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The knowledge of how to achieve effective pain relief is of major importance to all doctors and healthcare professionals that is treating patients undergoing surgery. Pain relief provides significant physiological benefits; hence, monitoring pain relief and its impact is increasingly becoming an important postoperative measurement of quality. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects, in order to achieve fast recovery and fast discharge of patients as well as to avoid chronification of postsurgical pain (PSP). Since the pathophysiology of postoperative pain is understood to a great extent, this can be helpful in order to establish an effective multimodal analgesic plan. For the treatment of PSP, a multimodal analgesic approach, as a part of an enhanced recovery protocol, is the best option for the patient. Beyond nonopioid systematic analgesics, regional analgesia, peripheral blocks, infiltration techniques and opioid analgesics, patient education, and nonpharmacological options have a substantial role. Individuality of pain (different type of surgeries, different population, etc.) is one of the most important characteristics that physicians who treat patients after surgery should take into account.

Next to winning, minimizing injuries during training and matches is one of the primary goals of professional team sports games. Soreness and pain can be early indicators and risk factors for acute or long‐term injuries. Monitoring pain intensity and duration, as well as potential sources, are useful for planning practices and can be effective means for preventing injury. The aim of this study was to assess the areas and locations of pain in young soccer goalkeepers during a training camp, and to differentiate the area and frequency between pain arising from the muscles (MP), joints (JP), or as a result of an impact (IP). Recordings of the MP, JP, and IP location along with the area were performed using digital body mapping software (Navigate Pain Android app, Aalborg University, Denmark) installed on a tablet personal computer at the end of each training day across a 5‐day training camp. There was a significant difference in the area between the three types of pain (p < 0.001). The post hoc analysis revealed statistically significant differences between the pixel areas of IP versus JP (p < 0.001), IP versus MP (p < 0.001), and JP versus MP (p < 0.001). There was no significant time‐effect for the IP area between 1‐5 days of training (p = 0.610), neither for MP (p = 0.118) or JP (p = 0.797) and no significant difference for all three pain areas between the front and the back side of the body. The body regions most often reported for MP were thighs, while for JP they were groin and hips, and for IP the hips, shoulders, and forearms were most frequently indicated. This is the first study to map and report the pain distribution associated with training across a 5‐day training camp in soccer goalkeepers, and these findings emphasize the value of using digital pain drawings clinically as well as for monitoring the health status of soccer players.

Pain is a health problem of vast dimension that requires prompt diagnosis. However, the evaluation criteria currently used in clinical settings are based on self-rating scales, which are subjective and prone to error. This may cause administering of improper analgesic treatments, either in dosage or in duration. For the scope of providing objective measures of pain and help devising effective therapeutic choices, we designed a personalized platform for sensing and monitoring pain. As input to the platform, visual, speech and physiological clues expressed by the patient during the pain experience are non-invasively measured, then sent to a cloud server to be integrated and analyzed. In this work, preliminary results obtained with the vision-based block of the platform are presented. Because the pain perceived by each individual is highly subjective, once the data are collected from each subject, quantitative descriptors are extracted and personalized selection of relevant features is performed to train a subject-specific regression model. Video sequences of genuine pain felt were tested and weighted accuracy values of 0.81 (0.19) and 0.84 (0.10) were obtained, respectively, for three-class and two-class scenarios, showing benefits and drawbacks of the proposed personalized platform.

