Measurement of Pain in the Prehospital Setting Using a Visual Analogue Scale

2003 ◽  
Vol 18 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Bill A. Lord ◽  
Brian Parsell
Keyword(s):  
Pain Management ◽  
Visual Analogue Scale ◽  
Pain Score ◽  
Analogue Scale ◽  
Management Practice ◽  
Mean Value ◽  
Pain Severity ◽  
Assessment Process ◽  
Measurement Tool ◽  
The Mean

AbstractIntroduction:The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients.Methods:This prospective, observational study used a VA S to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain.Results:A total of 262 patients were enrolled in this study. The mean value for thereduction in VAS (T0-Tend) was 18.2±23.9 mm [±SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3–21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5 ±24.7 mm [±SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4–14.8 mm). Fo rty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice.Conclusion:The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such auditsmust have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.

scholarly journals The Linearity of the Visual Analogue Scale in Patients with Severe Acute Pain

2005 ◽  
Vol 33 (1) ◽  
pp. 54-58 ◽  
Author(s):  
P. S. Myles ◽  
N. Urquhart
Keyword(s):  
Pain Relief ◽  
Visual Analogue Scale ◽  
Acute Pain ◽  
Analogue Scale ◽  
Initial Assessment ◽  
Measurement Tool ◽  
Linear Scale ◽  
The Subject ◽  
The Mean ◽  
Scale Properties

The visual analogue scale (VAS) is a standard measurement tool in pain research and clinical practice, and has been shown to have linear scale properties for mild to moderate pain. Our aim was to evaluate the scaling properties of the VAS in subjects with severe acute pain. After Ethics Committee approval we studied 22 patients and asked them to rate the severity of their pain on a 100 mm VAS at the initial assessment (VAS1), and again after administration of analgesic medication. The subject was asked to nominate when they considered their pain intensity had halved, and at this time they were asked to rate this on a second VAS (VAS0.5). When the subject had received satisfactory relief of their pain, they were asked to describe how much their pain had been relieved and were then asked to rate their final pain state using a third VAS (VASfinal). The mean (SD) scores were VAS1 84 (14) (range 56–100), VAS0.5 42 (13) and VASfinal 21 (16). The mean (95% CI) for VASratio was 0.51 (0.45–0.57). The mean (SD) patients’ estimate of pain relief was 77 (21)% from that of baseline, with a mean (SD) VASfinal 0.26 (0.20), 95% CI 0.17–0.38. The correlation of the patients’ estimate of pain relief with the VASfinal was r=0.89, rho=0.87, both P<0.001. The VAS is a linear scale in subjects with severe acute pain. Changes in the VAS score represent a relative change in the magnitude of pain sensation.

scholarly journals Complex Regional Pain Syndrome: Current Practice Management and Referral Trends in a Closed Healthcare System

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 39-47
Author(s):  
Connor Zale ◽  
Joshua Hansen ◽  
Paul Ryan
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Healthcare System ◽  
Pain Syndrome ◽  
Occupational Outcomes ◽  
Mean Delay ◽  
Significant Difference ◽  
The Mean ◽  
Over Time

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

scholarly journals The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
pp. 205435812199399
Author(s):  
Sara N. Davison ◽  
Sarah Rathwell ◽  
Sunita Ghosh ◽  
Chelsy George ◽  
Ted Pfister ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Chronic Pain ◽  
Pain Management ◽  
Meta Analysis ◽  
Pain Severity ◽  
Chronic Pain Management ◽  
Dialysis Patients ◽  
Severity Scores ◽  
The Mean

Background: Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD. Objectives: To determine the prevalence and severity of chronic pain in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported. Results: Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates. Limitations: Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain. Conclusions: Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided. Trial registration: PROSPERO Registration number CRD42020166965

scholarly journals The reproducibility of subjective appetite scores

1995 ◽  
Vol 73 (4) ◽  
pp. 517-530 ◽  
Author(s):  
Anne Raben ◽  
ANNA TAGLIABUE ◽  
Arne Astrup
Keyword(s):  
Visual Analogue Scale ◽  
Food Consumption ◽  
Analogue Scale ◽  
Prior Experience ◽  
Random Noise ◽  
Normal Weight ◽  
Vas Scores ◽  
The Mean ◽  
The Difference ◽  
Mean Differences

