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Purpose of the study: The study aimed to develop and validate a holistically based follow-up pain assessment diary for patients with cancer pain in Sri Lanka. Design of the study: Mixed-method design adapted. Methods used: Developing a pain diary and testing its psychometric qualities were done in two phases. Comprehensive literature research and qualitative semistructured interviews with patients, clinical, and subject specialists created the pain diary items. Content, face, construct, criterion validity, and reliability were evaluated. Findings: The essential domains to be assessed were identified under six main categories; pain and related characteristics, physical, psychological, social, spiritual, and financial aspects. The average variance extracted from the subscales "Influence on daily life," "Gastric disturbances," and "Pain intensity" were 0.526, 0.562, and 0.696, respectively. The heterotrait-monotrait criterion values between subscales were from 0.691 to 0.44, which was lower than the threshold. Good to excellent correlation coefficients were demonstrated with the scores of reference tools. Cronbach's alpha was computed for each subscale and ranged from 0.75 to 0.92 and composite reliability from 0.921 to 0.826. Conclusions: Pain diary is a reliable and valid instrument for follow-up assessment of holistic pain experience enabling holistic nursing among patients with cancer pain in Sri Lanka.

We assessed the factor structure, correlates, and incremental validity of the Pain Appraisal Inventory in Chinese adult chronic pain samples. In an initial exploratory factor analysis sample ( N  = 301), the original two-component (threat, challenge) 16-item Pain Appraisal Inventory and a 10-item short form (Pain Appraisal Inventory-Short Form) were supported. Within a confirmatory factor analysis sample ( N  = 285), uniformly acceptable fits were observed only for the Pain Appraisal Inventory-Short Form. Furthermore, Pain Appraisal Inventory-Short Form threat and challenge subscales had significant correlations with conceptually related measures and added to prediction models for pain-related coping and adjustment, independent of other pain belief scales. Together, results indicated that the Pain Appraisal Inventory-Short Form has utility in Chinese chronic pain samples.

Background: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention., Measures: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management., Results: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability., Conclusion: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.

The purpose of this study was to evaluate the psychometric properties of the Spanish version of the Fear of Pain Questionnaire-III. The original three-factor structure of the Fear of Pain Questionnaire-III was confirmed and indicated a good to excellent level of internal consistency. Criterion validity was supported by positive significant correlations between the Fear of Pain Questionnaire-III scores and measures of pain catastrophizing and anxiety sensitivity; discriminant validity was supported by non-significant correlations between the Fear of Pain Questionnaire-III scores and measures of pain intensity and depressive symptomatology. The findings support the reliability and validity of the scores obtained by the Spanish version of the Fear of Pain Questionnaire-III.

Background: Family caregivers encounter many barriers to managing patients' pain in the home hospice setting. However, there are limited clinically applicable resources for hospice providers to help family caregivers identify and address these barriers., Aim: To develop a pain management manual for hospice providers to support family caregivers and conduct a preliminary providers' evaluation of the manual., Design and Participants: A pain management manual was developed and structured into 3 parts: (1) 5 common pain management case scenarios based on a secondary data analysis of a hospice clinical trial; (2) a list of suggested assessment questions and strategies for each case scenario was developed based on a caregiver framework; and (3) pain educational material was included from established clinical guidelines. The manual was vetted by 5 experts and then was evaluated by interviewing 25 hospice providers. Interview data were analyzed using thematic analysis., Results: The hospice providers found that the manual could potentially serve as a reference in their practice and be a source for their continuing education. They suggested enhancing the clarity of the case scenarios and adding additional strategies to the manual. Moreover, they suggested expanding the paper-based version and developing a web-based platform to deliver the content would maximize its utility., Conclusions: The manual has the potential to be integrated into routine hospice care to improve the quality of pain management.

