Validation of the Numerical Rating Scale for Pain Intensity and Unpleasantness in Pediatric Acute Postoperative Pain: Sensitivity to Change Over Time

10089 Background: The prolonged use of opioids is usually associated with the appearance of adverse events as drowsiness, constipation, nausea/vomiting, and dizziness. Some effects are self-limiting over time for the onset of tolerance while others, as constipation, persist. Clinical studies demonstrated that the association oxycodone-naloxone (OXN), reduced the constipation in the presence of unchanged analgesic efficacy. Though, the variability of the analgesic response to OXN is not explained yet. The aim of this study was to evaluate the association between the clinical and genetics factors and analgesics response at OXN. Methods: In this study the cancer patients with moderate to severe pain received OXN and followed for 28 days. At each visit pain intensity modifications of therapy and adverse drug reactions (ADRs) were recorded. The primary efficacy endpoint was the proportion of responders, defined as patients with a decrease of the average pain intensity from baseline to last visit ≥30% and a final average pain score≤4, measured on 0-10 numerical rating scale. Genetic tests to identify SNPs related to opioid response were performed in each patient. Results: 14 centers participated in the study and recruited 206 patients. Among 176 patients analyzed for a primary endpoint the mean age was 68 (SD 10); 56% were male. Average and worst pain intensity decreased from baseline to last visit from 6.2 to 2.9 and from 8.3 to 4.6 respectively. 81% of patients were responders. Digestive system tumors (p = 0.05), concomitant thyroid endocrinopathy (p = 0.023), psychological irritability (p = 0.0029) and breakthrough pain at baseline were found to decrease the risk of positive response. None of the investigated polymorphisms influenced the analgesic response. Moderate to severe intensity ADRs were mainly constipation (26%), drowsiness (19%) and dry mouth (12%). Conclusions: In patients with moderate to severe cancer pain, OXN showed a strong analgesic effect (about 50% pain reduction). In comparison with other studies the induced constipation appears substantially lower. Some clinical factors influence the analgesic response while none genetic polymorphisms modulate the response. Clinical trial information: NCT02293785.

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Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.10.11547 ◽

2020 ◽

Vol 103 (10) ◽

pp. 1028-1035

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Control Group ◽

Study Group ◽

Analgesic Requirement ◽

Supratentorial Craniotomy ◽

Numerical Rating ◽

Fentanyl Consumption ◽

Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

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Proportion of immediate severe postoperative pain in laparoscopic sterilization under general anaesthesia: A cross-sectional study (postoperative pain in laparoscopic sterilization)

Serbian Journal of Anesthesia and Intensive Therapy ◽

10.5937/sjait2106111m ◽

2021 ◽

Vol 43 (5-6) ◽

pp. 111-116

Author(s):

Girijanandan Menon ◽

Manjit George

Keyword(s):

Postoperative Pain ◽

General Anaesthesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Cross Sectional Study ◽

Cross Sectional ◽

Post Operative Pain ◽

Severe Postoperative Pain ◽

Numerical Rating ◽

Laparoscopic Sterilization

Background: Effective control of immediate post operative abdominal pain following laparoscopic sterilization is challenging. The objective of the study was to estimate the incidence of immediate severe postoperative pain following laparoscopic sterilization under general anaesthesia by the proportion of patients with the pain assessed on a numerical rating scale. Methods: A cross sectional study was conducted with the approval of institutional review board and ethics committee. Fifty seven participants with written informed consent underwent the study over a period of six months. Pain was assessed by a trained recovery nurse and data was collected and analyzed. The main outcome measure was immediate severe post operative pain on numerical rating scale (NRS). Results: Among the 57 participants, 14 (24.6%) had immediate severe post operative pain with median score of five in the inter quartile range of 0 to 5.75 and 43 (75.4%) participants had no severe pain. Conclusion: The incidence of immediate severe postoperative abdominal pain after laparoscopic sterilization under general anaesthesia is high. Therefore, the management of pain following laparoscopic sterilization requires individually based multimodal analgesia.

