Continuous Assessment of Labour Pain using Handgrip Force

BACKGROUND: Assessment of dynamic changes in painful experiences, such as labour, using conventional rating scales (eg, numerical rating scale [NRS]) has limitations. An alternative for continuous pain evaluation could be a signal generated by voluntary action of the parturient. Remifentanil administration for obstetric analgesia could be improved by these dynamic measures of labour pain. In the present study, handgrip force was measured by a dynamometer to signal labour pain.OBJECTIVES: To evaluate: whether continuous monitoring of labour pain using handgrip force allows for determination of pain measurement during contractions; and the correlation between handgrip force and pain intensity on NRS.METHODS: The present observational, single-centre study included 43 parturients. After calibration of the dynamometer for individual hand muscle strength, pain was recorded during early and late labour using a dynamometer and an NRS. The primary end point was the correlation coefficient between NRS ratings and peak intensity recorded by the dynamometer.RESULTS: All dynamometer-registered readings were also registered by the external tocogram. All contractions recorded by external tocogram were also registered by the dynamometer. Handgrip force was moderately correlated with pain scores on the NRS. Mean handgrip force during contractions had the highest correlation coefficient (Pearson’s r=0.67) compared with peak handgrip force (r=0.56) and area under the curve of handgrip force (r=0.55).CONCLUSIONS: Pain intensity and duration can be assessed continuously using handgrip force measured via a dynamometer. The feedback of intensity and duration of pain could optimize patient-controlled remifentantil application for obstetric analgesia and other situations of highly variable pain intensity.

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Communication of pain intensity and unpleasantness through magnitude ratings: Influence of scale type, but not sex of the participant

10.1101/2021.06.24.21259433 ◽

2021 ◽

Author(s):

Hadas Nahman-Averbuch ◽

Cassidy Hughes ◽

Marie-Eve Hoeppli ◽

Kristina White ◽

James Peugh ◽

...

Keyword(s):

Pain Intensity ◽

Rating Scales ◽

Rating Scale ◽

Visual Stimulation ◽

Numerical Rating Scale ◽

Sex Discrimination ◽

Random Order ◽

Major Influence ◽

Intensity Level ◽

Noxious Heat

A critical aspect for much human pain research is the ability of participants to communicate their first person, experiential perspective to a third person observer. This communication is frequently accomplished via pain ratings. The type of scale and how participants/patients may differentially use the scale has a major influence on the communication of pain experiences. The present study examined the role of sex on the pain rating process using both noxious and innocuous stimuli and two different types of rating scales. Participants underwent noxious heat, auditory and visual stimulation paradigms. Pain intensity and unpleasantness ratings were collected using the visual analog scale (VAS) and numerical rating scale (NRS) in a random order. For noxious heat stimuli, low (44-45 degrees celsius) and high (47-48 degrees celsius) intensity stimuli were delivered. To identify if one rating scale allows better discrimination between different stimulus intensities and if this is dependent on sex, discrimination thresholds were calculated. Significant effect for rating scale and intensity level of stimuli were found for all stimulus modalities (noxious heat, auditory and visual) indicating that higher intensity and unpleasantness ratings were found using the NRS compared to the VAS. No effect of sex or interaction with sex was found. No differences in rating scale and sex were found for the discrimination thresholds. Biases in rating scales usage exist with NRS yielding higher ratings to the same stimuli. However, this bias does not appear to contribute significantly to sex differences in pain.

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Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10143056 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3056

Author(s):

Ada Holak ◽

Michał Czapla ◽

Marzena Zielińska

Keyword(s):

Pain Management ◽

Pain Intensity ◽

Pain Assessment ◽

Rating Scales ◽

Rating Scale ◽

Low Frequency ◽

Numeric Rating Scale ◽

Health Concern ◽

School Age Children ◽

Medical Teams

Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

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Effectiveness of Neck Myofascial Release Techniques and Exercise Therapy on Pain Intensity and Disability in Patients with Chronic Tension-Type Headache

Global Journal of Health Science ◽

10.5539/gjhs.v9n6p47 ◽

2016 ◽

Vol 9 (6) ◽

pp. 47

Author(s):

Mohammad Hosseinifar ◽

Razieh Bazghandi ◽

Zahra Azimi ◽

Bahareh Khodadadi Bohlouli

Keyword(s):