Varlik K Erel,1 Heval Selman Özkan2 1Department of Anaesthesiology and Reanimation, 2Department of Plastic Surgery, School of Medicine, Adnan Menderes University, Aydin, Turkey Objectives: Today, many subjective methods are used to measure pain. Wong Baker and Hicks Facial Pain Scale is one of the most commonly used method. Clinicians grade pain according to the facial mimetic reaction of the patient. Unfortunately, there is no objective measure for monitoring pain. By using the same principle of the Wong Baker and Hicks Facial Pain Scale, in this study, we aimed to objectively measure pain by using a thermal camera to detect instant facial temperature changes.Materials and methods: Thirty volunteers who attended blood collection unit were subjected to facial thermal monitoring and measurements were obtained 5 minutes before needle puncture (BNP), during needle puncture (DNP), and after needle puncture (ANP). Data were processed with TestoIRSoft 3.8 software program and mean temperatures of the whole face (FFM) and highest temperature points (HP), horizontal line (HOR) between two pupils and first glabellar wrinkle, and bilateral lines starting from the nasolabial sulcus to oral commissure (NLS-1 at right, NLS-2 at left) were evaluated. All data were statistically analyzed with paired sample t-test.Results: Statistically, temperature measurements of HOR, NLS-1, NLS-2, HP, and FFM were significantly higher between BNP and DNP, significantly lower between ANP and DNP, and significantly higher between BNP and ANP (p

Currently there is no accurate objective measure for monitoring pain during the state of drug-induced unconsciousness (such as during surgical anesthesia). Moreover, the absence of an objective measure for detecting pain hampers the physician's ability to provide an optimal dose of analgesics. We have developed a novel method for detecting pain by quantifying skin blood flow dynamics using a miniaturized dynamic light scattering (mDLS) sensor placed on the skin. Healthy awake volunteers were studied with mDLS sensors placed on both index fingers while being subjected to a series of cutaneous painful stimuli (electric shock and heat), randomly applied in a range between the subjects’ pain threshold and tolerance. Power spectrum analysis of the recorded signal was performed with a focus on two frequency bands, representing relative blood flow of non-pulsatile vessels and larger pulsatile arterioles. Relative blood flow of pulsatile vessels decreased while flow of non-pulsatile vessels increased in response to painful stimulation, with a high correlation between the responses obtained on the right and left index fingers. The changes in hemodynamics that occur during painful stimulation suggest a redistribution of blood flow between pulsatile and non-pulsatile vessels, probably related to central activation of the sympathetic system combined with local dynamic autoregulatory responses. Thus, optical parameters of skin blood flow can detect nociceptive stimuli and consequently can serve as objective biomarkers of pain.

Monitoring of prescription pain medications is strongly recommended, considering their abuse liability. We used hair analysis for monitoring pain medications in 12 women with chronic migraine and drug overuse. Hair samples were collected at baseline and after 4 and 8 months and analyzed by liquid chromatography-electrospray tandem mass spectrometry (LC-ESI-MS/MS). Intra-patient variability of the hair-level-to-dose ratio was

Estudos têm demonstrado que a dor é uma das principais queixas dos pacientes que são atendidos nas Unidades de Urgência e Emergência, sendo avaliados os sinais vitais e, além disso, a gravidade da dor para posterior classificação e seguimento do atendimento. O objetivo foi analisar as produções científicas a respeito do manejo da dor frente à urgência e emergência. Para tanto se realizou uma pesquisa descritiva de revisão de literatura do tipo integrativa, sendo a busca dos artigos científicos realizada na base de dados SciELO e biblioteca virtual, utilizando-se os termos: “dor”, “urgência e emergência”, em todos os campos, e “enfermagem” em área do conhecimento. Os principais resultados apresentaram avaliação da dor frente a urgência e emergência, analisando durante o acolhimento do paciente o grau de dor para posterior classificação, atendimento médico e ser medicado conforme prescrição médica e monitorar o alívio da dor após analgésicos.

