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Background: The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3–4):190–201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia. Methods: Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement. Results: PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35–0.50; transfer: 0.38–0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer. Conclusions: Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results. [ABSTRACT FROM AUTHOR]

Abstract Background The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3–4):190–201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia. Methods Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement. Results PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35–0.50; transfer: 0.38–0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer. Conclusions Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results.

Introduction In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. Methods A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18–55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. Results There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Conclusions Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

Abstract Background and aims Pain is common in older individuals. In order to understand and treat pain in this group, reliable and valid measures are needed. This study aimed to evaluate: (1) the validity, utility, incorrect response rates and preference rates of 5 pain rating scales in older individuals; and (2) the associations between age, education level, and cognitive function and both (a) incorrect response and (b) preference rates. Methods Two hundred and one orthopedic clinic outpatients ≥ 65 years old were asked to rate their current pain, and least, average, and worst pain intensity in the past week using 5 scales: Verbal Numerical Rating Scale (VNRS), Faces Pain Scale - Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS). Participants were also asked to indicate scale preference. We computed the associations between each measure and a factor score representing the shared variance among the scales, the incorrect response and scale preference rates, and the associations between incorrect response and preference rates and age, education level, and cognitive function. The incorrect responses included being unable to respond, providing more than one response, responses outside a range, providing range answers rather than fixed answers, and responses indicating ‘least > average,’ ‘least > worst,’ and ‘average > worst’. Results The findings support validity of all 5 scales in older individuals who are able to use all measures. The VNRS had the lowest (2%) and the VAS had the highest (6%) incorrect response rates. The NRS was the most (35%) and the VAS was the least (5%) preferred. Age was associated with the incorrect response rates of the VRS and VAS, such that older individuals were less likely to use these scales correctly. Education level was associated with the incorrect response rates of the FPS-R, NRS and VAS, such that those with less education were less likely to use these measures correctly. Cognitive function was not significantly associated with incorrect response rates. Age, education level and cognitive function were not significantly associated with scale preference. Conclusions Although all five scales are valid, the VNRS evidences the best overall utility in this sample of older individuals with pain. The NRS or FPS-R would be fine alternatives if it is not practical or feasible to use the VNRS.

Background and aims: Pain is common in older individuals. In order to understand and treat pain in this group, reliable and valid measures are needed. This study aimed to evaluate: (1) the validity, utility, incorrect response rates and preference rates of 5 pain rating scales in older individuals; and (2) the associations between age, education level, and cognitive function and both (a) incorrect response and (b) preference rates. Methods: Two hundred and one orthopedic clinic outpatients ≥ 65 years old were asked to rate their current pain, and least, average, and worst pain intensity in the past week using 5 scales: Verbal Numerical Rating Scale (VNRS), Faces Pain Scale - Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS). Participants were also asked to indicate scale preference. We computed the associations between each measure and a factor score representing the shared variance among the scales, the incorrect response and scale preference rates, and the associations between incorrect response and preference rates and age, education level, and cognitive function. The incorrect responses included being unable to respond, providing more than one response, responses outside a range, providing range answers rather than fixed answers, and responses indicating 'least > average,' 'least > worst,' and 'average > worst'. Results: The findings support validity of all 5 scales in older individuals who are able to use all measures. The VNRS had the lowest (2%) and the VAS had the highest (6%) incorrect response rates. The NRS was the most (35%) and the VAS was the least (5%) preferred. Age was associated with the incorrect response rates of the VRS and VAS, such that older individuals were less likely to use these scales correctly. Education level was associated with the incorrect response rates of the FPS-R, NRS and VAS, such that those with less education were less likely to use these measures correctly. Cognitive function was not significantly associated with incorrect response rates. Age, education level and cognitive function were not significantly associated with scale preference. Conclusions: Although all five scales are valid, the VNRS evidences the best overall utility in this sample of older individuals with pain. The NRS or FPS-R would be fine alternatives if it is not practical or feasible to use the VNRS. [ABSTRACT FROM AUTHOR]

