The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

218 Background: Appropriate cancer pain documentation is one of the quality indicators in American Society of Clinical Oncology (ASCO)’s Quality Oncology Practice Initiative (QOPI). Medstar Washington Cancer Institute (MWCI) has participated in QOPI since 2008. Documentation of plan of care for moderate/severe pain defined as a pain score of ≥4 on a numeric pain scale was 69%, (compared to QOPI aggregate of 79%) during the fall 2011 round which led to a quality improvement project with an aim of ≥ 90%. Methods: MWCI created a team of physicians, nurses and administrative staff. We attended ASCO’s quality training workshop from October 2013 to March 2014 for guidance. We implemented a Plan Do Study Act (PDSA) methodology for our quality improvement project. We created a process map, cause and effect diagram and Pareto chart based on survey of physicians citing common reasons for lack of documented plan of care for pain. Results: Baseline rate of documented plan of care for pain control in November 2013 was 70%. In January 2014, we implemented action plans to increase the awareness of pain documentation (Electronic Health Record (HER) trigger for pain ≥ 4, fellows and mid level education and faculty consensus on documenting management for pain unrelated to cancer). After intervention, the pain documentation rate was improved to 90.2% (Table). Conclusions: After one cycle of PDSA, we achieved our goal of pain documentation rate. In order to sustain our project, we will continue to monitor the pain documentation rate quarterly in 2014 and continue the process of education and orientation to new staff as well rotating residents and fellows. [Table: see text]

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The treatment of coccydynia in adolescents

Bone & Joint Open ◽

10.1302/2046-3758.15.bjo-2020-0017 ◽

2020 ◽

Vol 1 (5) ◽

pp. 115-120

Author(s):

Ante Matti Kalstad ◽

Rainer Günter Knobloch ◽

Vilhjalmur Finsen

Keyword(s):

Pain Scale ◽

Adult Patients ◽

Injection Therapy ◽

Control Group ◽

Treatment Results ◽

Results Of Treatment ◽

Adolescent Patients ◽

Numeric Pain Scale ◽

One Year

Aims To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes. Methods Overall, 32 adolescents with coccydynia were treated at our institution during a seven-year period; 28 responded to final follow-up questionnaires after a minimum of one year, 14 had been treated with only injection therapy, and 14 had been operated with coccygectomy. We collected data with regards to pain while sitting, leaning forward, rising from a sitting position, during defecation, while walking or jogging, and while travelling in trains, planes, or automobiles. Pain at follow-up was registered on a numeric pain scale. Each adolescent was then matched to adult patients, and results compared in a case control fashion. The treatment was considered successful if respondents were either completely well or much better at final follow-up after one to seven years. Results Out of the 28 treated adolescents, 14 were regarded as successfully treated. Seven were somewhat better, and the remaining seven were unchanged. In the adult control group the corresponding number was 15 successfully treated, eight patients were somewhat better, and five were unchanged. Six of the 14 successfully treated adolescents had been operated. There were no significant differences between the groups in the various registered domains, or on numeric pain scale. Conclusion Treatment results in adolescent patients seem similar to those in adults. The long-term success rate of injection therapy is low. In case of injection treatment failure, operation may be considered, also in adolescents.

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Comparative study between medial canthus episcleral block versus peribulbar block in intracapsular cataract surgery

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00138-6 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Ahmed Fayez Abd el raof Elsayed ◽

Mohammed Ali Ahmed Zaghlol ◽

Sherif Samir Wahba Rizk Allah ◽

Ahmed Moustafa Mohamed Mohamed

Keyword(s):

Cataract Surgery ◽

Statistical Significance ◽

Pain Scale ◽

Medial Canthus ◽

High Statistical Significance ◽

Peribulbar Block ◽

Peribulbar Anesthesia ◽

Numeric Pain Scale ◽

Double Blinded ◽

Time To Onset

Abstract Background Ophthalmic regional anesthesia is now the most common anesthetic technique used for eye surgeries. There are various modes of needle-based ophthalmic anesthesia which are retrobulbar, peribulbar, and episcleral. The sub-Tenon episcleral anesthesia technique became a potential alternative to the retrobulbar and peribulbar anesthesia in most of the anterior and posterior segment eye surgeries; this is due to its better safety profile and tolerability than the other blocks. The aim of this study was to compare between medial episcleral block and peribulbar block in intracapsular cataract surgery as regards anesthesia and akinesia of the eye, the need of supplementation of local anesthetic, and finally the safety profile of each block. This was a prospective, comparative, randomized, double-blinded clinical study. It was carried out on 60 patients that were scheduled for intracapsular cataract surgery in ophthalmic surgery unit. The patients were randomly allocated into two equal groups; group A received medial canthus episcleral block technique and group B received peribulbar block technique. Results Results of this prospective, comparative, randomized, double-blinded study showed no statistical difference between the two groups as regards demographic and vital data. As regards Akinesia score, the ESA group had better akinesia score at 1, 5, and 10 min and at the end of surgery than PBA group (P value, 0.001). No patient in the ESA group received supplemental injection via inferotemporal peribulbar block technique, while 66.7% of PBA group was in need of supplementation. Regarding time to onset of acceptable akinesia score; ESA group had a faster onset with high statistical significance (P value, 0.001). Numeric pain scale was better in ESA group than PBA group with high statistical significance. There were chemosis after injection in two of the ESA group (6.6%). On the other hand, slight pricking pain at the end pf surgery developed in two cases in the PBA group. Conclusion Medial canthal episcleral technique proved to be superior in motor akinesia score, time to onset of acceptable akinesia score, and numeric pain scale in comparison to peribulbar anesthesia with high statistical significance between the two groups. Both techniques proved to be safe with no incidence of major complications.