Background Rapid acute pain exacerbations, colloquially called pain flares, affect quality of life and are a key driver for patients to seek healthcare. There is no standardised definition of pain flare.1 Daily collection of patient-reported symptoms with mobile technology enables monitoring pain flares in real-time. The choice of definition may identify different people and patterns of pain severity. If remote monitoring of flares is to inform clinical practice and research, it is important to understand the implications of these choices. Objectives Investigate the frequency of pain flares from daily pain symptoms under various definitions in a population with chronic pain. Methods Participants with chronic (≥3 months) musculoskeletal pain in the smartphone study Cloudy with a Chance of Pain2 reported daily pain severity and impact of pain on a 5-point scale. Pain flares were defined in five ways: 1. Worse than average: pain severity higher than personal median 2. Above threshold: pain value 4 or 5 3. Move to above threshold: pain value 1 or 2 or 3 yesterday to 4 or 5 today 4. Absolute change: 2-point increase in pain since yesterday 5. Composite: 2-point increase in pain severity since yesterday and impact 4 or 5 Daily pain-flare rate was calculated by dividing the number of pain flares by the number of days a pain flare would have been possible, hereafter called at-risk days (def. 1+2: total days of symptom entry; def 3 to 5: days of data entry for which participant also entered data on preceding day). Monthly pain-flare rates per person were calculated by multiplying the rate by 30. Results The study smartphone app was downloaded by 13 256 people. After excluding people that never reported pain severity (n=2020), did not complete the baseline questionnaire (n=947), stayed in the study for less than 7 days (n=3418), and reported non-musculoskeletal chronic pain (n=728), 6143 were eligible for analysis. Table 1 shows that the portion of eligible people with at least one pain flare varies by definition, with 42% reporting at least one pain flare according to the most restrictive classification criterion. Depending on the criterion used, the monthly pain-flare rate per ranges from 0.9 to 8.7. Under the ‘worse than average’ and ‘above threshold’ definition, most participants have more than 10 pain flares per month (figure 1). Under the two most stringent definitions, most participants have between 0 and 3 pain flares per month. Conclusions The five plausible definitions for a pain flare are demonstrated to generate quite different flare rates through time. Pain flares in people with chronic musculoskeletal pain, however, remain common even as classification criteria become increasingly strict. As daily data collection of patient-generated data becomes possible, careful thought must be given to flares should best be defined for clinical practice and research. References [1] Gossec L, et al. doi:10.1136/annrheumdis-2015-208593 [2] Druce KL, et al. doi:10.2196/mhealth.8162 Disclosure of Interest None declared

Monitoring pain and finding more efficient methods for analgesic administration during anaesthesia is a challenge that attracts the attention of both clinicians and engineers. This work focuses on the application of Machine Learning techniques to assist the clinicians in the administration of analgesic drug. The problem will consider patients undergoing general anaesthesia with intravenous drug infusion. The paper presents a preliminary study based on the use of the signal provided by an analgesia monitor, the Analgesia Nociception Index (ANI) signal. One aim of this research is studying the relation between ANI monitor and the changes in drug titration made by anaesthetist. Another aim is to propose an intelligent system that provides decisions on the drug infusion according to the ANI evolution. To do that, data from 15 patients undergoing cholecystectomy surgery were analysed. In order to establish the relationship between ANI and the analgesic, Machine Learning techniques have been introduced. After training different types of classifier and testing the results with cross validation method, it has been demonstrated that a relation between ANI and the administration of remifentanil can be found.

Background: The vigilance-(attentional) avoidance hypothesis (VAH) developed for explaining phobic reactions describes an early attentional bias towards a feared stimulus followed by attentional avoidance of this stimulus. Such a pattern of attentional shifts might also be found when processing of pain-related stimuli is required. The purpose of the present study was to test the VAH for pain-associated stimuli, i.e., faces displaying pain, using the method of eye-tracking in a pain-free sample. Methods: Forty-eight healthy participants observed pictures of faces displaying pain and other emotions (anger, joy), presented concurrently with neutral faces, while their gaze behaviours were recorded continuously. Results: Analysis of the time course of fixation durations revealed a distinct pattern for pain faces. Participants gazed at pain faces longer than at neutral faces at the beginning (up to 1000 ms) but reduced preference for pain faces increasingly thereafter (up to 2000 ms); this decline in vigilance did not occur for anger and joy faces. Strong fear of pain (Fear of Pain Questionnaire) tended to increase attentional preference for negative faces (pain, anger), a finding, which however did not reach significance. Conclusions: We assume that initial vigilance for pain-associated stimuli might reflect an adaptive reaction to detect a potentially harmful stimulus. Subsequently, the pain-associated stimulus might be less attended for the purpose of mood regulation when all clear is given in this situation.