INTRODUCTION In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. METHODS A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. RESULTS There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. CONCLUSIONS Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke. [ABSTRACT FROM AUTHOR]

Perceived pain is a multi-factorial subjective variable, commonly measured by numeric rating scales, verbal descriptive scales (VDS), or by a position on an analogue line (VAS). A major question is whether an individual’s VAS and VDS pain assessments, on the same occasion, could be comparable. The aim was to compare continuous and discretized VAS pain data with verbal descriptive pain datasets from the Oswestry Disability Index (ODI) and the European Quality of Life Scale (EQ-5D) in paired pain datasets.

Purpose of Review: It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. Recent Findings: Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. Conclusion: Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population. [ABSTRACT FROM AUTHOR]

Background: People with profound intellectual disabilities are a population with complex comorbidities. Total pain recognises the interconnectedness of aspects of pain; social, psychological, physical, emotional, spiritual. Pain is under‐recognised due to communication challenges and carers perceptions. This review's purpose is to synthesise current literature and provide guidance for future research and care. Methods: Five databases were searched in this mixed methods systematic review (Cinahl, Medline, Psycinfo, Web of Science, Scopus). Articles retrieved were reported via a PRISMA flow diagram. Quality appraisal utilised the mixed methods appraisal tool (MMAT). A convergent qualitative design was the method of data synthesis. Results: Data from 16 included articles generated four themes; Absent voices, reductionist assessment, pain intensity, valuing expertise. Data included physical pain only. Conclusion: Multifaceted pain needs inclusion in research. Assessment must consider the unique expressions of pain by individuals with profound intellectual disabilities. A sharing of expertise may improve pain care. [ABSTRACT FROM AUTHOR]

Newborns feel pain and the more premature they are, the more immature are their pain attenuation system. Facial expression recognition provides a non-invasive method that has been widely used in clinical practice to assess pain in newborns. In this context, this work has performed a qualitative and quantitative assessment between the ranking importance of neonatal facial features proposed by 13 clinical scales commonly cited in the literature and the visual perception of 143 health and non-health professionals on those same features. The degree of similarity between these two ranking approaches was evaluated by Kendall's correlation. To the clinical scales, the most relevant facial features are the eyes, regions in-between eyebrows and forehead. However, according to the visual perception of the participants when assessing pain on face images, regardless of clinical expertise, the most relevant facial feature is the nose. These qualitative results are statistically supported by the Kendall analyses carried out. Specifically, our results highlight that the neonatal facial features ranked as the most important ones by the clinical scales cannot be considered correlated with the visual perception of the participants, either experts or non-experts. Moreover, all groups of participants have presented high correlated rankings between each other. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate painful procedures in ICU patients and to investigate their effect as well as the role of analgesia in the outcome. We measured pain level and vital signs before, during and after potentially painful procedures by using the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). We analyzed the correlation of these measurements and of analgesia with the outcome. Twenty-eight patients were subjected to 160 stimuli. There were statistically significant differences in pain scores and most vital signs between the different timepoints (before-during, during-after). Most of them were significantly correlated with each other. Physiotherapy proved to be the most painful procedure. Regarding the outcome, the administration of extra analgesia predicted less days of mechanical ventilation (p = 0.015) and of ICU stay (p = 0.016). The higher change in BPS was correlated with more days of mechanical ventilation [B (95% CI) = 3.640 (1.001–6.280), p = 0.007] and of ICU stay [B (95% CI) = 3.645 (1.035–6.254), p = 0.006]. The higher change in CPOT and the nonuse of extra analgesia were related to increased mortality [OR (95% CI) = 1.492 (1.107–2.011), p = 0.009 and OR (95% CI) = 2.626 (1.013–6.806), p = 0.047]. Increased pain in ICU patients was successfully assessed by the BPS and CPOT and correlated to worse outcomes, which the administration of extra analgesia might improve. [ABSTRACT FROM AUTHOR]