Although subjective appetite scores are widely used, studies on the reproducibility of this method are scarce. In the present study nine healthy, normal weight, young men recorded their subjective appetite sensations before and during 5 h after two different test meals A and B. The subjects tested each meal twice and in randomized order. Visual analogue scale (VAS) scores, 10 cm in length, were used to assess hunger, satiety, fullness, prospective food consumption and palatability of the meals. Plasma glucose and lactate concentrations were determined concomitantly. The repeatability was investigated for fasting values, Δ-mean 5 h and mean 5 h values, Δ-peak/nadir and peak/nadir values. Although the profiles of the postprandial responses were similar, the coefficients of repeatability (CR = 2SD) on the mean differences were large, ranging from 2·86 to 5.24 cm for fasting scores, 1·36 to 1·88 cm for mean scores, 2·98 to 5·42 cm for Δ-mean scores, and 3·16 to 6·44 cm for peak and Δ-peak scores. For palatability ratings the CK values varied more, ranging from 2·38 (taste) to 8·70 cm (aftertaste). Part of the difference in satiety ratings could be explained by the differences in palatability ratings. However, the low reproducibility may also be caused by a conditioned satiation or hunger due to the subjects' prior experience of the meals and therefore not just be a reflection of random noise. It is likely, however, that the variation in appetite ratings is due both to methodological day-to-day variation and to biological day-to-day variation in subjective appetite sensations.

scholarly journals The Minimum Clinically Significant Difference in Visual Analogue Scale Pain Score in a Local Emergency Setting

2009 ◽  
Vol 16 (4) ◽  
pp. 233-236 ◽  
Author(s):  
MSM Mark ◽  
TTS Au ◽  
YF Choi ◽  
TW Wong
Keyword(s):  
Visual Analogue Scale ◽  
Pain Score ◽  
Analogue Scale ◽  
Education Level ◽  
Chinese Patients ◽  
Visual Analogue Scale Pain ◽  
Emergency Setting ◽  
Significant Difference ◽  
Analogue Scale Pain ◽  
Clinically Significant

Objectives To determine whether the minimum clinically significant difference (MCSD) in visual analogue scale (VAS) pain score varies with age, gender, education level and cause of pain (trauma versus non-trauma) in Chinese patients. Methods This was a prospective descriptive study of local Chinese patients 15 years of age or older who presented with pain to the accident & emergency department. On presentation, patients were asked to indicate their current pain severity with a single mark through a standard 100–mm visual analogue scale. Then they would be offered an analgesic for pain-relief. After 30–45 minutes, the patients were asked to give a verbal categorical rating of their pain as ‘a lot better’, ‘a little better’, ‘much the same’, ‘a little worse’, or ‘much worse’ and to mark the level of pain on a VAS of the same type as used previously. The MCSD in VAS pain score was defined as the mean difference between the current and preceding scores when the subject reported ‘a little worse’ or ‘a little better’ in pain. Data were compared based on gender, age, education level, and traumatic versus non-traumatic causes of pain. Results 186 patients were enrolled in the study, yielding 77 evaluable comparisons where pain was rated as ‘a little better’ or ‘a little worse’. Overall, the MCSD in VAS pain score in the group was 17 mm (95%CI 13.6 mm to 20.6 mm). There were statistically significant differences between the MCSD in VAS pain score between genders and causes of pain (trauma versus non-trauma). Conclusions The MCSD in VAS pain scores was found to be 17 mm. There was significant differences in MCSD in VAS pain score in different genders and between trauma and non-trauma cases.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  
Keyword(s):  
Pain Score ◽  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Mean Value ◽  
Injection Pain ◽  
P Value ◽  
Duration Of Symptoms ◽  
De Quervain’S Tenosynovitis ◽  
Minimum Age ◽  
The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

Type lll internal hemipelvectomy for primary bone tumours with and without allograft reconstruction

2021 ◽  
Vol 103-B (6) ◽  
pp. 1155-1159
Author(s):  
Khodamorad Jamshidi ◽  
Farshad Zandrahimi ◽  
Abolfazl Bagherifard ◽  
Fatemeh Mohammadi ◽  
Alireza Mirzaei
Keyword(s):  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Functional Outcome ◽  
Surgical Complications ◽  
Analogue Scale ◽  
Allograft Reconstruction ◽  
Internal Hemipelvectomy ◽  
Type Iii ◽  
The Mean ◽  
Reconstruction Group