Background: Little is known about the feasibility and acceptability of using mobile technology among seriously ill older adults experiencing moderate to severe pain. Objective: A smartphone application was tested for feasibility and acceptability of use among ethnically-diverse older adults experiencing moderate to severe pain. Additionally, authors aimed to document patient perceived barriers and facilitators of using the mobile device for pain monitoring. Methods: Twenty-three participants were enrolled in a prospective feasibility study and followed for 75 days. Participants were provided prepaid smartphones with a preloaded pain application and were asked to send daily reports of pain to a palliative care physician within a managed care clinic. Pain was measured on an 11-point numeric rating scale (NRS) from no pain to worst ever; patients reporting a pain score of greater than 3 were contacted by a palliative care physician. Surveys on technology ease of use, usefulness, and intrusiveness were conducted at 30 days; qualitative interviews were conducted at the end of the 75-day study period. Results: The study was completed fully by 74% of the sample. Qualitative analyses revealed several themes related to benefits of smartphone use in monitoring pain and symptoms While participants reported the physical challenges using the mobile application, most reported application useful, and 100% would recommend to others. Conclusions: Older adults experiencing significant pain may be receptive to using mobile technology to monitor pain and transmit pain reports to physicians. However, simplified technological interactions are needed to overcome challenges experienced by older adults.

Previous research studies have confirmed therapeutic physical and psychological benefits of Tai Chi for both the able-bodied and disabled populations. However, given the limited availability of seated Tai Chi, there have not been any studies to date that have examined the effectiveness of seated Tai Chi in individuals with spinal cord disorder (SCD). We designed a customized seated Tai Chi program to meet the need for improved exercise options for individuals with SCD.Twenty-six participants were enrolled in a 12-week seated Tai Chi course consisting of weekly sessions. After each Tai Chi session, patients reported improved visual analog scale (VAS) monitoring pain (P) (3.18 v 2.93; P 1.63E-03), emotional sense of well-being (EWB) (2.61 vs 2.04; P 2.86E-07), mental distraction (MD) (3.13 v 2.29; P 9.36E-08), physical sense of well-being (PWB) (2.84 v 2.25; p 7.38E-08), and sense of spiritual connection (SC) (3.28 v 2.50; P 6.46E-08). In our limited follow-up of 9 participants who completed half of the sessions and the long term surveys after the 12-week course, there were no detectable differences in weekly P, EWB, MD, PWB, and SC before each session.Individuals with SCD demonstrated benefits in pain, emotional sense of well-being, mental distraction, physical sense of well-being, and sense of spiritual connection immediately after seated Tai Chi exercise sessions in our pilot study. More research in a larger population would be needed to study the long-term impact of seated Tai Chi.

Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.

Pain is one of the the most common symptoms with which patients present in primary care. Before pain can be managed, its severity and nature need to be understood. The nature of pain is important, as a good clinical history will guide further investigation, leading to diagnosis. Monitoring pain severity is critical, as pain is largely a subjective experience, which cannot be properly managed if worsening or improvement is not monitored from a baseline. Using a standard pain measurement tool will allow for pain management over time, as the response to analgesics can be properly monitored. Different tools, to allow practitioners to assess pain in any setting, are available for patients of all ages.

In April 2004, a questionnaire was distributed to veterinary nurses across the UK to assess their attitudes towards the assessment and management of pain in practice. During the six-week collection period, a total of 541 questionnaires were returned, of which 24 (4.25 per cent) were discounted due to completion errors. Overall, the pain scores for procedures involving dogs were higher than those for cats; the veterinary nurses' pain scores were higher for all procedures than those of veterinary surgeons in a previous study. Both veterinary nurses and veterinary surgeons were primarily involved with monitoring pain postoperatively, and 96 per cent of veterinary nurses felt that their knowledge of pain management could be enhanced; 8.1 per cent of the practices used a formal pain scoring system, with the simple descriptive scale most commonly used; 80.3 per cent of the veterinary nurses agreed that a pain scale was a useful clinical tool.