In previous years interest has grown in investigating the attitudes and capabilities of veterinarians regarding the recognition, quantification and treatment of animal pain throughout different parts of the world and encompassing various species. This is the first report exploring the attitudes and self-rated abilities of veterinarians in Bosnia and Herzegovina (B&H) concerning recognition and quantification of pain in domestic animals. A study questionnaire was made available to 535 general practice veterinarians throughout B&H and 73 (14%) responded in full. The questionnaire contained polar, multiple choice, ordinal and interval scale questions and consisted of sections asking about demographic data, attitudes to pain recognition and quantification, use and availability of analgesics, estimates of pain intensity during specific surgical procedures, and the perceived need for pain assessment and continuing education programmes for analgesia. Half of the respondents considered the recognition and quantification of pain to be difficult while 89% did not make use of pain assessment scales. Of the respondents, (33/73; 45%) felt a certain level of pain to be advantageous since it reduces the activity of the healing animal, whereas 52% (38/73) did not agreed with this concept. Cost was a consideration when deciding whether or not to use analgesics for 58% (42/73) of the respondents with the most commonly used types being NSAIDs (72/73;99%) and opioids (60/73; 82%). Practitioners in B&H displayed awareness of the importance of pain assessment and management however a significant proportion were unaware of pain scales and relied upon physiological indicators of pain.

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services. [ABSTRACT FROM AUTHOR]

Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain. [ABSTRACT FROM AUTHOR]

Effective pain management is widely acknowledged as a core determinant for the provision of high quality care for both acute and chronic paediatric health care settings. Children with cognitive disabilities (CD), including intellectual disabilities (IDs), and cognitive impairments, have been identified as being at greater risk of experiencing pain and commonly they are lacking the ability to communicate pain adequately. Scope of this special article is to point out the importance of self-reporting with the use of simple pain tools in these children and to provide readers with a tool set for observational and proxy assessment. Moreover, introduces the idea of a systematic mixed method of assessment for adequate pain recognition in every setting. The main barriers for pain assessment in children with cognitive impairment are verbal restrictions and their inability to communicate pain as well as the atypical way they commonly express pain. Therefore, the use of an individualized approach with a mixed method of self-report, proxy report, and observational validated tools is highly recommended. The development of specific tools designed to detect and assess pain in children with intellectual disabilities is an important step in the assessment and management of the pain they experience. Since there is no ideal tool to achieve an accurate measurement of pain, the most appropriate evaluation scale according to the circumstances, or a combination of different tools, should be implemented. Clinical and translational research should focus more on the development, validation and reliability of pain assessment tools for children with cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: Assessing pain intensity is an important palliative care task. Self-report pain intensity scales are frequently used within assessment. In contrast to formal studies of validity and reliability, we examine administration of, and responses to these scales in everyday palliative care.Methods: We searched episodes of pain scale use in a dataset of (video/audio-recorded) UK palliative care consultations involving five doctors, 37 terminally ill patients and their companions. We found five, and applied the techniques and tools of conversation analysis to characterise scales' administration and functioning.Results: Generally, the patients responded to scales by reporting multiple aspects of pain; the doctors supported and encouraged this. In two episodes, the scales generated misunderstandings. The doctors worked to resolve these in ways that avoided implying the patient was at fault.Conclusion: Pain intensity scales can yield richer information than just intensity. They can also generate misunderstandings and social friction which take skill and effort to resolve.Practice Implications: Patients tend to respond to pain intensity scales by reporting on multiple aspects of pain, professionals should support them in this. These scales sometimes generate misunderstandings. To preserve the therapeutic relationship, professionals should work to resolve these without implying the patient is to blame. [ABSTRACT FROM AUTHOR]

