scholarly journals Objectifying the Assessment of Pain

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Michael Strauss ◽  
Wendy Strauss
Keyword(s):  
Pain Management ◽  
Health Care Providers ◽  
Scoring System ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Initial Assessment ◽  
Care Providers ◽  
Thought Processes ◽  
Pain Scales ◽  
Activity Scale

Category: Other Introduction/Purpose: Pain is a pervasive problem that accounts for a high percentage of referrals to health care providers including foot and ankle surgeons and is an important factor in narcotic addictions and their related deaths. Unfortunately, the analogue pain scores are determined by subjective (SUB) responses of the patient and fail to utilize objective criteria for making the assessments. In an attempt to resolve the subjectivity/objectivity concerns, we developed a scoring system that uses objective (OBJ) criteria based on three 0-to-10 scales. The measurements include the patients’ requirements for analgesics, how the pain affects their levels of activity and how it affects their thought processes. Methods: Over an 18 month period and as part of a physician pain management group’s initial assessment of their patients, the study group was asked to rate their pain using the three SUB scales (Numerical Rating Scale, Visual Analogue Scale and Verbal Rating Scale) as well as our three OBJ scales. Each of our three OBJ (analgesics, activities and thought processes) scales used precise terms to quantify the numerical value for the scale. For example, the analgesics requirement ranged from no drug (0-points) to requirement for hospitalization for pain management (10-points). The activity scale ranged from no limitations (0-points) to pain noticed only with activity (4-points) to total limitation of activities (10-points). Analogous objective criteria were used for the third scale, how pain affects thought processes. Data analysis included patients’ responses to the objective pain measurements as well as correlations between OBJ and SUB evaluation scoring systems. Results: Data was collected prospectively on 109 patients. The mean scores (summation of the3 SUB pain scales divided by 3 and doing likewise for the OBJ pain scales was significantly higher for the SUB scores (6.4 vs. 4.2, p < 0.001). The lowest correlations between the SUB scores and each OBJ scale was with analgesic use (r = .36 vs. r’s = .53 for the other 2 OBJ scales). In general patients who scored highest on the SUB scores, preferred them to the OBJ measurements. Differences between the scores on the OBJ activity scale versus the OBJ thought processes scale helped distinguish pain of central versus peripheral origins. Ninety percent of patients completed the SUB plus OBJ scoring in less than 3 minutes. Conclusion: Our OBJ Pain Score helped differentiate those patients who magnified their pain symptom from those who did not. Patients with higher scores on the thought processes scale would appear to be best managed by central nervous system acting drugs. Conversely those with higher OBJ activity scores would likely respond to peripheral acting agents such as non-steroidal analgesics, local injections or analgesic patches. In summary, our scoring system moves the evaluation of pain from subjective to objective. This has important ramifications for pain management, analgesic selection and avoidance of narcotic dependency.

scholarly journals Determinants of Pain Severity Changes in Ambulatory Patients With Cancer: An Analysis From Eastern Cooperative Oncology Group Trial E2Z02

2014 ◽  
Vol 32 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Fengmin Zhao ◽  
Victor T. Chang ◽  
Charles Cleeland ◽  
James F. Cleary ◽  
Edith P. Mitchell ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Eastern Cooperative Oncology Group ◽  
Pain Severity ◽  
Initial Assessment ◽  
Pain Level ◽  
Ambulatory Patients

Purpose To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. Patients and Methods We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. Results We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. Conclusion One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

scholarly journals Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

2020 ◽  
Author(s):  
Betiel Yihdego Kidanemariam ◽  
Traudl Elsholz ◽  
Laban L. Simel ◽  
Eyasu H. Tesfamariam ◽  
Yonatan Mehari Andemeskel
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Work Experience ◽  
Statistical Significance ◽  
Demographic Data ◽  
Postoperative Pain Management ◽  
Perceived Barriers ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Manage My Pain