1.1 Background: Pain asessment is a challenge in patients who are unable to communicate verbally, e.g. neonates. Consequently, they may receive less effective analgesic treatment. Visual, behavioural and physiological pain scales are used clinically but they are not always reliable, especially in premature infants. Some studies have been published on the reliability and efficacy of a Skin Conductance Algesimeter (SCA) in monitoring pain in infants. However, the data is limited by small sample size and lack of utility in specific situations such as in ventilated children and during potentially painful procedures. 1.2 Objective: To evaluate clinical usefulness of SCA as a reliable measure of pain intensity and stress response in preterm infants. 1.3 Methods: The study was conducted over a period of 3 years and parents of all infants admitted to the NNU were invited to participate in the study. The SCA was compared with simultaneous measurement of ‘Premature Infant Pain Profile’ (PIPP) and ‘Face, Legs, Activity, Cry and Consolability (FLACC) scores during invasive / painful procedures by 2 independent assessors. Assessments were recorded for 3 minutes before, during and after the procedure. 1.4 Results: 85 measurements were recorded. PIPP and FLACC scores started low, increased during the procedure and decreased afterwards. For all SCA measurements, there was an increase in score pre-pro and a decrease in score pro-post. However, the standard deviation for variations was wider for some measurements than for others. Paired t-test comparing Delta pre-pro with Delta pro-post for all measurements {PIPP, FLACC, Area (small) and Peaks/sec} individually showed statistically significant differences (P

Electronic data collection for monitoring pain has become increasingly popular in clinical research. However, no direct comparison has been made between electronic diaries and self-report paper diaries or phone interviews. We asked 36 patients with chronic low back pain to monitor their pain for 1 year; 20 of them used both a palmtop computer and paper diaries, and 16 used paper diaries alone. All patients were called once a week and asked to rate their pain. Regression analyses with a measurement error model were run on hourly pain scores recorded by both palmtop computer and paper diaries. Ratings of pain intensity were highly reliable between data recorded with a palmtop computer and with data from paper diaries. Patients who monitored their pain with the palmtop computer entered data on average 6.75 times a week and were 89.9% compliant with daily monitoring throughout the year. Two-way messaging available through the palmtop computer seemed to encourage continued use of the device. Internal consistency of reporting and correlations with phone reports and standardized measures were highly significant, suggesting that data from electronic diaries are both reliable and valid. Patients using electronic diaries preferred them to paper diaries and showed much higher rates of compliance and satisfaction over the 1-year trial.

Background: Laboratory urine drug testing of patients on chronic opioid therapy requires providing a large test menu of medications commonly prescribed for this population as well as metabolites and illicit substances. It has been shown that liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the preferred method to analyze urine specimens for these substances. Purpose of the study: To describe the challenges and some of the techniques to validate the analytical procedures used to identify and quantify these medications and substances. Methods: Using data obtained from testing over one million specimens, the authors developed a proposed test menu. Potential isobaric interferences were established by using literature references. A list of potentially interfering medications was obtained by using the proposed test menu and the most commonly prescribed medications. Finally, criteria were designed to detect possible carryover. Results: The LC-MS/MS instrumentation eliminated all potential interferences and provided quantitative data over the test range needed to monitor these patients. Carryover could be eliminated by setting the carryover thresholds for each analyte. Conclusions: Reference laboratories utilizing LC-MS/MS technology to conduct urine drug testing for pain clinicians should employ specific techniques described in this study to develop an optimal test menu and validate procedures that include isolating retention times for isobaric compounds, identifying interfering substances including impurities in medicinal and illicit substance preparations, monitoring ion suppression, and avoiding carryover.