Evidence supporting the safe use of the single-port (SP) robot for partial nephrectomy is scarce. The purpose of this study was to compare perioperative outcomes for patients undergoing robotic assisted SP vs multi-port (MP) partial nephrectomy (PN) in a time-matched cohort. All patients with clinically localized renal masses who underwent robotic PN from January 2019 to March 2020 were evaluated. Patients were stratified according to SP vs MP approach. Postoperative analgesia was administered in accordance with department-wide opioid stewardship protocol and outpatient opioid use was tracked. Total of 78 patients underwent robotic PN with 26 patients in the SP cohort. The majority of renal masses had low-complexity (53, 67.9%) R.E.N.A.L. nephrometry scores, without a significant difference between the two cohorts (p = 0.19). A retroperitoneal approach was performed in 16 (20.5%) patients overall, though more commonly via the SP robotic approach (13 vs 3, p < 0.001). Mean operative time for SP cases was 183.9 ± 63.5 min vs 208.6 ± 65.0 min in the MP cohort (p = 0.12). Rate of conversion to radical nephrectomy was 3.8% vs 9.6% for SP vs MP cases, respectively, (p = 0.37). The majority of patients were discharged on postoperative day one (67.9%) irrespective of operative approach (p = 0.60). There were no differences in inpatient milligram morphine equivalents administered (MME, p = 0.08) or outpatient postoperative MME prescribed (p = 0.21) between the two cohorts. In this retrospective single-institution study, SP robotic approach offers similar short-term perioperative outcomes to MP platforms for minimally invasive, nephron-sparing surgery. Using the SP system was not associated with a reduction in postoperative opioid analgesic requirements. [ABSTRACT FROM AUTHOR]

Abstract Objective To present the Pain-Track, a novel framework for the description and analysis of the pain experience based on its temporal evolution, around which intensity and other attributes of pain (texture, anatomy), interventions and clinical symptoms can be registered. This time-series approach can provide valuable insight on the expected evolution of the pain typically associated with different medical conditions and on time-varying (risk) factors associated with the temporal dynamics of pain. Results We illustrate the use of the framework to explore hypotheses on the temporal profile of the pain associated with an acute injury (bone fracture), and the magnitude of the pain burden it represents. We also show that, by focusing on the critical dimensions of the pain experience (intensity and time), the approach can help map different conditions to a common scale directly relating to the experiences of those who endure them (time in pain), providing the basis for the quantification of the burden of pain inflicted upon individuals or populations. An electronic version for data entry and interpretation is also presented.

Background: Adenotonsillectomy is associated with severe postoperative pain. The parent's postoperative pain measure (PPPM), a 15‐item instrument to measure a child's pain at home, has been validated with a seven‐point faces scale in children 7–12 years and with the parents' global report of pain in children 2–6 years. Aims: Our primary objective was to validate the PPPM with a recommended age‐appropriate pain scale in children 2–12 years after adenotonsillectomy. Our secondary objective was to reduce the PPPM components and validate this reduced PPPM. Methods: We recruited 319 children out of the 563 adenotonsillectomies performed between December 19, 2017, and December 18, 2018. Parents recorded administration of analgesics and their child's pain scores twice daily for 14 days: PPPM for all children and either the face, legs, arms, crying, consolability (FLACC) pain scale for children 2–3 years or the faces pain scale‐revised (FPS‐R) for children 4–12 years. In addition, parents recorded analgesics. Results: Among the 354 eligible children, 9% of parents declined. 252 (79%) families submitted pain diaries. The median age was 2.9 [2.5–3.3] years for FLACC (n = 114) and 5.6 [4.5–7.2] years for FPS‐R (n = 138). Across the 14‐day recovery period, Cronbach's alpha for PPPM was 0.77 to 0.87. Generalized linear mixed models evaluated the association between PPPM and reference pain scales after adjustment for potential confounders. Time of day and postoperative days were included as predictors in the models. PPPM was strongly associated with FLACC and FPS‐R (beta coefficient = 0.4; p < 0.0001). The association decreased over time, and the reduction was more significant for FPS‐R than FLACC (beta coefficient = −0.13 vs. −0.04, respectively; p < 0.0001). There was a positive association between PPPM and the use of analgesics. A reduction analysis eliminated items from the original PPPM: four for FLACC and five for FPS‐R, suggesting age‐related differences. The reduced PPPM instruments achieved similar associations with their respective reference pain scales (beta coefficient = 0.5; p < 0.0001). Conclusions: This study extends previous work by validating the PPPM in children as young as 2 years with a recommended age‐appropriate pain scale over 14‐day convalescence after adenotonsillectomy. The reduced PPPM instruments differed in the two age groups. Future studies might explore these age‐appropriate reduced PPPM instruments to assess pain at home following adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Pain communication in healthcare is challenging. We examine use of pain scales to communicate pain severity via a case study of people with sickle cell disorder (SCD). We show how pain communication involves complex social interactions between patients, healthcare professionals and significant others – none of which are included in pain ratings. Failure to account for relational aspects of pain may cause problems for any patient. For SCD, mutual distrust shapes pain communication, further complicating clinical assessments. Moreover, SCD pain is particularly severe, making ratings hard to interpret compared with ratings from non-SCD patients, potentially exacerbating problems in managing pain relief. [ABSTRACT FROM AUTHOR]