2019 ◽  
pp. 642-667
Author(s):  
Aliza Weinrib ◽  
Muhammad Abid Azam ◽  
Vered Valeria Latman ◽  
Tahir Janmohamed ◽  
Hance Clarke ◽  
...  
Keyword(s):  
Health Care ◽  
Pain Management ◽  
General Hospital ◽  
Health Care Providers ◽  
Virtual Community ◽  
User Engagement ◽  
Care Providers ◽  
Management Platform ◽  
Surgical Pain ◽  
Chronic Post Surgical Pain

This chapter describes the Manage My Pain digital pain management platform and its integration into the Transitional Pain Service at Toronto General Hospital. A collaboration between ManagingLife, the developer of Manage My Pain, and the Transitional Pain Service led to the creation of a patient-provider virtual community with the aim of managing complex pain after surgery so as to prevent the transition from acute post-surgical pain to chronic post-surgical pain. User engagement, motivation, and satisfaction are discussed with respect to the needs of (1) people living with pain and (2) health care providers. Challenges in implementation are described, along with new features developed for the digital platform as a result of the partnership between ManagingLife and the Transitional Pain Service.

scholarly journals Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1331-1346 ◽  
Author(s):  
Steven P Cohen ◽  
Zafeer B Baber ◽  
Asokumar Buvanendran ◽  
Brian C McLean ◽  
Yian Chen ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Risk Mitigation ◽  
Health Administration ◽  
Care Providers ◽  
Health Crisis ◽  
Management Services

Abstract Background It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. Methods To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. Results In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. Conclusions The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.

scholarly journals P023: Code Resus - using a quality improvement approach to improve health care provider response during resuscitations

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S86-S86
Author(s):  
L.B. Chartier ◽  
S. Hansen ◽  
D. Lim ◽  
S. Yi ◽  
B. McGovern ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Providers ◽  
Rating Scale ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Change Initiatives ◽  
Chi Square ◽  
Before And After

Introduction: In order to achieve the best possible outcomes for patients requiring resuscitation (PRRs) in the emergency department (ED), health care providers (HCPs) must provide an efficient, multi-disciplinary and coordinated response. A quality improvement (QI) project was undertaken to improve HCP response to PRRs at two tertiary care hospital EDs in Toronto. Methods: We conducted a before-and-after mixed-method survey to evaluate the perception of the adequacy of HCP response and clarity of HCP role when responding to PRRs. The results were compared using the Chi-square test. Qualitative responses to the first survey were also used to inform the development of the QI project. Through interviews of key stakeholders and with continuous input from front-line ED HCPs, a multi-disciplinary team modified the ED resuscitation protocol. This included standardized pre-hospital communication form with paramedics, ED-wide overhead announcement of ‘Code Resus’, dedicated HCPs assigned to respond to PRRs, and specific duties assigned to each responder. Change initiatives were reinforced through education and posters in the ED. Six months after implementation, a second survey was conducted to evaluate the sustained effects of the intervention. Results: Baseline measures indicated that 16 of 52 (30.8%) nurses surveyed believed their role was often or always apparent to themselves and others when they attended to a PRR (on a 5-point rating scale). This proportion increased to 35 of 55 (63.6%) nurses in the post-implementation survey (p < 0.001). Regarding adequacy of the number of HCPs responding to PRRs, 17 of 39 (43.6%) physicians and 23 of 53 (43.4%) nurses surveyed thought the appropriate number of HCPs responded to PRRs; the remainder thought that there were too few or too many HCPs. In the post-implementation survey, 34 of 41 (82.9%) physicians (p < 0.001) and 36 of 56 (64.3%) nurses (p = 0.029) surveyed felt that the appropriate number of HCPs attended to PRRs. Conclusion: Using a quality improvement approach, we identified and quantified perceived deficiencies in HCP response to PRRs in the ED. Through feedback-based modifications of the ED resuscitation protocol and by engaging HCP stakeholders, change initiatives were implemented to improve HCP response. As a result, this project achieved significant and sustained improvements in HCPs’ perceived response to PRRs.