Pain Intensity ◽

Exercise Therapy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Tension Type Headache ◽

Control Group ◽

Myofascial Release ◽

Headache Intensity ◽

Headache Disability ◽

Type Headache

PURPOSE: Tension type headache (TTH) is one of the most prevalent types of headache. TTH is classified as episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. Tension, anxiety and depression are some etiological factors for TTH which leads to work efficiency reduction. Today the interest in non-pharmacological methods is increasing; massage is one of these approaches which has no side effects. Aim of this study was to investigate the effects of neck Myofascial Release (MFR) techniques and exercise therapy on pain intensity and disability in patients with chronic tension-type headache.METHODS: This randomized clinical trial study was investigated on 30 females suffering from TTH. Participants were randomly assigned into two equal groups (n=15). The MFR group received neck MFR massage and exercise therapy four times a week for 3 weeks, each session lasting 45 minutes. Control group had no intervention. Outcomes were headache intensity and disability measured by numerical rating scale (NRS) and headache disability index (HDI), respectively. Data was analysed through independent and pair t-test.RESULTS: Between group comparison showed significant improvement of headache intensity and disability rate in MFR group (p<0.05) than control group (p=0.000).DISCUSSION: This study provides evidences that MFR technique and exercise therapy have significant effect on patients with TTH.

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The Effect of the Treatment at a Pain Clinic on the Patients’ Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040586 ◽

2019 ◽

Vol 16 (4) ◽

pp. 586

Author(s):

Dariusz Kosson ◽

Marcin Kołacz ◽

Robert Gałązkowski ◽

Patryk Rzońca ◽

Barbara Lisowska

Keyword(s):

Mental Disorders ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Depression Scale ◽

Emotional Disturbances ◽

Pain Clinic ◽

Pain Clinics ◽

Pain Symptoms ◽

Anxiety Depression

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65–79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients’ pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.

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Reconsidering the Psychometrics of the GRS-S: Evidence for Parsimony in Measurement

Assessment for Effective Intervention ◽

10.1177/1534508418824743 ◽

2019 ◽

Vol 46 (1) ◽

pp. 55-66

Author(s):

Yaacov Petscher ◽

Steven I. Pfeiffer

Keyword(s):

Rating Scales ◽

Rating Scale ◽

Area Under The Curve ◽

Cut Scores ◽

Scale Level ◽

Intelligence Scale ◽

Scale Reliability ◽

Point Rating Scale ◽

Item Level ◽

Scale Down

The authors evaluated measurement-level, factor-level, item-level, and scale-level revisions to the Gifted Rating Scales–School Form (GRS-S). Measurement-level considerations tested the extent to which treating the Likert-type scale rating as categorical or continuous produced different fit across unidimensional, correlated trait, and bifactor latent factor structures. Item- and scale-level analyses demonstrated that the GRS-S could be reduced from a 72-item assessment on a 9-point rating scale down to a 30-item assessment on a 3-point rating scale. Reliability from the reduced assessment was high (ω > .95). Receiver operating characteristic (ROC) curve comparisons between the original and reduced versions of the GRS-S showed that diagnostic accuracy (i.e., area under the curve) of the scales was comparable when considering cut scores of 120, 125, and 130 on the WISC-IV Full Scale ( Wechsler Intelligence Scale for Child–Fourth Edition) and verbal IQ and the WIAT-III (Wechsler Individual Achievement Test–Third Edition) composite score. The findings suggest that a brief form of the GRS-S can be used as a universal or selective screener for giftedness without sacrificing key psychometric considerations.

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Mycophenolate for persistent complex regional pain syndrome, a parallel, open, randomised, proof of concept trial

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0154 ◽

2018 ◽

Vol 18 (1) ◽

pp. 29-37 ◽

Cited By ~ 3

Author(s):

Andreas Goebel ◽

Anu Jacob ◽

Bernhard Frank ◽

Paul Sacco ◽

Guillermo Alexander ◽

...

