Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute.

144 Background: Medstar Washington Cancer Institute (MWCI) has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources, and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters ( p = 0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]

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Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute (MWCI).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20700 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20700-e20700

Author(s):

Sekwon Jang ◽

Vishal Navnitray Ranpura ◽

Lynne Wood ◽

Heller Stephanie ◽

Linda Self

Keyword(s):

Severe Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Administrative Staff ◽

Chi Square ◽

Potential Explanation ◽

Chi Square Test ◽

Oncology Practice ◽

Pain Documentation ◽

Numeric Rating

e20700 Background: MWCI has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the Fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the Table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters (p =0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]

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Hubungan intensitas pemakaian gawai dengan neck pain pada usia 15-20 tahun

Jurnal Biomedika dan Kesehatan ◽

10.18051/jbiomedkes.2019.v2.71-76 ◽

2019 ◽

Vol 2 (2) ◽

pp. 71-76

Author(s):

Yuni Tri Yustianti ◽

Pusparini Pusparini

Keyword(s):

Neck Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Chi Square ◽

Cross Sectional ◽

Numeric Rating

LATAR BELAKANG Dekade terakhir menunjukkan neck pain pada remaja semakin meningkat, bersamaan dengan meningkatnya penggunaan gawai (gadget). Seiring perkembangan zaman, gawai menjadi kebutuhan dan gaya hidup masyarakat luas. Pelajar menjadi pasar terbesar dalam penggunaan gawai sehubungan dengan kebutuhan belajar yang memerlukan akses Internet. Salah satu faktor penyebab neck pain pada pengguna gawai adalah intensitas penggunaan gawai yang mempengaruhi lamanya posisi fleksi pada otot leher. Tujuan penelitian ini adalah untuk mengetahui hubungan intensitas pemakaian gawai dengan neck pain pada usia 15-20 tahun. METODE Penelitian ini merupakan studi observasional dengan desain cross sectional yang mengikutsertakan 164 pelajar SMAN 28 Jakarta dan Fakultas Hukum Universitas Trisakti. Data dikumpulkan dengan cara pengisian kuesioner yang meliputi usia, jenis kelamin, intensitas pemakaian gawai dan keluhan neck pain. Penilaian neck pain menggunakan NRS (Numeric Rating Scale). Analisis data dilakukan dengan uji Chi-square dengan tingkat kemaknaan p<0.05. HASIL Subjek perempuan berjumlah 121 orang (73.8%). Paparan gawai dengan intensitas >56 jam/minggu dijumpai pada 109 subjek (66.5%). Keluhan neck pain dijumpai pada 138 subjek (84.1%). Uji Chi-square menunjukkan terdapat hubungan yang bermakna antara intensitas penggunaan gawai dengan neck pain pada usia 15-20 tahun dengan nilai p=0.004. KESIMPULAN Terdapat hubungan yang bermakna antara intensitas penggunaan gawai dengan neck pain pada usia 15-20 tahun.

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Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing

Frontiers in Psychology ◽

10.3389/fpsyg.2016.01466 ◽

2016 ◽

Vol 7 ◽

Cited By ~ 92

Author(s):

Anne M. Boonstra ◽

Roy E. Stewart ◽

Albère J. A. Köke ◽

René F. A. Oosterwijk ◽

Jeannette L. Swaan ◽

...

Keyword(s):

Musculoskeletal Pain ◽

Severe Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Chronic Musculoskeletal Pain ◽

Numeric Rating

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Pain after Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200610000-00026 ◽

2006 ◽

Vol 105 (4) ◽

pp. 794-800 ◽

Cited By ~ 135

Author(s):

Pasi Lahtinen ◽

Hannu Kokki ◽

Markku Hynynen

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Scale Score ◽

Severe Pain ◽

Rating Scale ◽

Artery Bypass ◽

Numeric Rating Scale ◽

Persistent Pain ◽

Numeric Rating Scale Score ◽

Numeric Rating

Background Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy. Methods The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days postoperatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain. Results The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently. Conclusions Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.

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Postoperative Pain and Age: A Retrospective Cohort Association Study

Anesthesiology ◽

10.1097/aln.0000000000004000 ◽

2021 ◽

Author(s):

Jacqueline F. M. van Dijk ◽

Ruth Zaslansky ◽

Regina L. M. van Boekel ◽

Juanita M. Cheuk-Alam ◽

Sara J. Baart ◽

...