Chantier qualité GA; One important objective for animal welfare is to maintain animals free from pain, injury or disease. Therefore, detecting and evaluating the intensity of animal pain is crucial. As animals cannot directly communicate their feelings, it is necessary to identify sensitive and specific indicators that can be easily used. The aim of the present paper is to review relevant indicators to assess pain in several farm species. The term pain is used for mammals, birds and fish, even though the abilities of the various species to experience the emotional component of pain may be different. Numerous behavioural changes are associated with pain and many of them could be used on farms to assess the degree of pain being experienced by an animal. Pain, as a stressor, is associated with variations in the hypothalamic-pituitary-adrenal axis as well as in the sympathetic and immune systems that can be used to identify the presence of pain rapidly after it started. However, most of these measures need sophisticated equipment for their assessment. Therefore, they are mainly adapted to experimental situations. Injuries and other lesional indicators give information on the sources of pain and are convenient to use in all types of situations. Histopathological analyses can identify sources of pain in experimental studies. When pronounced and/or long lasting, the pain-induced behavioural and physiological changes can decrease production performance. Some indicators are very specific and sensitive to pain, whereas others are more generally related to stressful situations. The latter can be used to indicate that animals are suffering from something, which may be pain. Overall, this literature review shows that several indicators exist to assess pain in mammals, a few in birds and very few in fish. Even if in some cases, a single indicator, usually a behavioural indicator, may be sufficient to detect pain, combining various types of indicators increases sensitivity and specificity of pain assessment. Research is needed to build and validate new indicators and to develop systems of pain assessment adapted to each type of situation and each species.

Three in four children with cerebral palsy experience pain and one in five has a sleep disorder. Early identification and intervention are critical to the well-being of children and their families. This study examines the incidence of pain and sleep disorders from prospectively collected surveillance data of individuals with cerebral palsy.

We've used Near-Infrared Spectroscopy (fNIRS) as a noninvasive tool to monitor blood oxygenation due to the acute pain stimuli. The aim of the study was to find a relationship between the signals recorded by activation of the anterior cingulated cortex (ACC) in healthy subjects, who experience pain via stimulation, and the subject reported pain. These findings will shed light on pain related cognitive studies. Based on our findings, we believe that the fNIRS can be used as a tool for monitoring pain in the brain as well as an effective tool for monitoring the objective efficiency of the pain treatments. Results have shown a correlation between the fNIRS signal and patients' subjective pain level (mild, moderate and severe) which is evidence that the fNIRS is a useful tool for monitoring objective pain response.

Biologic medications are highly efficacious in juvenile idiopathic arthritis. However, a recent study found that a subgroup of children treated with anti-TNF agents had persistent pain despite good disease control. This finding highlights the importance of monitoring pain symptoms during treatment with modern DMARDs.

Background Assessment of pain is a challenge in neonatal setting. Visual, behavioural and physiological pain scales are not always reliable in premature infants. Few studies with limited sample size have been published on the reliability and efficacy of Skin Conductance Algesimeter (SCA) in monitoring pain in infants and children. Aim To identify the clinical usefulness of SCA as a reliable and valid measure of pain intensity and stress response in preterm infants. Methods Parents of all preterm infants admitted to the neonatal unit were invited to participate in the study. The usefulness of SCA was compared with simultaneous measurement of ‘Premature Infant Pain Profile’ (PIPP) and ‘Face, Legs, Activity, Cry and Consolability (FLACC) scores during invasive and/or painful procedures. Results 85 measurements were recorded. PIPP and FLACC scores started low, increased during the procedure and decreased afterwards. For all SCA measurements, there was an increase in score pre-pro and a decrease in score pro-post. However, the standard deviation for variations was wider for some measurements than for others. Paired t-test comparing Delta pre-pro with Delta pro-post for all measurements {PIPP, FLACC, Area (small) and Peaks/sec} individually showed statistically significant differences (p Conclusions SCA, PIPP and FLACC scores increased during the painful procedures. Although the SCA, PIPP and FLACC data is mathematically correlated, at a clinical level, the correlation is too imprecise to use the SCA to predict or measure behavioural responses to noxious stimuli in neonates.