Keyword(s):

Quality Of Life ◽

Pain Intensity ◽

Complex Regional Pain Syndrome ◽

Rating Scales ◽

Rating Scale ◽

Pain Syndrome ◽

Analysis Of Covariance ◽

Proof Of Concept ◽

Numeric Rating

Abstract Background and aims: Current therapies for persistent complex regional pain syndrome (CRPS) are grossly inadequate. With accruing evidence to support an underlying immunological process and anecdotal evidence suggesting potential efficacy of mycophenolate, we wished to explore the feasibility and effectiveness of this treatment in patients with CRPS. Methods: A randomised, open, parallel, proof of concept trial was conducted. Patients with Budapest research criteria CRPS of >2-year duration and moderate or high pain intensity (numeric rating scale score ≥5) were enrolled. Eligible patients were randomised 1:1 to openly receive mycophenolate as add-on treatment, or their usual treatment alone, over 5.5 months. They then switched to the other treatment arm for 5.5 months. The main outcome was average the patients’ average pain intensity recorded over 14 days, between 5.0 and 5.5 months post randomisation, on 11-point (0–10) numeric rating scales, compared between trial arms. Skin sensitivities and additional outcomes were also assessed. Results: Twelve patients were enrolled. Nine provided outcomes and were analysed for the main outcome. Mycophenolate treatment was significantly more effective than control [drug-group mean (SD): pre: 7.4 (1.2)- post: 5.2 (1.3), n=4, control: pre: 7.7 (1.4)- post: 8.1 (0.9), n=5; −2.8 (95% CI: −4.7, −1.0), p=0.01, analysis of covariance]. There were four treatment responders (to mycophenolate treatment either before, or after switch), whose initial exquisite skin hyper-sensitivities, function and quality of life strongly improved. Side effects including itchiness, skin-cryptitis, increased pain, and increased depression caused 45% of the subjects to stop taking mycophenolate. Conclusions: Mycophenolate appears to reduce pain intensity and improve quality of life in a subgroup of patients with persistent CRPS. Implications: These results support the feasibility of conducting a definite trial to confirm the efficacy and effect size of mycophenolate treatment for persistent CRPS (EudraCT 2015-000263-14).

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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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The antistress effect of Xenon in subnarcotic concentrations in children with severe injuries

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-4-249-255 ◽

2020 ◽

Vol 24 (4) ◽

pp. 249-255

Author(s):

Vladimir G. Bagaev ◽

V. A. Mitish ◽

T. C. Sabinina ◽

O. C. Melnichuk ◽

P. V. Medinsky ◽

...

Keyword(s):

Pain Intensity ◽

Rating Scale ◽

Acute Stress ◽

Numerical Rating Scale ◽

Terrorist Attack ◽

Stress Hormones ◽

Pain Syndrome ◽

Stress Effect ◽

Drug Induced ◽

Severe Injuries

Introduction. In the present trial, the authors studied anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe traumas. Purpose. To study anti-stress properties of subnarcotic concentrations of gas Xenon (Xe) which is used for treating children with severe injuries. Material and methods. 10 children, aged 13 ± 3 years, with severe trauma were taken into the study: 6 girls with mine-explosive injuries ( a terrorist attack in Kerch in 2018), 3 boys with multiple dog bites and one patient after a traffic accident. To treat them, 20-30% Xe with O2 was used. A session lasted for 20 minutes; the course included from 5 to 12 sessions. Device KTK-01 (LLC “KseMed”, Russia) was used. Pain intensity was assessed with the numerical rating scale (NRS) , sedative effect - with BIS index and Ramsey sedation scale. Patients’ blood was also examined for the level of somatotropic hormone (STH), cortisol (Co) and insulin. Results. Indications for Xe therapy in children were: persistent pain syndrome (PS) and acute stress disorder (ASD). Patients fell asleep (drug-induced sleep) under 20-30% Xe concentration in the respiratory mixture. The average values of BIS index decreased from 95.5 ± 2.5 U to 86.5 ± 5.0 U (p <0.05), and of Ramsay scale - from 5.5 ± 0.5 to 2.7 ± 1.2 points (p <0.05). Pain intensity by NRS decreased from 4.1 ± 1.8 to 1.1 ± 0.4 points (p <0.05). The level of stress hormones during Xe session went down: STH- from 4.8 ± 0.9 ng / ml to 1.9 ± 0.5 ng / ml (p <0.001); Ko - from 375.5 ± 23.6 nmol / L to 303.2 ± 20.7 nmol / L (p <0.0001); insulin - from 19.9 ± 3.6 pmol / L to 11.7 ± 2.7 pmol / L (p <0.001). To restore sleep, 2 - 3 sessions were needed; to relief PS - 5 sessions, to refuse of painkillers in phantom pains - 12 sessions. Conclusion. 20-30% Xe with oxygen therapy has a pronounced analgesic, sedative and anti-stress effect in children with severe injuries.