School nurses are afforded minimal resources related to assessing pain in students with intellectual disability (ID) and have called for continuing education. The purpose of this study was to measure the effectiveness of an education program regarding best practices for assessing pain in students with ID. Educational sessions were presented to 248 school nurses. Pre-, post-, and follow-up surveys measured (1) difficulty school nurses face when assessing pain, (2) knowledge and use of pain assessment methods, and (3) intent to change and actual changes to professional practices. Participants experienced less difficulty assessing pain following the educational program. Almost all participants intended to change pain assessment practices, but large caseloads limited new practice adoption. Policy makers must consider population size and acuity when determining school nurse staffing. Trainings and other resources should be made available to school nurses in order to make pain assessments for students with ID more thorough and efficient.

Background: There is a lack of knowledge about how the provision and availability of specialized palliative care relates to the quality of dying in hospital and community-based settings., Aim: We aimed to explore the quality of care during last week of life in relation to different levels of palliative care development., Design: We investigated access to palliative care in Southern Sweden, where one region offers palliative care in accordance with European Association for Palliative Care guidelines for capacity, and the other region offers less developed palliative care. Data on approximately 12,000 deaths during 2015 were collected from the Swedish Register of Palliative Care. The quality of care was investigated by region, and was measured in terms of assessment of oral health and of pain, and end-of-life conversation, companionship at death and artificial nutrition/fluid in the last 24 h., Results: The overall quality of care during last week of life was not consistently better in the region with fully developed palliative care compared with the less developed region. In fact, for patients dying in hospitals and community-based settings, the quality was statistically significantly better in the less developed region. The small proportion of patients who had access to specialized palliative care had superior quality of care during the last week of life as compared to patients in other care settings., Conclusion: The capacity of specialized palliative care does not per se influence the quality of care during the last week of life for patients in other settings.

The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.

The objective of this work was to study the agreement between four pain intensity scales when administered electronically: the Numerical Rating Scale-11, the Faces Pain Scale-Revised, the Visual Analogue Scale and the Coloured Analogue Scale. In all, 180 schoolchildren between 12 and 19 years old participated in the study. They had to report the maximum intensity of their most frequent pain using the electronic versions of the four scales. Agreement was calculated using the Bland-Altman method. Results show that the electronic versions of Numerical Rating Scale-11, Coloured Analogue Scale and Visual Analogue Scale can be used interchangeably.

Background: This prospective study evaluated the intermediate-term outcomes of operatively treating primary osteochondral lesions of the talus (OLT) of 1.5 cm 2 or smaller with arthroscopic excision, microfracture, and allograft cartilage extracellular matrix (ECM)., Methods: Between 2012 and 2015, 30 consecutive patients received allograft cartilage ECM at their microfractured OLT of 1.5 cm 2 or smaller after failing nonoperative treatment. Preoperative and postoperative function and pain were graded using the Foot and Ankle Ability Measure (FAAM) and a visual analog scale (VAS), respectively. Postoperative imaging was assessed for osteochondral healing and degenerative changes. This included computed tomography (CT) at 6 months from surgery. Data regarding postoperative complications were recorded. All 30 patients that received allograft cartilage ECM for their OLT were evaluated for final follow-up at a mean of 20.2 months., Results: Mean FAAM increased from 51.4 preoperatively to 89.3 of 100 at final follow-up. Mean VAS decreased from 8.1 preoperatively to 1.7 of 10 at final follow-up. These differences between preoperative and postoperative function and pain were statistically significant ( P < .05). At 6 months from surgery, 2 patients (6.7%) received CT scans that revealed incomplete chondral formation at their OLT. At 19 months after surgery, a separate patient (3.3%) developed ankle arthritic changes., Conclusion: Treating OLTs with allograft cartilage ECM has not been previously reported. Using allograft cartilage ECM resulted in a high rate of improvement in ankle function and pain in patients with OLTs. These findings are important as allograft cartilage ECM could be of significant benefit for patients with OLTs., Level of Evidence: Level III, prospective comparative series.