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Effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170165 ◽

2017 ◽

Vol 5 (2) ◽

pp. 631

Author(s):

Zahra Abbas Ali Madadi ◽

Jalil Azimian ◽

Farzaneh Falahatpishe ◽

Mahmoud Alipour Heidari

Keyword(s):

Pain Intensity ◽

Arteriovenous Fistula ◽

Rating Scale ◽

Control Method ◽

Numerical Rating Scale ◽

Simple Random Sampling ◽

Hemodialysis Patients ◽

Numerical Rating ◽

Rating Scale Data ◽

Frequent Hemodialysis

Background: Pain and stress of hemodialysis are experienced by more than 50% of patients who are suffering from renal disease; hence decreasing a part of these adverse effects can be effective on individual’s long term coping with hemodialysis. The current study was done to determine the effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients.Methods: This clinical trial was conducted on 31 hemodialysis patients in 2014. The patients were selected by simple random sampling method and placed in one group. First, the pain intensity of all patients was measured in the six frequent hemodialysis sessions without any intervention (control method). After two weeks, the intervention of warm footbath with vibration was done on all patients and the pain intensity was measured for six frequent hemodialysis sessions (intervention method). The patients were received 40±2 °C footbath with vibration by foot massage spa machine for ten minutes; then, fistula needles were placed and the pain intensity was assessed by using a numerical rating scale. Data were analyzed by ANOVA and T test.Results: The study group had contained 20 males (64.5%), 11 females (35.5%), with an average age of 44.16±14.85 and a range of 18 to 65 years old, which shows that the pain intensity of the warm footbath with vibration method was lower than the control method (P< 0.05).Conclusions: Warm footbath with vibration can be used as an effective palliative method to reduce pain of hemodialysis patients.

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Correlations between Numerical Rating Scale and Visual Analog Scale Pain Scores in the Assessment of Postoperative Pain

Korean Journal of Anesthesiology ◽

10.4097/kjae.2003.45.2.238 ◽

2003 ◽

Vol 45 (2) ◽

pp. 238 ◽

Cited By ~ 2

Author(s):

Sun Ok Song ◽

Sae Yeon Kim ◽

Seon Young Lee

Keyword(s):

Postoperative Pain ◽

Visual Analog Scale ◽

Rating Scale ◽

Numerical Rating Scale ◽

Analog Scale ◽

Pain Scores ◽

Visual Analog Scale Pain ◽

Numerical Rating

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What is the clinical relevance of the Numerical rating scale for pain?

10.1093/med/9780198834359.003.0059 ◽

2018 ◽

Author(s):

Felicia Cox

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Clinical Importance ◽

Patient Global Impression ◽

Numerical Rating ◽

Group A ◽

Clinically Significant ◽

Global Impression Of Change

The landmark paper discussed in this chapter is ‘Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale’, published by Farrar et al. in 2001. The numerical rating scale is now the standard instrument used in chronic pain studies to measure pain intensity. Farrar et al. determined the changes in pain intensity that were clinically significant for studies of chronic pain while measuring the patient’s global impression of change. The paper used pooled data from ten recent studies of pregabalin in 2,724 subjects. The authors reported a consistent relationship between pain intensity and patient global impression of change, regardless of study, disease type, age, sex, study result, or treatment group. A reduction of approximately two points on the numerical rating scale, or of 30% in the global impression of change of pain intensity, represented a clinically important difference.

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Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain

Pain Research and Management ◽

10.1155/2018/5042067 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Izumi Makino ◽

Young-Chang Arai ◽

Shuichi Aono ◽

Masayuki Inoue ◽

Hiroki Sakurai ◽

...

Keyword(s):

Standard Deviation ◽

Combination Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

End Of Treatment ◽

Before And After ◽

Numerical Rating ◽

Therapy Treatment ◽

Nonpharmacological Treatments

Objective. To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods. Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results. The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion. There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

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Agreement Between Verbal and Electronic Versions of the Numerical Rating Scale (NRS-11) when Used to Assess Pain Intensity in Adolescents

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000104 ◽

2015 ◽

Vol 31 (3) ◽

pp. 229-234 ◽

Cited By ~ 22

Author(s):

Elena Castarlenas ◽

Elisabet Sánchez-Rodríguez ◽

Rocío de la Vega ◽

Roman Roset ◽

Jordi Miró

Keyword(s):

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Numerical Rating

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On the electronic measurement of pain intensity: Can we use different pain intensity scales interchangeably?

Journal of Health Psychology ◽

10.1177/1359105316633284 ◽

2016 ◽

Vol 22 (13) ◽

pp. 1658-1667 ◽

Cited By ~ 10

Author(s):

Elisabet Sánchez-Rodríguez ◽

Elena Castarlenas ◽

Rocío de la Vega ◽

Roman Roset ◽

Jordi Miró

Keyword(s):

Visual Analogue Scale ◽

Pain Intensity ◽

Analogue Scale ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Scale ◽

Maximum Intensity ◽

Bland Altman Method ◽

Numerical Rating ◽

Electronic Measurement

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

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