Copyright of KONTAKT - Journal of Nursing & Social Sciences related to Health & Illness is the property of University of South Bohemia in Ceske Budejovice, Faculty of Health & Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pain has become a hospital priority, and a parameter of quality of care, even being considered the fifth vital sign. The most frequent prototype of pain is postoperative pain, if it is not treated properly it may have important repercussions. Making the patient understand that the scale that we are going to evaluate is the responsibility of the nurse. A correct assessment and adequate treatment of pain will help patients to have a more comfortable postoperative period, with less pain and in this way help them to regain, as far as possible, their autonomy. [ABSTRACT FROM AUTHOR]

Context Pain is a common complaint in maintenance hemodialysis (MHD) patients, and it is often inadequately assessed and inappropriately treated. Objectives The study goal was to preliminarily evaluate pain management in MHD patients. Methods The study was a cross-sectional study conducted in 2013–2015. A sample of 277 MHD patients who reported pain within the last 24 hours from five hospital hemodialysis units in Israel were interviewed and evaluated. Study tools included the Brief Pain Inventory, the Pain Management Index (PMI), demographic and clinical characteristics. Pharmacy computerized data were reviewed to identify the type of analgesics used. Results Mean pain level was 7.2 ± 2.2 (median: 8). Pain level was mild in 17 (6.1%), moderate in 120 (43.3%) and severe in 140 (50.5%) of patients. Only 185 participants (66.8%) were treated with analgesics during the year prior to the interview. Of these, 99 (53.5%) received opioids. Using the PMI to preliminarily assess the appropriateness of the treatment, 214 (77.3%) of patients with pain in the last 24 hours were undertreated, and 52 patients (18.8%) were appropriately treated. In a multivariable analysis, factors associated with inappropriate treatment were severe pain intensity and a higher Functional Independent Measure (FIM). A lower FIM was associated with opioid use in a multivariable analysis. Conclusions According to the PMI, most dialysis patients were found to be inappropriately treated. About one third received opioids, but even among them, inappropriate treatment was common. Pain management in MHD patients needs to be improved. [ABSTRACT FROM AUTHOR]

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.

Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

Objective: To present the Pain-Track, a novel framework for the description and analysis of the pain experience based on its temporal evolution, around which intensity and other attributes of pain (texture, anatomy), interventions and clinical symptoms can be registered. This time-series approach can provide valuable insight on the expected evolution of the pain typically associated with different medical conditions and on time-varying (risk) factors associated with the temporal dynamics of pain. Results: We illustrate the use of the framework to explore hypotheses on the temporal profile of the pain associated with an acute injury (bone fracture), and the magnitude of the pain burden it represents. We also show that, by focusing on the critical dimensions of the pain experience (intensity and time), the approach can help map different conditions to a common scale directly relating to the experiences of those who endure them (time in pain), providing the basis for the quantification of the burden of pain inflicted upon individuals or populations. An electronic version for data entry and interpretation is also presented. [ABSTRACT FROM AUTHOR]