Background: Ankle arthritis is a debilitating condition that causes severe functional impairment. While arthrodesis has been the gold standard of surgical treatment for this condition, significant improvements in total ankle arthroplasty have made it a viable alternative. The purpose of this study was to look at the midterm follow-up of the Agility total ankle., Methods: A retrospective review of prospectively collected data was conducted on 127 consecutive Agility total ankles implanted between 2002 and 2009. Charts were reviewed to collect patient demographics. In addition, coronal alignment, overall arc of motion, tibiotalar component motion, syndesmotic fusion, zones of osteolysis, and subsidence were determined. A Kaplan-Meier survival and linear regression analysis were used to predict implant failure. A multivariate regression analysis was used to assess whether radiographic measures were predictive of patient satisfaction., Results: Ninety (78.2%) of 115 patients retained their primary implant, of which 105 were available for evaluation, with an average follow-up of 9.1 years. Twenty-five had their implant removed. The average score for the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale was 82.4, FAAM sport subscale 55.3, postoperative visual analog scale (VAS) for pain 12.7, and Short Form-12 (SF-12) Health Survey physical component 45.8 and SF-12 mental component 56.1. Average arc of motion across the implant was 22.3 and 6.3 degrees in adjacent joints. Osteolysis most commonly occurred in zones 1 and 6. No statistical differences were found in the rate or location of subsidence. Linear regression analysis demonstrated that age at the time of surgery was predictive of failure ( P = .036). Inflammatory and atraumatic arthritis demonstrated higher likelihoods of revision. No correlation was detected between radiographic parameters and outcomes scores ( P > .05; rho >0.2). A significant reduction in mean VAS pain scores by 67.6% was maintained at an average of 8 years., Discussion: Our results were improved over the nondesigner outcomes published in the current literature. Survivorship approached 80% at 9 years, with Kaplan-Meier 14-year survival calculated at 70.4%. Patients with their original implant were functioning with a high level of satisfaction based on statistically validated outcome scores, which was independent of the radiographic appearance of their implant. Age at the time of surgery and inflammatory/atraumatic arthritis were predictive of failure., Level of Evidence: Level IV, case series.

Background: The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID., Methods: We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1)., Results: Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value < .001). There were no statistical differences between demographics or preoperative AOFAS scores of patients with good versus fair satisfaction levels. At 2 years, patients who had good satisfaction had higher AOFAS scores than fair satisfaction (83.9 vs 78.1, P < .001) and higher mean change (30.2 vs 22.3, P = .015). Mean change in AOFAS score in patients with good satisfaction was 30.2 (SD = 19.8). Mean difference in good versus fair satisfaction was 7.9. Using ROC analysis, the cut-off point is 29.0, with an area under the curve (AUC) of 0.62. Effect size method derived an MCID of 8.4 with a moderate effect size of 0.5. Multiple linear regression demonstrated increasing age (β = -0.129, CI = -0.245, -0.013, P = .030) and higher preoperative AOFAS score (β = -0.874, CI = -0.644, -0.081, P < .001) to significantly decrease the amount of change in the AOFAS score., Conclusion: The MCID of AOFAS score in hallux valgus surgery was 7.9 to 30.2. The MCID can ensure clinical improvement from a patient's perspective and also aid in interpreting results from clinical trials and other studies., Level of Evidence: Level III, retrospective comparative series.

Objective: This study examined the role of English language use in the reported frequency of musculoskeletal pain among Hispanic and non-Hispanic White youth., Method: This is a secondary data analysis using a cross-sectional sample of 12,189 Hispanic and non-Hispanic White adolescents recruited for the National Longitudinal Study of Adolescent to Adult Health. Respondents were classified into three groups: (a) English-speaking non-Hispanic Whites, (b) English-speaking Hispanics, and (c) Spanish-speaking Hispanics., Results: After controlling for body mass index and demographic, socioeconomic, and behavioral variables, Spanish-speaking Hispanics reported the least frequent musculoskeletal pain ( OR = 0.415, 95% CI [0.361, 0.477]; p < .001), followed by English-speaking Hispanics ( OR = 0.773, 95% CI [0.690, 0.865]; p < .001)., Conclusion: The experience of musculoskeletal pain is a physiological as well as a cultural phenomenon., Implications for Practice: Health care providers should consider the role of language use in reports of pain in Hispanic and non-Hispanic White adolescents.