Aim There is insufficient evidence to support bony reconstruction of the pubis after a type III internal hemipelvectomy (resection of all or part of the pubis). In this study, we compared surgical complications, postoperative pain, and functional outcome in a series of patients who had undergone a type III internal hemipelvectomy with or without bony reconstruction. Methods In a retrospective cohort study, 32 patients who had undergone a type III hemipelvectomy with or without allograft reconstruction (n = 15 and n = 17, respectively) were reviewed. The mean follow-up was 6.7 years (SD 3.8) for patients in the reconstruction group and 6.1 years (SD 4.0) for patients in the non-reconstruction group. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system and the level of postoperative pain with a visual analogue scale (VAS). Results The mean MSTS score of the patients was significantly better in patients after reconstruction (26 (SD 1.7) vs 22.7 (SD 2.0); p < 0.001). The mean visual analogue scale score for pain was significantly less in the reconstruction group (2.1 (SD 2) vs 4.2 (SD 2.2); p = 0.016). One infection occurred in each group. Bladder herniation occurred in three patients (17.6%) in the non-reconstruction group but none in the reconstruction group. Five patients (29.4%) in the non-reconstruction group and one (7%) in the reconstruction group had a limp. Graft displacement occurred in two patients in the reconstruction group. Conclusion We recommend reconstruction of the bony defect after a type III hemipelvectomy: it gives a better functional result, less postoperative pain, and fewer late surgical complications. Cite this article: Bone Joint J 2021;103-B(6):1155–1159.

Analysis of reproducibility, evaluation, and preference of the new iC100 rebound tonometer versus iCare PRO and Perkins portable applanation tonometry

2019 ◽  
Vol 30 (6) ◽  
pp. 1349-1355 ◽  
Author(s):  
Mercedes Molero-Senosiaín ◽  
Laura Morales-Fernández ◽  
Federico Saenz-Francés ◽  
Julian García-Feijoo ◽  
Jose María Martínez-de-la-Casa
Keyword(s):  
Intraocular Pressure ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Normal Subjects ◽  
Applanation Tonometry ◽  
Rebound Tonometer ◽  
The Mean ◽  
The Difference ◽  
The Comparative Study ◽  
Mean Time

Objectives: To analyze the reproducibility of the new iC100 rebound tonometer, to compare its results with the applanation tonometry and iCare PRO and to evaluate the preference between them. Materials and methods: For the study of reproducibility, 15 eyes of 15 healthy Caucasian subjects were included. Three measurements were taken each day in three separate sessions. For the comparative study, 150 eyes of 150 Caucasian subjects were included (75 normal subjects and 75 patients with glaucoma). Three consecutive measurements were collected with each tonometer, randomizing the order of use. The discomfort caused by each tonometer was evaluated using the visual analogue scale. Results: No statistically significant differences were detected between sessions. In the comparison between tonometers, the measurements with iC100 were statistically lower than those of Perkins (−1.35 ± 0.417, p = 0.004) and that iCare PRO (−1.41 ± 0.417, p = 0.002). The difference between PRO and Perkins was not statistically significant ( p = 0.990). The mean time of measurement (in seconds) with iC100 was significantly lower than with Perkins (6.74 ± 1.46 vs 15.53 ± 2.01, p < 0.001) and that PRO (6.74 ± 1.46 vs 11.53 ± 1.85, p < 0.001). Visual analogue scale score with iC100 was lower than Perkins (1.33 ± 0.99 vs 1.73 ± 1.10, p < 0.05). In total, 61.7% preferred iC100 against Perkins. Conclusion: The reproducibility of this instrument has been proven good. iC100 underestimates intraocular pressure compared to applanation tonometry at normal values and tends to overestimate it in high intraocular pressure values. Most of the subjects preferred iC100 tonometer.

Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults

2020 ◽  
Vol 134 (2) ◽  
pp. 145-149
Author(s):  
M Casale ◽  
A Costantino ◽  
L Sabatino ◽  
A Luchena ◽  
A Moffa ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Visual Analogue Scale ◽  
Minimally Invasive ◽  
Chronic Rhinosinusitis ◽  
Invasive Surgery ◽  
Local Anaesthesia ◽  
Analogue Scale ◽  
Nasal Polyps ◽  
Post Operative Pain ◽  
The Mean

AbstractObjectiveThis paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia.MethodsA retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund–Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale.ResultsThe mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0).ConclusionOur study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

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