Detecting Acute Pain is Enough: The Conundrum of Pain Assessment

Neonatal Pain ◽  
2017 ◽  
pp. 105-111
Author(s):  
C. V. Bellieni ◽  
G. Buonocore
Keyword(s):  
Acute Pain ◽  
Pain Assessment

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

scholarly journals Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Marina C. Evangelista ◽  
Ryota Watanabe ◽  
Vivian S. Y. Leung ◽  
Beatriz P. Monteiro ◽  
Elizabeth O’Toole ◽  
...  
Keyword(s):  
Acute Pain ◽  
Pain Assessment ◽  
Rater Reliability ◽  
Analgesic Treatment ◽  
Naturally Occurring ◽  
Total Pain ◽  
Excellent Internal Consistency ◽  
Development And Validation ◽  
Validated Instrument ◽  
Control Study

AbstractGrimace scales have been used for pain assessment in different species. This study aimed to develop and validate the Feline Grimace Scale (FGS) to detect naturally-occurring acute pain. Thirty-five client-owned and twenty control cats were video-recorded undisturbed in their cages in a prospective, case-control study. Painful cats received analgesic treatment and videos were repeated one hour later. Five action units (AU) were identified: ear position, orbital tightening, muzzle tension, whiskers change and head position. Four observers independently scored (0–2 for each AU) 110 images of control and painful cats. The FGS scores were higher in painful than in control cats; a very strong correlation with another validated instrument for pain assessment in cats was observed (rho = 0.86, p < 0.001) as well as good overall inter-rater reliability [ICC = 0.89 (95% CI: 0.85–0.92)], excellent intra-rater reliability (ICC > 0.91), and excellent internal consistency (Cronbach’s alpha = 0.89). The FGS detected response to analgesic treatment (scores after analgesia were lower than before) and a cut-off score was determined (total pain score > 0.39 out of 1.0). The FGS is a valid and reliable tool for acute pain assessment in cats.

Topical Review: State of the Field of Child Self-Report of Acute Pain

2019 ◽  
Author(s):  
Lindsey L Cohen ◽  
Matthew R Donati ◽  
Sharon Shih ◽  
Soumitri Sil
Keyword(s):  
Acute Pain ◽  
Pain Assessment ◽  
Comprehensive Evaluation ◽  
Clinical Care ◽  
Preschool Age ◽  
Self Report ◽  
Common Features ◽  
Topical Review ◽  
Review State ◽  
State Of The Field

Abstract Objective Children experience acute pain with routine and emergent healthcare, and untreated pain can lead to a range of repercussions. Assessment is vital to diagnosing and treating acute pain. Given the internal nature of pain, self-report is predominant. This topical review reflects on the state of the field of pediatric acute pain self-report, and proposes a framework for acute pain assessment via self-report. Method We examine self-report of acute pain in preschool-age children through adolescents, and we detail a three-step process to optimize acute pain assessment. Results The first step is to decide between a pain screening or assessment. Several 0–10 self-report scales are available for pain screenings. Assessment requires specification of the goals and domains to target. Core criteria, common features, modulating factors, and consequences of acute pain provide a framework for a comprehensive pain assessment. Whereas there are some measures available to assess aspects of these domains, there are considerable gaps. Last, it is important to integrate the data to guide clinical care of acute pain. Conclusions Self-report of acute pain is dominated by single-item intensity scales, which are useful for pain screening but inadequate for pain assessment. We propose a three-step approach to acute pain assessment in children. However, there is a need for measure development for a comprehensive evaluation of the core criteria, common features, modulating factors, and consequences of pediatric acute pain. In addition, there is limited guidance in merging data found in multifaceted evaluations of pediatric acute pain.

Acute Pain Management

2018 ◽  
Author(s):  
Nihar Patel
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Treatment Options ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Age Appropriate ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

scholarly journals Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

2022 ◽  
Vol 9 ◽  
pp. 237437352110496
Author(s):  
Jenni Hämäläinen ◽  
Tarja Kvist ◽  
Päivi Kankkunen
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numerical Rating ◽  
Emergency Department Patients ◽  
Pain At Rest ◽  
Patients Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

scholarly journals A Pilot Study of a Functional Pain Assessment for Adult Patients Admitted with Sickle Cell Pain Crisis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4693-4693
Author(s):  
Marquita Nelson ◽  
Monica Peek ◽  
Kenneth Cohen ◽  
Danielle Bowsman ◽  
Nabil Abou-Baker
Keyword(s):  
Sickle Cell ◽  
Acute Pain ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Adult Patients ◽  
Free Response ◽  
Response Options ◽  
Pain Scores ◽  
Functional Pain ◽  
Pain Crisis