Hispanic adults experience significant pain, but little is known about their pain during hospitalization. The purpose of this research was to describe Hispanic inpatients' pain intensity and compare their pain intensity with that of non-Hispanic patients. A post hoc descriptive design was used to examine 1,466 Hispanic inpatients' medical records (63.2% English speakers) and 12,977 non-Hispanic inpatients' medical records from one hospital for 2012. Mean documented pain intensity was mild for both Hispanic and non-Hispanic inpatients. Pain intensity was greater for English-speaking Hispanic patients than Spanish speakers. The odds of being documented with moderate or greater pain intensity decreased 30% for Spanish-speaking patients. Greater pain intensity documented for English-speaking Hispanic inpatients suggests underreporting of pain intensity by Spanish-speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioners' language(s)., (© The Author(s) 2014.)

Background: Pain is a frequent and distressing symptom in palliative care patients worldwide. Careful assessment is the first vital step to relieve this suffering. Assessment tools form a useful adjunct to pain management, but whether they make a difference to the patient is not known., Aim: The objective of this study was to investigate whether the use of a patient-held pain assessment tool can make a difference in patient's pain control., Setting and Participants: AIC Kijabe Hospital, Kenya, has had a nurse-led Palliative Care Service since 2002, with an annual case-load of around 600 patients. Study participants were recruited from among adult palliative care patients attending the Outpatient Department., Design: A quantitative experimental study methodology was employed. In the pre-intervention phase, pain was assessed at study entry and at 2 weeks, following 'standard' care at home; 49 patients were recruited for this phase. In the intervention phase, pain assessments were made at entry, with follow-up assessment after introduction to a patient-held pain assessment tool taken home by each patient; 50 patients were recruited for this phase. Analysis involved a comparison of baseline and 2-week pain scores between the two groups., Results: The results demonstrated that the use of a patient-held pain assessment tool led to an increase in the number of patients reaching satisfactory pain relief, from 30% in the pre-intervention group, to 69% in the intervention group., Conclusion: This study has demonstrated that a simple pain assessment tool, when linked to some action, may help achieve better analgesia., (© The Author(s) 2014.)

The medication assessment tool for cancer pain management (MAT-CP) measures the quality of medication use in relation to guidelines. The original MAT-CP was reviewed, modified and tested at a comprehensive cancer center in Jordan. The tool comprised 30 criteria covering six different aspects of pain management. Seventy patients were included, males 41 (59%), females 29 (41%), mean age 49 (range, 20-79) years. The overall level of adherence to guidelines was 78% with good inter-rater reliability (κ= 0.899). The tool's implementation showed opportunities for improvement in pain management at our institution. The MAT-CP was revised and validated for the first time outside Europe. This tool can be routinely used to assess and compare the quality of pain management in different institutions.

Background: The Massachusetts General Hospital Acupuncture Sensation Scale (MASS) is a tool to measure needle sensations. The aims of the present study were to develop a Chinese version and to assess its psychometric properties., Methods: This study was a methodological and exploratory study. The English version of the MASS was translated into Chinese using standardised translation procedures. Content validity was conducted by nine acupuncture experts. The prefinal Chinese version (C-MASS) was then administered to 30 acupuncture-naïve, healthy subjects. Electroacupuncture was performed on the right LI4 and LI11 acupoints for 30 min. A test-retest reliability measurement was administered 1-2 weeks later. Construct validity was examined by comparing results from C-MASS and the Short-Form McGill Pain Questionnaire (SF-MPQ). The construct validity was further assessed by the principle component analysis., Results: C-MASS demonstrated a content validity ratio on relevance and importance from -0.04 to 1.00. Convergent validity was demonstrated by its significant association with the sensory dimension of SF-MPQ (γ=0.63, p<0.05). Discriminant validity was demonstrated by its low association with the affective dimension of SF-MPQ (γ=-0.3, p=0.111). A five-factor structure of C-MASS was established by factor analysis. C-MASS demonstrated good internal consistency (Cronbach's α=0.71) and test-retest reliability (intraclass correlation coefficient=0.92). Since the descriptor 'sharp pain' was not a valid needle sensation related to deqi, this was removed from C-MASS. We renamed the scale as the Modified MASS-Chinese version (C-MMASS)., Conclusions: A 12-descriptor C-MMASS was established and shown to be a reliable and valid tool in reporting needle sensations associated with deqi among healthy young Chinese people.

