Procedural Pain Assessment in Infants Without Analgosedation: Comparison of Newborn Infant Parasympathetic Evaluation and Skin Conductance Activity - A Pilot Study

Objective: New technologies to measure pain responses, such as heart rate variability and skin conductance hold promise in the development of tools that can be reliable and quantifiable of detecting pain. The main objective of this study was to assess the capability of two monitors i.e., Newborn Infant Parasympathetic Evaluation (NIPE) and Skin Conductance Algesimeter for detecting procedural pain in non-anesthetized infants.Materials and Methods: Thirty-three non-anesthetized infants were enrolled to the study. To detect pain caused by heel stick, NIPE, and Skin Conductance monitors and behavioral pain scales were used. Three minutes before and just after heel stick, pain was evaluated by behavioral scales, and simultaneously over the whole period by NIPE and SCA.Results: A statistically significant decrease of NIPE Index and an increase of SCA values were found after the HS procedure. There were no statistically significant differences between the decrease in NIPEi values and the increase in PPS values between subgroups based on pain assessment by behavioral-scale scores.Conclusion: Both NIPE and SCA can be useful for detection of procedural pain and may constitue an additional valuable tool for better handling of pain among patients treated in NICUs. More studies on larger groups of patients are needed.

Penerapan Tindakan Kompres Hangat Dalam Menurunkan Skala Nyeri Pada Penderita Gout Arthritis

Gouty Arthritis is a disease associated with an inborn errors of purine matabolism. Gout Arthritis occurs due to a buildup of uric acid that exceeds the normal limit in the joints. This can cause pain in gouty arthritis sufferers so giving warm compresses is necessary for gouty arthritis sufferers. This study was a descriptive case study aiming to describe the application of warm compresses in reducing pain scale in patirnts with Gouty Arthritis. A client assessment form, observation sheets, pain scales, WWZ (Warm Water Zak), and uric acid measurement kid were the instuments being used to collect data. The findings showed that there was a decrease in the pain scale in patiens with Gouty Arthritis. In case I, there was a decrease of pain scale from 5 to 2; meanwhile, in case II the pain scale decreased from 6 to 3. The conclusion from this study was that the application of warm compress therapy with WWZ (Warm Water Zak) could reduce the pain scale. Thus, patients of Gouty Arthritis are suggested to apply warm compress therapy with WWZ (Warm Water Zak) to reduce the pain because of the disease.Keywords: Warm compress, pain, gouty arthritis AbstrakGout Arthritis merupakan hasil metabolisme atau pecahan purin dari makanan yang tinggi purin. Gout Arthritis terjadi karena penumpukan asam urat yang melebihi batas normal dipersendian. Hal ini dapat menyebabkan nyeri pada penderita gout arthritis sehingga pemberian kompres hangat sangat diperlukan untuk penderita gout arthritis. Studi kasus ini bertujuan untuk menggambarkan penerapan tindakan kompres hangat dalam menurunkan skala nyeri pada penderita Gout Arthtitis. Metode studi kasus ini menggunakan studi kasus deskriptif. Instrumen studi kasus ini dengan menggunakan format pengkajian klien, lembar observasi, skala nyeri, WWZ (Warm Water Zak) dan alat ukur untuk mengukur kadar asam urat. Hasil studi kasus ini menunjukkan ada penurunan skala nyeri pada penderita Gout Arthritis pada kasus I terjadi penurunan skala nyeri awal 5 turun menjadi 2 sedangkan pada kasus II skala nyeri awal 6 turun menjadi 3. Simpulan dari studi kasus ini bahwa terapi kompres hangat dengan WWZ (Warm Water Zak) dapat menurunkan skala nyeri. Saran bagi klien yang mengalami Gout Arthritis agar dapat mengontrol dengan menggunakan terapi kompres hangat menggunakan WWZ (Warm Water Zak) secara mandiri.Kata kunci: Kompres hangat, nyeri, gout arthritis

Pain Assessment in Impaired Cognition (PAIC15) Instrument: Cutoffs Against Three Standards

Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□ 0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.

Research on Psychache in Suicidal Population: A Bibliometric and Visual Analysis of Papers Published During 1994–2020

Background: Psychache is a negative introspective experience, which is positively associated with the risk of suicide, independently of depression. It is undeniable that psychache is an important influencing factor to trigger suicide, which can also mediate the effect between depression and suicide variables. Nevertheless, the research tendency and current hotspots on psychache of suicide population have not been systematically investigated based on bibliometric analysis.Aim: The aim of the study was to analyze the research status, hotspots, and frontiers of psychological pain in the field of suicidology, so as to provide reference for domestic clinical research.Methods: The literature related to psychache in suicide individuals published from 1994 to 2020 was included and selected from the Web of Science Core Collection database on May 28, 2021. CiteSpace (version 5.7.R2) software was used to visualize and analyze highly cited journals, authors, and articles as well as co-occurrence analysis for countries, institution, authors, and keywords.Results: A total of 230 articles from the WoS database were included. The number of papers over the years showed an overall upward trend. The United States has made the largest contribution, with the majority of publications (89, 38.70%), followed by Canada (48, 20.87%), Israel (31, 13.48%), China (20, 8.80%), and Portugal (17, 7.39%). The most productive institution was Queen's University. Edwin S. Shneidman has the largest achievement and profound influence, and the most prolific author is Ronald R. Holden. However, the cooperation between institutions and authors was comparatively weak. The current hotspots in this field focus on the studies on the relationships between depression, despair, psychache, and suicide, the risk assessments of psychological pain, and the development of psychological pain scales. Suicide and Life-Threatening Behavior was the most frequently cited journal in this field.Conclusions: This analysis not only reveals the current research trend and hotspots but also provides some instructive suggestions on the development of psychache in the suicidology. Future work should pay more attention to develop effective psychological pain intervention programs for diverse suicide population. Additionally, longitudinal study can also be conducted to grasp the trajectory changes of psychological pain among suicide individuals.