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Oral or nasal breathing; preferred breathing pattern for endodontics

10.53350/pjmhs211592721 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2721-2723

Author(s):

Usman Sana ◽

Attique Ur Rehman ◽

Faizan Haroon ◽

Lubna Yousaf ◽

Maryam Virda ◽

...

Keyword(s):

Pain Perception ◽

Breathing Pattern ◽

Positive Outcome ◽

Pain Scale ◽

Breathing Patterns ◽

Nasal Breathing ◽

Mild Pain ◽

Numeric Pain Scale ◽

Relationship Of ◽

The Relationship

Objective: The objective of study was to explore the relationship of breathing and pain during endodontic therapy. Materials and methods: 500 patients who presented in the department of operative dentistry were included in the study. Numeric pain scale was used to document the pain perceived during endodontic therapy. Results were analysed using SPSS version 23. Results: Among the 500 cases, 250 cases presented with mild pain, 158 presented with moderate pain while 92 presented with severe pain. 55.4% cases were of nasal breathers while 44.6% cases were of oral breathers. Conclusion: Patients presenting with nasal breathing pattern reported with mild pain perception during endodontic therapy when compared to patients who were oral breathers. Considering life style modifications like breathing patterns, body hydration and sleep impact the patient’s life and pain management during endodontic therapy. Educating patients on proper breathing and its benefits will have positive outcome on endodontic therapy. Keywords: Oral breathing, nasal breathing, pain perception, endodontics.

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The Use of Orbital Morphine for Postoperative Analgesia in Pterygium Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x0002800107 ◽

2000 ◽

Vol 28 (1) ◽

pp. 43-45 ◽

Cited By ~ 16

Author(s):

K. Wishaw ◽

D. Billington ◽

D. O'Brien ◽

P. Davies

Keyword(s):

Side Effects ◽

Postoperative Analgesia ◽

Scale Effects ◽

Pain Scale ◽

Double Blind Study ◽

Morphine Group ◽

Corneal Surgery ◽

Double Blind ◽

Pterygium Surgery ◽

Lower Pain Score

A prospective double-blind study compared the analgesic effectiveness of peribulbar lignocaine with peribulbar morphine and lignocaine for postoperative analgesia in pterygium surgery. Twenty patients were randomly divided to receive a peribulbar injection preoperatively of either 1% lignocaine 2 ml or 1% lignocaine 1.6 ml and 4 mg morphine. Effects on pain at injection and pain at 24 hours and 48 hours postoperatively were measured with a visual analog pain scale. Effects of the injections on sedation, pupil size and unwanted side-effects were also recorded. The groups were comparable for age, weight and surgical technique. There was a significantly lower pain score at 24 hours after operation in the morphine group (P=0.035). There were no significant differences in sedation or side-effects between the groups. The physiological effects of morphine on the eye are reviewed. The study suggests that orbital morphine may be an effective and safe form of analgesia for corneal surgery and further investigation is warranted.

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The verbal numeric pain scale: Emergency Department patients' understanding and perspectives

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.07.002 ◽

2020 ◽

Author(s):

Catherine A. Marco ◽

Brian Patrick Murray ◽

Mitchell McMurray ◽

Blake Nelson ◽

Declan Feery ◽

...

Keyword(s):

Emergency Department ◽

Pain Scale ◽

Numeric Pain Scale ◽

Emergency Department Patients

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The treatment of coccydynia in adolescents

Bone & Joint Open ◽

10.1302/2633-1462.15.bjo-2020-0017 ◽

2020 ◽

Vol 1 (5) ◽

pp. 115-120 ◽

Cited By ~ 1

Author(s):

Ante Matti Kalstad ◽

Rainer Günter Knobloch ◽

Vilhjalmur Finsen

Keyword(s):

Pain Scale ◽

Adult Patients ◽

Injection Therapy ◽

Control Group ◽

Treatment Results ◽

Results Of Treatment ◽

Adolescent Patients ◽

Numeric Pain Scale ◽

One Year

Aims To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes. Methods Overall, 32 adolescents with coccydynia were treated at our institution during a seven-year period; 28 responded to final follow-up questionnaires after a minimum of one year, 14 had been treated with only injection therapy, and 14 had been operated with coccygectomy. We collected data with regards to pain while sitting, leaning forward, rising from a sitting position, during defecation, while walking or jogging, and while travelling in trains, planes, or automobiles. Pain at follow-up was registered on a numeric pain scale. Each adolescent was then matched to adult patients, and results compared in a case control fashion. The treatment was considered successful if respondents were either completely well or much better at final follow-up after one to seven years. Results Out of the 28 treated adolescents, 14 were regarded as successfully treated. Seven were somewhat better, and the remaining seven were unchanged. In the adult control group the corresponding number was 15 successfully treated, eight patients were somewhat better, and five were unchanged. Six of the 14 successfully treated adolescents had been operated. There were no significant differences between the groups in the various registered domains, or on numeric pain scale. Conclusion Treatment results in adolescent patients seem similar to those in adults. The long-term success rate of injection therapy is low. In case of injection treatment failure, operation may be considered, also in adolescents.

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