There are currently two indicators, Morphine Consumption Data and the Pain Management Index, that have been widely used to assess the efficacy of cancer pain treatment. Both are based on the World Health Organization guidelines for cancer pain and both have limitations in their ability to assess the quality of pain care for cancer patients. The published studies that have used these methods all report that cancer pain is generally undertreated in a wide range of clinical settings and care models.

Objectives: Duruöz Hand Index (DHI) is a functional disability scale that can be used successfully to assess the functional disability with different hand arthropathies. The hands are frequently involved in diabetic patients. We aimed to examine the use of DHI for its accuracy and ease in assessing these patients., Methods: Forty patients with diabetes mellitus were recruited in this study. Hand pain was assessed with the visual analog scale. Duruöz Hand Index and Hand Functional Index were applied to assess the disability of hand. We evaluated the grip strength and 3 types of pinch strength (tip pinch, lateral or key pinch, and chuck or 3-finger pinch) for the dominant (D) and nondominant (ND) hands of each patient by 2 different kinds of Jamar dynamometers (JA Preston Corp, Jackson, MI)., Results: The Jamar dynamometer scores were as follows (mean [SD]): grip strength-D (21.56 [5.86]), grip strength-ND (16.42 [4.26]), tip strength-D (5.14 [1.50]), tip strength-ND (5.13 [1.42]), lateral strength-D (5.15 [1.52]), lateral strength-ND (5.07 [1.19]), chuck strength-D (5.40 [1.40]), chuck strength-ND (5.33 [1.28]). There was a high correlation between DHI and Hand Functional Index (P < 0.001, rho = 0.586) showing that DHI has good convergent validity. The DHI had significant correlation with nonfunctional parameters such as visual analog scale-pain (P < 0.001), restricted hand motion (P = 0.020), chuck strength-D (P = 0.006), pins test-D (P < 0.001), pins test-ND (P = 0.013), and assembly test (P = 0.025)., Conclusions: The DHI is a practical scale that is efficient in accurate assessment of hand dysfunction in diabetic patients.

This research was aimed at developing a tool for pain assessment specifically for parents to use with children of the Isaan culture of Northeast Thailand. The Khon Kaen University (KKU) Pediatric Pain Assessment Tool was first constructed through the use of a qualitative study and literature reviews. Then, it was modified using the results of a pilot study with 38 stakeholders. Seventeen nurses, 150 postoperative children, and 150 family caregivers participated in a study comparing the tool with the standard Faces Scale and Numeric Rating Scale. Results revealed no difference in children's pain scores, as well as no statistical difference in children's pain score ratings between the three groups, suggesting the new tool is appropriate for Isaan children.

This study analyzed parental perception of the impact of diarrhea on quality of life of their children. A standardized questionnaire was completed by 2023 parents in Germany with children with diarrhea who were younger than 2 years old. Parents stated the most worrying aspects of diarrhea. A health score was measured using a visual analogue scale (0 = worst health, 100 = best health). Clinical symptoms were quoted by 72% of parents as one of the most worrying dimensions, with duration/frequency of diarrhea and weight loss perceived most meaningful. Next were behavioral/physical symptoms (51%), with an inflamed bottom for mild disease and pain for severe cases being most meaningful. Parental concern is characterized by sympathy and anxiety for the child. The health score for the diarrheal episode was 54.6 for mild and 33.9 for severe cases. Parents perceive a high disease burden of diarrhea and clinically less meaningful aspects play a significant role.

Six months of survival as a key criterion is extremely important for decision making in enrollment of critically ill patients to palliative settings. This was a prospective cohort study with 6 months of follow-up during a 24-month period performed in the Division of Geriatric Medicine in a tertiary general hospital. One-hundred three consecutively admitted, bedridden patients with end-stage dementia were evaluated. The Mini-Suffering State Examination scale was performed. Interrelations between the Mini-Suffering State Examination score at admission and 6-month survival and mortality were evaluated. A significant difference was proven among survival curves of subgroups of patients according to the mini scores (0-3, 4-6, 7-10). Survival was shorter and mortality higher in patients with a high Mini-Suffering State Examination score, as shown by the Kaplan-Meier method using the log rank (P=.001) and Breslow tests (P=.001). The Mini-Suffering State Examination scale is useful for predicting the last 6 months of survival and mortality of end-stage dementia patients.