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Traditional Acupuncture and Laser Acupuncture in Chronic Nonspecific Neck Pain: Study Protocol for a Randomized Controlled Trial

10.21203/rs.3.rs-853159/v1 ◽

2021 ◽

Author(s):

RAFAELA PERON ◽

Érika Patrícia Rampazo ◽

Richard Eloin Liebano

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Rating Scale ◽

Acupuncture Treatment ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Pressure Pain Threshold ◽

Pain Modulation ◽

Laser Acupuncture ◽

Acupuncture Points

Abstract Background: Nonspecific neck pain is a multifactorial and very common condition in adult individuals. No reports were found in the literature comparing the effectiveness of Traditional Acupuncture (TA) and Laser Acupuncture (LA) in cases of chronic nonspecific neck pain. Therefore, the aim of the present study is to investigate the effectiveness of TA and LA therapies in individuals with chronic nonspecific neck pain.Methods/design: This study will be a controlled and randomized clinical trial. A total of 60 individuals will be randomized into two groups (30 each). The TA group will receive the acupuncture treatment using needles, while the LA group will receive the laser acupuncture treatment. The acupuncture points (Tianzhu, Fengchi, Jianjing, and Jianzhongshu) will be stimulated bilaterally with needles or laser. The primary outcome will be pain intensity, determined using the numerical rating scale. The secondary outcomes will be pressure pain threshold, temporal summation of pain, conditioned pain modulation, use of analgesic drugs after treatment, and the global perceived effect scale. The assessments will be performed immediately before and after treatment. At the follow-up, 1 months after the end of the treatments, evaluation will be made of the pain intensity and the global perceived effect. Statistical analysis of the data obtained will consider a significance level of p < 0.05.Discussion: This study will provide evidence concerning the effects of LA treatment, in comparison to TA, leading to benefits for individuals suffering from chronic nonspecific neck pain.Trial registration: RBR-7vbw5gd (Brazilian Registry of Clinical Trials - ReBEC)

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Electroencephalogram-derived pain index for evaluating pain during labor

PeerJ ◽

10.7717/peerj.12714 ◽

2021 ◽

Vol 9 ◽

pp. e12714

Author(s):

Liang Sun ◽

Hong Zhang ◽

Qiaoyu Han ◽

Yi Feng

Keyword(s):

Correlation Analysis ◽

Rating Scale ◽

Numerical Rating Scale ◽

Point Of Care ◽

Pearson Correlation ◽

Area Under The Curve ◽

Labor Pain ◽

Youden Index ◽

Discriminative Ability ◽

Pearson Correlation Analysis

Background The discriminative ability of a point-of-care electroencephalogram (EEG)-derived pain index (Pi) for objectively assessing pain has been validated in chronic pain patients. The current study aimed to determine its feasibility in assessing labor pain in an obstetric setting. Methods Parturients were enrolled from the delivery room at the department of obstetrics in a tertiary hospital between February and June of 2018. Pi values and relevant numerical rating scale (NRS) scores were collected at different stages of labor in the presence or absence of epidural analgesia. The correlation between Pi values and NRS scores was analyzed using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to estimate the discriminative capability of Pi to detect labor pain in parturients. Results Eighty paturients were eligible for inclusion. The Pearson correlation analysis exhibited a positive correlation between Pi values and NRS scores in parturients (r = 0.768, P < 0.001). The ROC analysis revealed a cut-off Pi value of 18.37 to discriminate between mild and moderate-to-severe labor pain in parturients. Further analysis indicated that Pi values had the best diagnostic accuracy reflected by the highest area under the curve (AUC) of 0.857, with a sensitivity and specificity of 0.767 and 0.833, respectively, and a Youden index of 0.6. Subgroup analyses further substantiated the correlations between Pi values and NRS scores, especially in parturients with higher pain intensity. Conclusion This study indicates that Pi values derived from EEGs significantly correlate with the NRS scores, and can serve as a way to quantitatively and objectively evaluate labor pain in parturients.

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