Context A high incidence of painful upper limb has been observed in the hemiplegic patients hospitalised in a neurorehabilitation unit of the University Hospital of Nantes. This lead to the setting up of a multidisciplinary working group including caregivers trained to professional practice evaluation (EPP). Our aim was to reduce the incidence of such pathology and improve patient9s functional recovery. Program The working-group meets monthly since January 2009 including a physical medicine and rehabilitation practitioner, a chief manager, a nurse, a physiotherapist, two occupational therapists and four nurses9 auxiliary. Quarterly meetings were organised for all caregivers in the hospital. Eight targets were established by the working group: (1) to define and precise the diagnosis9 criteria of the Complexe Regional Pain Syndrom; (2) to identify risks factors to detect and prevent occurrence; (3) to define useful clinical assessment; (4) to share patients9multidisciplinary evaluation tasks out; (5) to assess professional practice of all caregivers involved in the patients rehabilitation; (6) to design a guideline of good practices based on literature data and evidence based practice; (7) to develop preventive and curative actions; and (8) to create a steering committee. Results Point 5 was a cross-sectional study in the unit on a day (June 2009) in order to assess the professional practice for hemiplegic9s nursing. Eight patients were concerned. All had experienced a painful upper limb since stroke onset. Their installation was described as poored in many cases. This cross-sectional study acknowledge the fact that hemiplegic nursing is complex, as it has to take to account the disability, the surrounding and the rehabilitation objectives. Needs that were identified were: Focus on the diagnosis and risk factors for CRPS type 1 (items 1, 2, and 3, March 2009) Presentation of the stake of multidisciplinary assessment for various situations encountered by the hemiplegic patient in a day (item 4, July 2009) Presentation of existing installation devices (item 7, July 2009) Training for nursing and handling (item 7, March 2010) Training for monitoring pain (item 7, December 2009) Revision of occupational and physiotherapeutical technics according to Evidence Based Practice. (item 6–7, June–September 2010) Discussion The next study is expected in March 2010 (after training). The clinical impact is expected to decrease the incidence of painful upper limb, improved pain assessment and installation. Caregivers are aware of the process and motivated to improve practice. This improvement of a professional practice might have a considerable impact because it will be applied not only at the stage of the patient and the caregiver but in a dynamic conception of patient9s way from initial stroke unit to home. Patient9s environment, daily activities, independence have to be considered in the process. Contexte, objectifs Une incidence elevee de douleurs du membre superieur deficitaire chez l9hemiplegique observee dans l9unite de medecine physique et readaptation (MPR) neurologique du CHU de Nantes prenant en charge des patients cerebroleses a conduit a la mise en place d9un groupe de travail pluridisciplinaire de personnes sensibilisees a l9evaluation des pratiques professionnelles (EPP). Le but est de diminuer cette incidence et d9ameliorer les probabilites de recuperation fonctionnelle des patients. Programme: description, mise en œuvre, suivi Le groupe se reunit mensuellement depuis janvier 2009. Il est constitue d9un medecin MPR, un cadre de sante, une infirmiere, un kinesitherapeute, deux ergotherapeutes et quatre aides soignantes issus de l9unite concernee. Une demarche EPP selon la methode dite du « Staff-EPP des equipes hospitalieres » est developpee sous la forme d9une reunion trimestrielle et s9adresse a l9ensemble du personnel du pole MPR. Apres problematisation, le groupe de travail a pose huit objectifs d9action: 1/ apprehender la definition du syndrome douloureux regional complexe et expliciter son diagnostic, 2/ identifier les facteurs de risque references dans la litterature afin de depister et agir, 3/ etablir un releve des bilans cliniques et paracliniques a realiser, 4/ repartir et coordonner les tâches d9evaluation pluridisciplinaire du patient, 5/ faire un etat des lieux des pratiques professionnelles de l9equipe medicosoignante de l9unite de soin en prenant en compte l9ensemble du parcours du patient, 6/ concevoir un referentiel de bonnes pratiques s9appuyant sur les donnees de la litterature et les niveaux de preuve (Evidence Based Practice), 7/ mettre en oeuvre des actions preventives et curatives, 8/ elaborer le dispositif de pilotage et de suivi. Resultats Le point 5 consistait en une etude transversale dans le service sur une journee (juin 2009) permettant d9evaluer les pratiques professionnelles d9installation des 8 patients hemiplegiques hospitalises dans l9unite a cette date. Tous ont presente durant leur sejour un membre superieur douloureux. Leur installation sur 24h etait qualifiee de mauvaise dans plusieurs situations. Le premier constat de cette coupe est qu9il n9y a pas une mais des installations a concevoir en prenant en compte l9autonomie, l9entourage et les objectifs de reeducation et de readaptation du moment. Des besoins ont ete identifies: mise au point sur le diagnostic et les facteurs de risque de SDRC de type 1 (point 1-2-3, mars 2009), presentation de l9enjeu de l9evaluation pluridisciplinaire du patient hemiplegique en considerant la diversite et la complexite des situations inherentes au patient et aux soignants sur 24h (parcours de soin) (point 4, juillet 2009), presentation des dispositifs existants pour l9installation (point 7, juillet 2009). Formation a l9installation et a la manutention (point 7, mars 2010). Formation a l9evaluation et au suivi de la douleur (point 7, decembre 2009). Revision et mise au point des techniques de massokinesitherapie et ergotherapie selon l9Evidence Based Practice. (point 6-7, juin et septembre 2010). Discussion Une prochaine coupe est prevue en mars 2010 apres la formation. L9impact clinique attendu est la diminution de l9incidence de membre superieur douloureux, une meilleure evaluation de la douleur et de l9installation. Les soignants sont sensibilises au processus et motives pour ameliorer la pratique. L9enjeu d9une intervention a fort impact clinique n9est pas seulement le bon dispositif d9installation du patient et les bonnes pratiques apppliquees par chaque intervenant soignant mais une conception dynamique du parcours du patient qui s9etend de l9unite d9hospitalisation en phase aigue jusqu9a son domicile, en prenant en compte son environnement, son emploi du temps, ses activites, ses capacites d9autonomie.