The objective of this study was to evaluate suffering of end-of-life cancer patients during their final hospice stay and the possible interrelations with survival. A cohort of consecutive patients hospitalized in an inpatient cancer hospice of a tertiary hospital was used for this study. Patients were evaluated upon admission and once weekly by the Mini-Suffering State Examination (MSSE). The distribution of patients for each MSSE score group, changes in MSSE scores (total and for each item of scale), and MSSE interrelation with clinical parameters associated with patients' condition during hospitalization were studied. In addition, the interrelation of MSSE score and survival was examined. Documentation of a high suffering level by the MSSE scale helps in identifying end-of-life cancer patients expected to benefit from enrollment in a hospice setting, provides quantitative information about various symptom dimensions, and may improve medical management and facilitate communication between these patients and caregivers.

Although two of the most commonly used multidimensional pain scales are the McGill Pain Questionnaire-Short Form (MPQ-SF) and the Brief Pain Inventory-Short Form (BPI-SF), there has been little psychometric analysis of these tools used among ethnic minority populations. The purpose of this study was to evaluate and compare psychometric properties of these two pain scales among 119 Asian American cancer patients. The Cronbach's alpha coefficients of the MPQ-SF and the BPI-SF were high (alpha = .85-.97). The correlation coefficients of the item analyses were .12 to .88 for the MPQ-SF and .44 to .90 for the BPI-SF. Two factors were extracted for both instruments. Correlations between pain scores and the usage of pain medications were low for the MPQ-SF (r = .23-.33) and moderate for the BPI-SF (r = .40-.42). The results of this study indicated that, among Asian Americans, both the pain scales were internally consistent; some items in each instrument were redundant; and the BPI-SF is more valid than the MPQ-SF.

Background: Achilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended., Purpose: To prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome., Study Design: Randomized clinical control trial; Level of evidence, 1., Methods: Thirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) and the pain level during tendon-loading activity., Results: No significant differences in the rate of improvements were found between the groups. Both groups showed, however, significant (P < .01) improvements, compared with baseline, on the primary outcome measure at all the evaluations. The exercise training group had a mean (standard deviation) VISA-A-S score of 57 (15.8) at baseline and 85 (12.7) at the 12-month follow-up (P < .01). The active rest group had a mean (standard deviation) VISA-A-S score of 57 (15.7) at baseline and 91 (8.2) at the 12-month follow-up (P < .01)., Conclusions: No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment. Our treatment protocol for patients with Achilles tendinopathy, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements. A training regimen of continued, pain-monitored, tendon-loading physical activity might therefore represent a valuable option for patients with Achilles tendinopathy.

Assessment of pain intensity using a standard self-reported pain score is standard practice in most institutions. These instruments require the cognitive ability to process the pain intensity into a numeric or descriptive value. Many institutions are considering adopting an assessment tool for cognitive impairment. The purpose of this study is to evaluate a clinician-administered assessment tool, PAINAD, in patients with cognitive impairment. Opioid consumption and frequency of documented unknown pain were collected in 2 cognitive impaired groups. In the control group, a self-reporting pain intensity tool was used, and in a second group, the PAINAD was used. Opioid use was significantly higher (P = .003) and the rates of reported unknown pain were significantly lower (P < .01) in the group using the PAINAD instrument compared to the control group of patients with cognitive impairment. There were no noted differences in opioid-induced adverse reactions in either group.