Abstract Background The assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain. Methods This cross-sectional study included 426 children (6–35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child’s pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher’s test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain. Results In children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P

Over decades, Brazilian livestock has experienced a great development in the areas of nutrition, genetics, management and especially with regard to animal welfare. A factor that is inversely related to welfare is pain, however pain measurement is still a challenge for producers and researchers, since cattle are stoic and do not show feelings. Despite this, it is known that pain promotes various disorders in the animal's health and, as a consequence, can cause an unpleasant sensory and emotional experience associated with current or potential injury. Thus, the objective of this review is to present the advances and the importance of evaluating animals affected by some type of injury through methods and techniques for identifying and measuring pain, in addition to its possible influence on the behavior and welfare of cattle. Studies in this field use physiological, hormonal and metabolic analyzes, as well as specific markers for pain, combined with the behavioral observation technique. However, there is no method that takes into account the combination of all these factors for cattle, thus indicating how important is the search for new means of diagnosis that can be applied in the field. One of these advances is through new technologies to assess animal behavior or what is the type of discomfort. Conclude that the advances in this case are constant and those that were made during the behavioral evaluation, in order to promote quality and safety of the products and consequently improve the recovery, sustainability and profitability of the productive system. [ABSTRACT FROM AUTHOR]

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Pain management is one of the main challenges in addressing the improved care of hospitalized newborns. The administration of oral sucrose with and without non-nutritive suction has been proposed as a nonpharmacological intervention to relieve procedural pain in newborns. The effects have not yet been well characterized. The aim of this study is to investigate, using skin conductance algesimeter (SCA) pain monitor index, the effects of 24% sucrose solution on pain perception during capillary and arterial blood sampling. It is a prospective, randomized controlled study: sucrose versus placebo. Sucrose was given orally to infants who were submitted to arterial or capillary sampling. The SCA was measured during, and for 3 min before and after the intervention. Fifty-six infants were enrolled: 31 in the sucrose group and 25 in the placebo group. SCA showed that the measurement of peaks per second of pain during and 3 min after the procedures was lower in the sucrose group than the placebo group and that this difference was statistically significant (p <.05). In conclusion, 24% sucrose administered orally is effective in reducing pain during and after capillary and arterial sampling in newborns and can be used for the prevention and treatment of pain in the Neonatal Intensive Care Unit. Brief rationale To treat neonatal pain, a tiered approach with nonpharmacological and pharmacological method can be used. Among nonpharmacological therapies, sucrose administration is safe and effective in reducing single episodes of minor procedural pain. This study aimed to investigate, the effects of 24% sucrose solution on pain perception during capillary and arterial blood withdrawn by using an objective method: skin conductance algesimeter (SCA) pain monitor index. This randomized controlled trial in which term and/or preterm neonates (postnatal age maximum of 28 days corrected for postmenstrual age) received sucrose for procedural pain. Oral sucrose was administered directly by a disposable plastic vial. SCA was measured by means of a specific device. We demonstrated, using SCA pain monitor index, the efficacy of 24% sucrose solution on pain perception during capillary and arterial blood withdrawn. The results of this study provide an objective evidence of sucrose efficacy for the prevention and treatment of neonatal painful procedures. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted in order to compare the level of compliance and patient preferences among the Visual Analogue, Numerical Rating, Verbal Descriptor and Facial Pain Rating scales that are commonly used in adults, including the elderly. Materials and Methods: The study was conducted using a descriptive research model at the surgery clinics of a university hospital between March 17 and June 17, 2016. A total of 120 adult patients, being 40 in each group, were included in the study. Individual Characteristics Form, Visual Analogue Scale, Numerical Rating Scale, Verbal Descriptor Scale and Facial Pain Scales were used to collect the data. Result: In this study, the correlation coefficients between 0.71 - 0.83 and four pain scales were found to be in conformity with each other. Numerical Rating Scale was the most simple scale that was preferred to be used in the future by all patients with the least error rate, while the Visual Descriptor Scale was the least simple and least preferred scale by the patients with the highest error rate. The most simple and more preferred scale to use by young and middle-aged patients was the Numerical Rating Scale, while the elderly selected the Visual Descriptor Scale as the most simple and more preferred scale to use. Conclusion: The four scales are in good agreement with each other and Numerical Rating Scale is the first choice, the Verbal Descriptor Scale is the second choice, and the Visual Analogue Scale is the last choice in evaluating the postoperative acute pain intensity. [ABSTRACT FROM AUTHOR]