Evaluation of pain management in medical transfer of trauma patients by air

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 776-783
Author(s):  
Isabelle H. Miles ◽  
Russell D. MacDonald ◽  
Sean W. Moore ◽  
James Ducharme ◽  
Christian Vaillancourt
Keyword(s):  
Pain Management ◽  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Trauma Centre ◽  
Air Transport ◽  
Future Research ◽  
Trauma Patients ◽  
Numerical Rating ◽  
Standard Deviation Range

ABSTRACTObjectivesWith regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.MethodsWe conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).ResultsWe included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).ConclusionsInitial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.

scholarly journals Perioperative Gabapentin in Pediatric Thoracic Surgery Patients—Randomized, Placebo-Controlled, Phase 4 Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1562-1571 ◽  
Author(s):  
Lucyna Tomaszek ◽  
Dariusz Fenikowski ◽  
Piotr Maciejewski ◽  
Halina Komotajtys ◽  
Danuta Gawron
Keyword(s):  
Patient Satisfaction ◽  
Placebo Group ◽  
Side Effects ◽  
Thoracic Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Care Providers ◽  
Significant Difference ◽  
Group 6 ◽  
Ravitch Procedure

Abstract Objective To determine whether the use of perioperative gabapentin reduces postoperative pain and anxiety, decreases ropivacaine consumption and side effects, and improves patient satisfaction. Design Randomized, placebo-controlled, phase 4 trial. Blinding Participants, care providers, investigators, data analysts. Setting Department of Thoracic Surgery of the Institute of Tuberculosis and Lung Disease, Rabka Zdrój Branch, Poland. Subjects Forty patients undergoing the Ravitch procedure. Methods Patients aged nine to 17 years were randomized into a gabapentin (preoperative 15 mg/kg, treatment) or placebo group. Postoperative analgesia included gabapentin (7.5 mg/kg) or placebo two times per day for three days, epidural ropivacaine + fentanyl, paracetamol, nonsteroidal anti-inflammatory drugs, and metamizol as a “rescue drug.” Pain, anxiety, analgesic consumption, side effects, and patient satisfaction were recorded. Results There was no statistically significant difference in median pain scores (numerical rating scale &lt; 1/10) or incidence of adverse side effects between the gabapentin group (N = 20) and the placebo group (N = 20). Postoperative anxiety scores were significantly lower than before surgery in the gabapentin group (6 [4–8] vs 7 [6–8.5], P &lt; 0.01) and remained unchanged in the placebo group (6 [5–6.5] vs 6 [5–7], P = 0.07). Gabapentin-treated patients received a lower number of doses of ondansetron when compared with the placebo group (6 [5–6] vs 7 [6–9], P = 0.02). A significant negative association was found between patient satisfaction and postoperative state anxiety in the gabapentin group (R = –0.51, P = 0.02). Conclusions Perioperative administration of gabapentin resulted in a decrease of postoperative anxiety in pediatric patients undergoing the Ravitch procedure.

scholarly journals Review of the Content and Quality of Mobile Applications About Alzheimer’s Disease and Related Dementias

2018 ◽  
Vol 39 (6) ◽  
pp. 601-608 ◽  
Author(s):  
Seul Ki Choi ◽  
Brooks Yelton ◽  
Victor K. Ezeanya ◽  
Kristie Kannaley ◽  
Daniela B. Friedman
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Health Care Providers ◽  
Mobile Applications ◽  
Rating Scale ◽  
Care Providers ◽  
Technical Functions ◽  
Public Collaboration

This study reviewed the content of mobile applications (apps) providing Alzheimer’s disease or related dementias (ADRD) information and assessed quality of the apps. Characteristics, content, and technical aspects of 36 apps in the U.S. Google Play Store and App Store were coded, and quality of the apps was evaluated using the Mobile Application Rating Scale. Caregiving (62.1%) and disease management (55.6%) content was frequently provided. Few apps had an app community (8.3%) or a reminder function (8.3%). Overall, quality of the apps was acceptable; apps by health care–related developers had higher quality scores than those by non-health care–related developers. This analysis showed that ADRD-related apps provide a range of content and have potential to benefit caregivers, individuals with ADRD, health care providers, and the general public. Collaboration of ADRD experts and technology experts is needed to provide evidence-based information using effective technical functions that make apps to meet users’ needs.

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