Caregiver–provider communication about pain in persons with dementia

Background Pain in older persons with dementia is both under-detected and under-managed. Family caregivers can play an important role in addressing these deficiencies by communicating their care recipient’s symptoms and behaviors to medical providers, but little is known about how caregivers and providers approach pain-related discussions in the context of dementia. The goal of this study was to explore how ambulatory care providers and family caregivers of persons with dementia view pain communication. Methods In-depth, semi-structured interviews were conducted with family caregivers ( n = 18) and healthcare providers involved in dementia care ( n = 16). Interviews focused on three specific content areas: (1) caregivers’ roles in communicating about pain in persons with dementia, (2) challenges experienced when communicating about pain in persons with dementia, and (3) strategies and recommendations for optimizing communication in this context. All interviews were audio-recorded, transcribed, and analyzed using the constant comparative method of data analysis. Results Caregivers and providers described various roles that caregivers assumed in communication processes, such as serving as historians, interpreters, and advocates. They identified two key features of problematic communication—receipt of inadequate information and interpersonal conflict about the care recipient’s pain—and articulated how ambiguity around pain and dementia, as well as preexisting beliefs and emotions, contributed to communication challenges. They also offered several suggestions to improve caregiver–provider communication processes, including the use of (1) written records to enhance the accuracy of caregivers’ reports and ensure that providers had specific information to inform symptom management and treatment plans, (2) pain scales and follow-up discussions to establish baseline data and clarify treatment recommendations, and (3) collaboration and rapport-building strategies to validate the caregivers’ contributions and maximize a team-based decision-making. Conclusion Receipt of inadequate information and interpersonal conflict are key challenges to caregiver–provider communication regarding pain in persons with dementia. Written records, pain scales, and rapport-building strategies may help to address these challenges.

The use of integrative and complementary practices in leprosy-related pain is influenced by sociodemographic, clinical and care factors: A case-control study

Purpose: Study in order to evaluate the use of complementary and integrative practices for leprosy-related pain. Cross-sectional, descriptive and quantitative research carried out at the University Hospital and Medical Specialties Center of Sergipe between February and June 2019. Methods: 170 people with leprosy pain contributed socio-demographic data, resources used for pain relief and factors that hinder adherence to practices. For pain assessment, the Verbal Pain Scales, Descriptor Scales and the tester Douler Neuropathic 4 were used. Results: Neuropathic pain was present in 119 individuals (70.0%) and the pain was assessed as severe in 85 (50.0%). Half of them (86; 50.6%) reported using pain relief: restricted diet (50, 29.4%), exercise (32, 18.8%), massage (31, 18.2%), among others. The factors that most influenced adherence to practices: lack of information (65, 38.2%), economic reasons (36, 21.2%), subjective characteristics (34, 20.0%). Women (45, 60.0%, p = 0.0427), patients with the borderline clinical form of the patient (23, 74.2%, p = 0.0014), reporting a burning sensation on the skin (70, 55, 5%, p = 0.0437), and those monitored by a physiotherapist (11, 84.6%, p = 0.0178) showed greater adherence to the practices. Conclusion: It is concluded that several complementary and integrative practices are being used for pain relief, but sociodemographic, clinical and care factors can influence adherence to these interventions.

Effects of Pain-Reporting Education Program on Children's Pain Reports—Results From a Randomized Controlled Post-operative Pediatric Pain Trial

Objective: Accurate assessment of patients' pain is an essential part of adequate analgesic treatment. Although reporting pain is a complex task, limited-to-no instructions are provided to pediatric patients regarding this process. Our goal in this randomized parallel-group clinical trial (Clinicaltrial.gov study protocol number NCT04306679) was to evaluate if a training program designed to improve children's ability to understand and use pain scales in a post-surgical setting would affect their pain scores.Methods: Eligible children (aged 8–17), hospitalized for elective surgery and their parents were randomized into two groups. Pre-surgery the intervention group underwent a multi-media program aimed to teach and train how to report pain. The control group received standard pre-surgical instructions. Post-surgery, the children reported their pain on 4 pain scales. The primary outcome was the concordance between children's pain intensity scores reported on four pain scales, both in terms of within-child standard deviation and absolute difference.Results: Ninety-six children met inclusion criteria and completed the study. The trained subjects' pain reports had significantly (p = 0.002) lower within-subject standard deviation (0.41 ± 0.31) than the control group (0.67 ± 0.46). In line, regarding absolute difference, the concordance of children's pain reports was twice better in the trained group (mean difference of 0.43 ± 0.40) than in the control group (0.88 ± 0.70) (p < 0.001).Discussion: Our results suggests that children's ability to report pain is a skill that can be improved. Future studies should test the potential clinical impacts of educational interventions aimed to improve pain assessment in children and adults.

How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others’ Use of Numerical Pain Scales

Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.