Keyword(s):

Postoperative Pain ◽

Retrospective Cohort ◽

Severe Pain ◽

Rating Scale ◽

Pain Treatment ◽

The Elderly ◽

Numeric Rating Scale ◽

Opioid Administration ◽

Patient Reported ◽

Numeric Rating

Background As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients. Methods In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. Results A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. Conclusions The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Pain Intensity on the First Day after Surgery

Anesthesiology ◽

10.1097/aln.0b013e31828866b3 ◽

2013 ◽

Vol 118 (4) ◽

pp. 934-944 ◽

Cited By ~ 525

Author(s):

Hans J. Gerbershagen ◽

Sanjay Aduckathil ◽

Albert J. M. van Wijck ◽

Linda M. Peelen ◽

Cor J. Kalkman ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Surgical Procedures ◽

Severe Pain ◽

Rating Scale ◽

Pain Treatment ◽

Numeric Rating Scale ◽

Treatment Needs ◽

Pain Scores ◽

Numeric Rating

Abstract Background: Severe pain after surgery remains a major problem, occurring in 20–40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0–10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6–7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many “minor” surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of “major” abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia. Conclusions: Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

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Kecemasan, Usia, Paritas dan Nyeri Persalinan Kala I Aktif

Jurnal Kesehatan Metro Sai Wawai ◽

10.26630/jkm.v12i2.2141 ◽

2019 ◽

Vol 12 (2) ◽

pp. 47

Author(s):

Yoga Tri Wijayanti ◽

Sumiyati Sumiyati ◽

Prasetyowati Prasetyowati

Keyword(s):

Rating Scale ◽

Sampling Technique ◽

Numeric Rating Scale ◽

Labor Pain ◽

Bivariate Analysis ◽

Chi Square ◽

Cross Sectional ◽

Purposive Sampling ◽

Self Rating ◽

Numeric Rating

Latar belakang: Nyeri persalinan merupakan kombinasi nyeri fisik akibat kontraksi miometrium disertai regangan segmen bawah rahim yang menyatu dengan kondisi psikologis ibu selama persalinan. Nyeri persalinan yang tidak diatasi menyebabkan partus lama dan asfiksia pada janin. Tujuan: Tujuan penelitian untuk mengetahui faktor yang berhubungan dengan nyeri persalinan. Metode: Rancangan penelitian menggunakan studi cross sectional. Sampel berjumlah 32 responden dan diambil dengan teknik purposive sampling. Variabel independen meliputi kecemasan, usia dan paritas, sedangkan variabel dependen nyeri persalinan. Pengumpulan data menggunakan alat kuesioner, Zung Self-Rating Anxiety Scales (ZSAC) untuk mengukur kecemasan dan lembar observasi Numeric Rating Scale (NRS) (skala 0-10) untuk nyeri persalinan. Analisis bivariat menggunakan uji chi square. Hasil: Hasil penelitian menunjukkan terdapat 43,75% ibu bersalin merasakan kecemasan menghadapi persalinan. Studi memperoleh hasil ada hubungan kecemasan dengan nyeri persalinan kala I (p = 0,017; POR 7,5 CI 95%: 1,3-43,7). Simpulan: Kecemasan pada ibu bersalin meningkatkan persepsi nyeri persalinan kala I. Perlu upaya penurunan atau menghilangkan kecemasan pada ibu bersalin dengan diberikan dukungan oleh keluarga atau Bidan dan pemahaman cara merespon nyeri.Background: Labor pain is a combination of physical pain due to myometrial contraction accompanied by a stretch of the lower uterine segment that integrates with the psychological condition of the mother during labor. Untreated labor pain causes prolonged labor and asphyxia in the fetus. Purpose: The purpose of this study was to determine factors associated with labor pain. Methods: The study design used a cross-sectional study. The sample consisted of 32 respondents and was taken by purposive sampling technique. The independent variables include anxiety, age, and parity, while the dependent variable is labor pain. Data collection using a questionnaire tool, Zung Self-Rating Anxiety Scales (ZSAC) to measure anxiety and observation sheet Numeric Rating Scale (NRS) (scale 0-10) for labor pain. Bivariate analysis using the chi-square test. Results: The results showed that 43.75% of mothers felt anxiety facing labor. The study found an association of anxiety with first stage labor pain (p = 0.017; CI 95%: 1,3-43,7). Conclusion: Anxiety in labor increases the perception of labor pain in the first stage. It is necessary to reduce or eliminate anxiety in labor by giving support from the family or midwife and understanding how to respond to pain.

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Does Metabolic Syndrome Determine Severity and Disability of Chronic Low Backache?