Introduction Acute vaso-occlusive pain crises are the most common complications of sickle cell disease (SCD). Pain is a subjective sensation and is often difficult to describe and for practitioners to understand. The complexity and multidimensional nature of pain requires additional evaluation beyond pain intensity. Pain assessment is also influenced by implicit and explicit biases related to race and ethnicity which can negatively influence treatment (Wandner et al J Pain 2012). In this pilot quality improvement study, we studied resident perceptions to a functional assessment tool in adult patients hospitalized with sickle cell vaso-occlusive crises. We used the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ), a validated questionnaire of physical function in youth experiencing acute pain (Zempsky et al J Pain 2014) (Figure 1). Resident responses to using the YAPFAQ were measured as an initial step to implementation of functional pain assessment in hospitalized adults with SCD pain crises. Methods We piloted this study on internal medicine residents. First, residents completed the Resident Acute SCD Pain Assessment Survey regarding their current management of acute pain in SCD (Figure 2). This was done to determine their baseline demographic information, methods of pain assessment, satisfaction with the numerical pain score system, and to understand barriers in assessing acute pain. This survey included a combination of multiple choice, free response, and binary response options. The residents then trialed the YAPFAQ with a patient admitted with vaso-occlusive pain crisis then the residents completed The Post YAPFAQ Evaluation Survey in response to this assessment tool (Figure 3). This survey included a combination of multiple choice, free response, and binary response options. The goal of this survey was to assess resident satisfaction with YAPFAQ, perceived patient receptiveness to YAPFAQ, and feasibility of using this tool during daily assessments. Patients were not surveyed during this pilot study. We performed descriptive statistics to describe the survey results. Results Sixteen residents completed the Acute SCD Pain Management survey prior to using the YAPFAQ. Sixty-nine percent of residents reported dissatisfaction with using numerical pain scores. Reported barriers to assessing pain included: subjectivity of pain scores, concern for malingering, and the ceiling effect of the numeric scale. Seven residents completed the post YAPFAQ evaluation survey. A majority of residents (86%) were extremely satisfied or satisfied with using the YAPFAQ. Fifty seven percent of residents felt that patients were extremely receptive or receptive to using this tool. The majority of residents (85%) felt that the YAPFAQ improved their understanding of patients' pain. All YAPFAQs were completed with patients in 10 minutes or less. Most residents (57%) reported that the tool would be feasible for implementation on rounds. Conclusions Similar to previous studies, our residents felt that numerical pain score systems inadequately describe pain. Residents had generally positive responses to the YAPFAQ. One resident stated that the questionnaire was "structured and easy to compare day to day." Functional pain assessment allows providers to better understand how pain limits daily activities and can provide useful functional targets for safe hospital discharge. Future directions of this project include performing a larger study of patients hospitalized with vaso-occlusive pain crises to validate the YAPFAQ in adult patients, survey patients regarding experiences with the YAPFAQ, and to create tailored pain management plans based on functional pain assessments. Disclosures No relevant conflicts of interest to declare.

scholarly journals Methods Used and Application of the Mouse Grimace Scale in Biomedical Research 10 Years on: A Systematic Scoping Review

2020 ◽  
Author(s):  
Alexandra L. Whittaker ◽  
Yifan Liu ◽  
Timothy H. Barker
Keyword(s):  
Animal Models ◽  
Biomedical Research ◽  
Acute Pain ◽  
Scoping Review ◽  
Pain Assessment ◽  
Facial Features ◽  
Academic Literature ◽  
Research Fields ◽  
Neuroscience Research ◽  
Wide Range

The Mouse Grimace Scale (MGS) was developed 10 years ago to assess pain through characterisation of changes in five facial features or action units. The strength of the technique is that it is proposed to be a measure of spontaneous or non-evoked pain. A comprehensive scoping review of the academic literature was performed. The MGS has been employed mainly in evaluation of acute pain, particularly in the pain and neuroscience research fields. There has however been use of the technique in a wide range of fields, and based on limited study it does appear to have utility for pain assessment across a spectrum of animal models. Use of the method does allow detection of pain of a longer duration, up to a month post-initial insult. There has been less use of the technique using real-time methods and this is an area in need of further research.

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