The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry is a multiple sclerosis (MS) self-report registry with more than 24,000 participants. Participants report disability status upon enrollment, and semi-annually using Performance Scales (PS), Patient Determined Disease Steps (PDDS) and a pain question. In November 2000 and 2001, we also collected the Pain Effects Scale (PES). Our aim was to validate the NARCOMS pain question using the PES as our criterion measure. We measured correlations between the pain question and age, disease duration, various PS subscales and PDDS to assess construct validity. We correlated pain question responses in participants who reported no change in PDSS or the PS subscales between questionnaires to determine test-retest reliability. We measured responsiveness in participants who reported a substantial change in the sensory, spasticity PS subscales. The correlation between the pain question and PES was r = 0.61 in November 2000, and r = 0.64 in November 2001 (both P < 0.0001). Correlations between the pain question and age, and disease duration were low, indicating divergent validity. Correlations between the pain question and spasticity, sensory PS subscales and PDSS were moderate, indicating convergent validity. Test-retest reliability was r = 0.84 (P < 0.0001). Responsiveness was 70.7%. The pain question is a valid self-report measure of pain in MS.

Back pain is common, and although many cases remit quickly, a significant number also continue a relapsing course over many months and years. Psychosocial factors have a significant influence on the condition. The evidence from clinical trials of the effectiveness of various therapies is available in summarised form in several resources, though is often inconclusive. There is good evidence that acute back pain should be managed by staying active and using non-steroidal anti-inflammatory and analgesic drugs, adding cognitive behaviour therapy for subacute pain. For chronic back pain, exercise, pain management programmes, non-steroidal anti-inflammatory and analgesic drugs, and trigger point and ligament injections are also recommended. There appears to be increasing evidence in favour of the use of acupuncture. Acupuncture appears to be useful to treat back pain, but patients should probably be advised to take advantage of any pain relief obtained to maintain or increase their activity. Acupuncturists must be aware of the psychosocial dimensions of back pain, as well as the physical ones, and should be careful to educate their patients about the condition and not make them become dependent on acupuncture to treat every acute episode.

The purpose of this research was to describe the kinds of pain assessments nursing home staff use with nursing home residents and the characteristics and behaviors of residents that staff consider as they assess pain. Twenty-one focus groups were held in 12 nursing homes. Nurses and other nursing home staff attended the focus groups. Coding techniques consistent with ethnographic methodology were used for data analysis. Four themes identified an underlying uncertainty in assessing residents' pain, the staff relationship-centered approach to pain assessment, the resident cues that alert staff to pain, and residents' characteristics important to the nursing assessment. Composition of focus groups made a difference in participation of certified nursing assistants in focus group discussion. Urban and rural differences were noted across the focus groups. Research is needed to further refine pain assessment techniques specifically for nursing home settings.

The primary goal of this single-group study was to determine the safety of a standard opioid titration order sheet to manage pain in ambulatory cancer patients. Secondary goals were to examine opioid toxicity and efficacy of this pain protocol. Twenty-seven patients who required fixed-dose opioids and who had uncontrolled pain were enrolled. All patients had their initial opioid dose titrated by the study physician using the opioid titration order sheet. Data were obtained by the study nurse during a weekly telephone interview and used to determine if pain was controlled. After initial titration, a trained study nurse titrated opioid doses based upon the standing order sheet. At each contact, patients were assessed for adverse effects, pain intensity, and analgesics used. Patients who completed the four-week trial (n = 17) did not differ from patients who did not complete the trial. No adverse effects were observed in 39 opioid titrations completed by the study nurse. Opioid toxicities, worst pain, usual pain, and pain-related distress declined from baseline to week four Patients who were adherent to their prescribed medications reported significantly lower pain intensity and distress (ps < or = . 06). The opioid titration order sheet, used by a trained nurse, is safe to use in ambulatory cancer patients who have moderate to severe pain. Common opioid toxicities were reduced. The protocol also demonstrated initial efficacy in improving worst and usual pain and pain-related distress. Further research to establish efficacy of the protocol is recommended.

Objectives: To assess the repeatability of the AbilityQ--a screening tool to assess technical ability to complete a questionnaire--in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain., Design: In a cross-sectional study, the AbilityQ and 'ShoulderQ' were administered on two consecutive days by a single investigator., Setting: Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability., Subjects: Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits., Results: Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36-72% for the verbal questions (kappa values 0.16-0.56). For visual analogue scale (VAS) questions, agreement +/- 1 on a 10-point scale was 36-59% with intraclass correlation coefficients 0.50-0.60 (p < 0.01). High verbal (> or = 3/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%., Conclusions: In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.