Background Assessment of pain is a challenge in neonatal setting. Visual, behavioural and physiological pain scales are not always reliable in premature infants. Few studies with limited sample size have been published on the reliability and efficacy of Skin Conductance Algesimeter (SCA) in monitoring pain in infants and children. Aim To identify the clinical usefulness of SCA as a reliable and valid measure of pain intensity and stress response in preterm infants. Methods Parents of all preterm infants admitted to the neonatal unit were invited to participate in the study. The usefulness of SCA was compared with the simultaneous measurement of ‘Premature Infant Pain Profile’ (PIPP) and ‘Face, Legs, Activity, Cry and Consolability (FLACC) scores during invasive and/or painful procedures. Results 46 measurements were recorded from 31 patients. The gestational age at birth ranged from 27+5 from 35+1. Mean PIPP scores Pre: 3.063±1.272, Pro: 9.175±3.761, Post 4.275±1.506. Two-tailed Paired t-test Pre - Pro, t=10.82, P Conclusions PIPP and FLACC scores were statistically significantly increased during the procedures. Further research is needed to ascertain the usefulness of SCA in preterm infants.

This article discusses the roles of the critical care team in providing pain relief. The attitudes of the staff concerning pain relief impact on the delivery of care. Assessment tools, computer systems, and flow sheets to assist in charting are described. Nurses have a role in use of epidural administration of narcotics, and provide relief with the use of patient-controlled analgesia and general pain relief measures. Pain as a nursing diagnosis, substance abuse in the medical profession, and control of narcotics are also issues discussed.

Registration of pain must take into consideration the private nature of the pain experience while providing researcher and practitioner with measures which obtain satisfactory levels of compliance, reliability and sensitivity. A three-component model of pain based on social learning theory, comprised of physiological, cognitive/affective and overt behavioural dimensions has been shown to be a valuable tool in monitoring pain. Applications of the model show that it has satisfactory methodological characteristics when used in a study with continuous self-recording by patients, that it can accommodate discrepancies in physiological and affective dimensions and that it offers a variety of sensitive measures for evaluating treatment of pain.