Background: Frequency, severity, and duration of attacks are some major parameters in headache management, affected by some other factors. Ignoring these factors in headache-related studies can lead to incorrect results. We aimed to model both socio-demographic characteristics and headache-associated symptoms related to frequency, severity and duration of headache attacks. Study design: A longitudinal panel study. Methods: Overall, 275 migraines or tension Type Headache (TTH) patients were visited at three different times in 2012 in Isfahan, Iran. On the first visit socio-demographic characteristics and headache symptoms of the patients were asked. In all of the visits, headache frequency, severity and attack duration were recorded. Results: Frequency of headaches was influenced by headache type, age, job status, working hours, residency, disease duration, laterality, and type of pain onset. In terms of intensity, headaches were more severe in patients with migraine-type; those suffering from longer headache history; and those who suffered from vomiting, photophobia, and phonophobia. On the other hand patients with migraine, married people, women and patients suffering from vomiting experienced longer headache attacks. Conclusion: Headache type (migraine/TTH), age, job status, residency, years of headache, laterality, type of onset, nausea, vomiting, photophobia, and phonophobia were the factors to be considered in the studies that would apply frequency, severity, and duration of headache attacks in order to evaluate headache management. [ABSTRACT FROM AUTHOR]

A variety of different scales have been used to measure the intensity of pain in osteopathic-specific clinical studies; however, the criteria for the options are not always clear or reported. To compare the different questionnaires used by researchers for assessing the intensity of pain in clinical trials in osteopathy and analyse the reasons for their choice. Methods: A systematic literature search was conducted using 7 electronic databases (SCOPUS, Cochrane Central, MEDLINE, PEDro, OSTMED.DR, ScienceDirect, and Web of Science) for Randomized Controlled Trial (RCT) articles, studying the efficacy/effectiveness of Osteopathic Manipulative Treatment (OMT) in reducing pain intensity. Only articles in English from 2012 to 2019 were selected. We used the Jadad score to assess the risk of bias. 130 studies were initially identified with a total of 26 included in this review. Sixteen studies used the Visual Analog Scale (VAS), four the Numeric Rating Scale (NRS), the remaining used other options. Researchers did not always provide an appropriate justification for their chosen evaluation instrument. The overall quality of the studies was considered moderate. Researchers in the field of osteopathy and other health care professions should provide a clear rationale for their chosen tools for measuring the intensity of pain, and these should align with the study design and objectives. [ABSTRACT FROM AUTHOR]