The purpose of this study was to examine the cultural validity, reliability, and preference of three pain assessment tools among 95 Jordanian children. Pain intensity was assessed using the Poker Chip, the Faces, and the Word Description Scales. The test-retest reliability and the convergent validity were supported for the three scales. Jordanian children preferred the Poker Chip Tool to the Faces Scale and the Word Descriptive Scale. Gender differences in relation to scale preference were evident: female children preferred the Poker Chip Tool and male children preferred the Faces Scale; such differences were contributes of the socialization process within the Arab culture. The three scales are valid, reliable, and can be used with confidence to assess pain among Jordanian children. Findings also showed that children have a subculture of their own regardless of their cultural orientation. Findings have implication to nurses in Jordan as well as to transcultural nursing.

This performance improvement project was undertaken to determine staff competency in pain management in several home care and hospice programs. The process used involved identifying and establishing the project, diagnosing the cause, remedying the cause, and holding the gains. Once the problem was identified and confirmed, the group worked to improve the competency of staff.

The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

Pain continues to be a very formidable foe in the care of the hospice patient. The incidence among hospice admissions may range from 50 to 80 percent. With such a high initial incidence of pain, the rapidity with which pain can be controlled becomes a very high priority for the hospice effort. The assessment and management of pain in a home-based hospice program presents some unique problems--and opportunities, in that much of this work is done by hospice nurses on site, rather than by the physician, who might remain quite removed from the process. In the study described below, 250 consecutive admissions to either a hospice, or pre-hospice (bridge) program were assessed for pain on admission. Those with pain scores of 5 or greater (on a 1 to 10 scale) were followed daily for 15 days by phone to reassess pain and treatment effects. Of the 250 consecutive patients surveyed, 41 (16 percent) gave pain scores of 5 or greater. Mean pain scores for the 41 patients dropped to < 5 within 24 hours of admission.

The nursing outcome of holistic comfort encompasses physical, psychospiritual, social, and environmental aspects of human nature. The primary purpose of this study was to test four propositions about the nature of comfort: (a) Comfort has equal proportions of state and trait characteristics; (b) comfort is sensitive to changes over time; (c) when subjects are exposed to an effective intervention, they demonstrate differences in comfort that increase in a linear way compared to a control group; and (d) the whole (total comfort) is greater than the sum of its parts (relief plus ease plus transcendence). A secondary purpose of this study was to present preliminary concurrent validity between two types of comfort instruments, a traditional questionnaire with a Likert-type format and visual analog scales. Findings were positive for all theoretical propositions and moderate concurrent validity between the Radiation Therapy Comfort Questionnaire and the visual analog scale for total comfort was demonstrated.

A program was developed to evaluate pain assessment skills of hospice nurses in the home setting, utilizing standardized patients (SPs). Hospice nurses were sent on a routine visit to a "patient's" home to evaluate someone dying of pancreatic cancer. They were not informed in advance that the "patient" was actually an SP, who had undergone intensive training from the staff to prepare him for his role. They performed their usual evaluation and then reported back to the referring physician by telephone. The referring physician, who used a written series of evaluation criteria, graded their assessments. The SP also evaluated the assessment skills of each nurse. After the exercise, the nurses were informed of the "patient's" identity and were provided with the written critique prepared by the SP. A second part of the program included a written examination of their pain assessment and treatment skills, followed by a didactic presentation. This is the first report we know of that has utilized SPs in the home setting to evaluate pain assessment skills in a blind fashion. Our findings indicate that this can be an effective method for measuring pain assessment skills as well as a valuable teaching device.

Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.

There are many options available to measure a child's self-report of pain. Many factors should be considered when choosing a scale, including previous testing, ease of administration, age of the child, and type of pain experience. When selecting a measure, it is important to pretest it with a sample similar to that in the proposed study to evaluate these factors.