have helped to improve the situation, the role of pain assessment remains central. This literature review discusses the standard of nurses' assessment and looks at the factors suggested to influence nurses' assessment of pain.
TL;DR: Non-nursing college students' decisions about pain assessment and use of opioids compared with decisions of practicing nurses strongly suggests that students enrolling in nursing programs already possess many misconceptions about pain management.
TL;DR: It is suggested that greater attention needs to be paid to how formal characteristics of pain assessment instruments influence patients' descriptions of their pain.
Abstract: A multitrait-multimethod design was used to examine the convergent and discriminant validity of seven pain measures from three widely used self-report instruments designed to assess the sensory, affective and intensity dimensions of pain. The instruments were the McGill Pain Questionnaire, the Pain Perception Profile and Numerical Ratings. Three distinct factor models, each corresponding to a different hypothesis about how these pain measures are related, were tested using confirmatory factor analysis in a sample of 419 headache sufferers. A three-factor model, postulating three correlated factors defined by the three assessment instruments best explained the correlations between the pain measures. Measures of sensory, affective and intensity dimensions from the three instruments failed to exhibit convergent or discriminant validity. Rather, instrument variance obscured the pain qualities the three pain instruments were designed to assess. These findings suggest that greater attention needs to be paid to how formal characteristics of pain assessment instruments influence patients' descriptions of their pain.
TL;DR: Improvements in pain management were felt to be due largely to staff having provided staff with the right tools to use in assessing, documenting, and controlling pain.
Abstract: Article-at-a-Glance Background In April 1994 at the University of California at Los Angeles Medical Center the Surgical Intensive Care Unit's (SICU's) Quality Improvement Council unanimously agreed on pain management as one of the major factors that negatively affect outcomes for their patient population. Using the FOCUS-PDCA (plan-do-check-act) model for quality improvement (QI), the council chartered a subcommittee to improve the pain management in their ICUs. Methodology The subcommittee first measured the pain assessment scores of patients at transfer from the ICU. After ascertaining that these scores were greater than the goal of 2, the process of providing pain relief was examined with the assistance of process control statistics, which showed a process barely capable of meeting the goal of pain score of 2 or less on a 0-5 scale. The process factors that affected this outcome were examined and changes were made where appropriate. One of these changes was development of a guideline for acute pain management based on the Agency for Health Care Policy Research's Acute Pain Management Clinical Practice Guideline. Reassessment of the pain scores and the process was then conducted. Results The pain assessment scores at transfer from the ICU decreased significantly. Thirty-five percent of patients in the preguideline survey rated their scores as greater than 2, compared with only 21% at the postguideline survey. Pain assessment and documentation also improved significantly. Conclusion The Quality Improvement Council felt that improvements in pain management were due largely to their having provided staff with the right tools to use in assessing, documenting, and controlling pain. Gains in pain management continue to be made.