Copyright of Douleur et Analgésie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Experiencing acute (transient) pain and discomfort can be a characteristic of exercise and sport participation. In this context, acute pain or discomfort can be experienced by injured and injury-free athletes alike. Acute pain or discomfort in the strength and conditioning (S&C) environment can be experienced during particular movements or exercises. This may be the result of poor exercise technique and/or soft-tissue dysfunction. This article proposes a possible strategy, which can be used by the S&C coach, to modify training based on the acute (transient) pain or discomfort experienced by athletes during training. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the upper limb. Morbidity is approx. 4 times higher in women than in men. Clinical observations suggest that the course of the disease, including the severity of symptoms, varies depending on the sex and age of the patients. The objective of the study was to investigate this issue. Materials and methods: The study group consisted of 1,117 patients, 909 women (81%) and 208 men (19%) with a mean age of 59 years. Each patient declared their subjective perception of pain intensity using the Numeric Rank Scale (NRS) and completed the Levine questionnaire which evaluates the severity of symptoms caused by the disease. Results: A mean pain intensity in the NRS (6.3 vs. 5.4) and in the symptoms judged by the Levine questionnaire (3.1 vs. 2.9) were statistically significantly higher in women than in men, although these differences were borderline regarding clinical significance. A comparison of variables in the age groups (from <40 to >80 years) showed no statistically or clinically significant differences: for NRS 5.8-6.5 and for the Levine symptom score 3.0-3.2. Conclusion: Women suffering from CTS experience slightly more intensive pain than men, but this has no clinical significance. The age of the patients has no impact on experience of complaints caused by the syndrome. [ABSTRACT FROM AUTHOR]

Pain is common among oncological patients, especially those who are exposed to invasive procedures. It is not simple for the professional to evaluate the painful experience, because it involves multidimensional factors. The objective was to present the main pain measurement scales, emphasizing the best way to meet the oncological patient and the construction of a booklet with the main scales for consultation of health professionals. This Is a descriptive study based on the traditional literature review, The literature survey occurred through studies indexed in the databases LILACS, SCIELO and BDENF. The main scales presented are: Visual Numerical Scale, Visual Analogue Scale, Verbal Descriptors Scale, Face Scale, Pain Assessment in Advanced Dementina, McGill Dor Questionnaire. The scales provide subsidies for professionals to identify the alterations present in patients using the appropriate intervention. Nurses must strive to apply the appropriate scale in an individualized manner. The Booklet encourages the nursing team regarding the importance of using the pain scales according to the patient's need, guaranteeing a humanized treatment and the best therapy. [ABSTRACT FROM AUTHOR]

Copyright of Nursing Care & Research / Nosileia kai Ereuna is the property of Greek Nursing Studies Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pain is a devastating symptom of advanced cancers. Inadequate assessment and failure in following WHO (World health organization) guidelines for pain management are barriers to pain control in cancer patients. Objectives: To determine frequency of inadequate pain assessment leading to inadequate pain control in advanced stage cancer patients receiving palliative care. Subjects and Methods: 180 patients, within age 18 to 70 years of both genders, of cancer with stage 3 and 4 disease receiving palliative treatment for pain due to primary or metastatic disease requiring opioid analgesics presenting to inpatient department of Medical Oncology, Mayo Hospital Lahore were selected using non probability, consecutive sampling. Study Design: Cross sectional descriptive study. Setting: Department of Medical Oncology, Mayo Hospital Lahore. Period: 6 months after approval of synopsis from 01.06.2017 to 01.01.2018. The Pain scales used were Numerical Rating Scale- NRS, followed by Visual Analogue Scale-VAS. All patients were evaluated whether or not their pain was assessed by a standard pain scale, the type of malignancy, and the stage of cancer. Results: A total of 180 patients with mean age of 49.68 years, with 62.2% females and 37.8% males were selected. Out of these 124 (68.89%) patients received inadequate assessment for their pain intensity as no documented pain scale was being used to assess them. Out of them 50(49.02%) were males and 52 (50.98%) were females. 56 patients (31.11%) were receiving inadequate pain assessment. 17 (30.35%) of them were assessed using VAS and 39 (69.65%) were assessed using NRS. The median pain score was 7.8/10 with the stage 4 patients mainly presenting with a score of >7/10 (69.94%) and stage 3 patients making up majority of pain with <7/10 score (58.82%). Conclusion: This study showed that pain is poorly managed in patients with advanced malignancy as majority of patients are not assessed according to standard methods for cancer pain. There is a strong need of physicians' education, development of proper palliative care services and implementation of WHO guidelines to achieve effective pain management for oncology patients. [ABSTRACT FROM AUTHOR]