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_430_17 ◽

2018 ◽

Vol 09 (02) ◽

pp. 208-213 ◽

Cited By ~ 1

Author(s):

Jayantee Kalita ◽

Kamlesh Kumar Sonkar ◽

Usha Kant Misra ◽

Sanjeev K. Bhoi

Keyword(s):

Metabolic Syndrome ◽

National Cholesterol Education Program ◽

Rating Scale ◽

Rank Correlation ◽

Numeric Rating Scale ◽

Test Results ◽

Adult Treatment Panel ◽

Chi Square ◽

Spearman’S Rank Correlation ◽

Numeric Rating

ABSTRACT Introduction: Obesity may be associated with more severe and disabling low backache (LBA) due to alteration in biomechanics, but there are no such studies from developing countries. Aims: We report the frequency of metabolic syndrome (MS) in chronic LBA (CLBA) and its association with severity and disability of CLBA. Subjects and Methods: Consecutive patients with CLBA attending to the neurology service from October 2015 to February 2016 were included in the study. Clinical and demographic parameters were recorded. Routine biochemical test was done. The severity of pain was assessed by a 0–10 Numeric Rating Scale (NRS) and disability by Oswestry Disability Index (ODI) version 2. Comparison of variables was done by Chi-square or independent t-test and correlation by Karl Pearson or Spearman's rank correlation test. Results: Seventy-none (39.3%) patients had MS as per the International Diabetic Federation (IDF) criteria and 68 (33.8%) as per the National Cholesterol Education Program Adult Treatment Panel III criteria. Abdominal obesity was the most common (171 [85.1%]) feature of MS. The patients with MS had longer duration of sitting work and did less frequently exercise. The NRS score (6.95 ± 1.06 vs. 6.65 ± 0.95; P = 0.04) and ODI score (54.91 ± 8.42 vs. 51.89 ± 8.54; P = 0.01) were higher in CLBA patients with MS compared to those without MS. Conclusion: About 40% patients with CLBA have metabolic syndrome, and they have more severe pain and disability.

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Relationship between acute pain trajectories after an emergency department visit and chronic pain: a Canadian prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040390 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040390

Author(s):

Raoul Daoust ◽

Jean Paquet ◽

Alexis Cournoyer ◽

Éric Piette ◽

Judy Morris ◽

...

Keyword(s):

Chronic Pain ◽

Cohort Study ◽

Pain Intensity ◽

Acute Pain ◽

Severe Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Pain Trajectories ◽

Numeric Rating

ObjectivesInadequate acute pain management can reduce the quality of life, cause unnecessary suffering and can often lead to the development of chronic pain. Using group-based trajectory modelling, we previously identified six distinct pain intensity trajectories for the first 14-day postemergency department (ED) discharge; two linear ones with moderate or severe pain during follow-up (~40% of the patients) and four cubic polynomial order trajectories with mild or no pain at the end of the 14 days (low final pain trajectories). We assessed if previously described acute pain intensity trajectories over 14 days after ED discharge are predictive of chronic pain 3 months later.DesignProspective cohort study.SettingTertiary care trauma centre academic hospital.ParticipantsThis study included 18 years and older ED patients who consulted for acute (≤2 weeks) pain conditions that were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity (0–10 numeric rating scale).OutcomesThree months after ED visit, participants were questioned by phone about their current pain intensity (0–10 numeric rating scale). Chronic pain was defined as patients with current pain intensity ≥4 at 3 months.ResultsA total of 305 participants remained in the study at 3 months, 49% were women and a mean age of 55±15 years. Twelve per cent (11.9; 95% CI 8.2 to 15.4) of patients had chronic pain at the 3-month follow-up. Controlling for age, sex and pain condition, patients with moderate or severe pain trajectories and those with only a severe pain trajectory were respectively 5.1 (95% CI 2.2 to 11.8) and 8.2 (95% CI 3.4 to 20.0) times more likely to develop chronic pain 3 months later compared with patients in the low final pain trajectories.ConclusionSpecific acute pain trajectories following an ED visit are closely related to the development of chronic pain 3 months later.Trial registration numberNCT02799004; Results.

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Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz153 ◽

2019 ◽

Vol 29 (5) ◽

pp. 714-721

Author(s):

Davide Tosi ◽

Mario Nosotti ◽

Gianluca Bonitta ◽

Alessandra Mazzucco ◽

Ilaria Righi ◽

...

Keyword(s):

Thoracic Surgery ◽

Severe Pain ◽

Rating Scale ◽

Estimating Equation ◽

Numeric Rating Scale ◽

Generalized Estimating Equation ◽

Inclusion Criteria ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Numeric Rating

Abstract OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I–II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62–3.21; P < 0.001] and OR 2.58 (95% CI 1.74–3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.

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