Pain Assessment Research Articles

Improving Pain Assessment After Inpatient Orthopedic Surgery: A Comparison of Two Scales

ABSTRACT Purpose: In pain assessment, the commonly used Numeric Rating Scale (NRS) offers an incremental 0-to-10 range of response options. But this broad range often leads to discordant evaluations between nurses and their patients. This study aimed to compare the NRS to the three-category Interventional Pain Assessment (IPA) scale, validate the IPA scale in an inpatient setting, and determine RN and patient scale preferences. Methods: This prospective study enrolled 122 postoperative orthopedic patients and their designated 104 RNs at a level 1 trauma center in the midwestern United States. Patients were asked to verbally rate their pain from 0 to 10 using the NRS and from 0 to 2 on the IPA scale. Patients were also asked which scale best conveyed their pain. The RNs were asked which scale best informed them of their patient's pain situation and which scale they preferred. To establish a correlation between the two scales, we considered NRS values of 0 to 7 (signifying no pain to moderate pain) to correspond to IPA scale values of 0 to 1 (signifying no pain to tolerable pain). NRS values of 8 to 10 (signifying severe pain) were considered to correspond to IPA scale values of 2 (signifying intolerable pain). Responses in which patients reported IPA scores indicating no pain to tolerable pain but NRS scores above 7 or IPA scale scores indicating intolerable pain but NRS scores of 7 or below were defined as discordant answers. Results: Data analysis revealed a strong significant correlation between the NRS and IPA scale (τ = 0.597), with an 82.7% concordance rate. Once an NRS score rose above 7, more discordance between the two scales became increasingly prevalent, as evidenced by the 45% of patients who also reported tolerable pain on the IPA scale. Significantly more patients (89.3%) preferred the IPA scale to communicate their pain level than the NRS (10.7%). Significantly more RNs (76%) felt the IPA scale best informed them of their patient's pain and was a better guide for treatment than felt the NRS did so (24%). Conclusions: The IPA scale asks about pain tolerability and thus has a direct role in the management of pain medications. Both patients and nurses felt they were better able to convey and understand pain when using the IPA scale than when using the NRS. There was consensus regarding pain scale preference among patients and their RNs, with both groups preferring the IPA scale due to its simplicity and, among the RNs, its usefulness in guiding treatment. The IPA scale may be a much better tool for accurately assessing a patient's pain experience and needs, with the potential to change practice and improve pain management.

Utilising Hyperspectral Autofluorescence Imaging in the Objective Assessment of Disease State and Pain in Patients with Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disease resulting in joint swelling and pain. Treatment options can be reliant on disease activity scores (DAS) incorporating patient global assessments, which are quantified via visual analogue scales (VAS). VAS can be subjective and not necessarily align with clinical symptoms, such as inflammation, resulting in a disconnect between the patient’s and practitioners’ experience. The development of more objective assessments of pain would enable a more targeted and personalised management of pain within individuals with RA and have the potential to improve the reliability of assessments in research. Using emerging light-based hyperspectral autofluorescence imaging (HAI) technology, we aimed to objectively differentiate disease and pain states based on the analysis of synovial tissue (ST) samples from RA patients. In total, 22 individuals with RA were dichotomised using the DAS in 28-joint counts (DAS-28) into an inactive (IA) or active disease (active-RA) group and then three sub-levels of pain (low, mid, high) based on VAS. HAI was performed on ST sections to identify and quantify the most prominent fluorophores. HAI fluorophore analysis revealed a distinct separation between the IA-RA and active-RA mid-VAS cohort, successfully determining disease state. Additionally, the separation between active-RA Mid-VAS and active RA High-VAS cohort suggests that HAI could be used to objectively separate individuals based on pain severity.

Extracorporeal Shock Wave Therapy (ESWT) vs. Exercise in Thumb Osteoarthritis (SWEX-TO): Prospective Clinical Trial at 6 Months

Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. A prospective clinical study was designed, in which 72 patients affected by rhizarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace was used on the first finger. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA) and disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH were statistically influenced by shock wave treatment (p < 0.001). Both therapies are effective in managing patients suffering from arthritis of the first finger, but the shock wave treatment could ensure greater persistence of improvements.

Automated acute pain prediction in domestic goats using deep learning-based models on video-recordings

Facial expressions are essential in animal communication, and facial expression-based pain scales have been developed for different species. Automated pain recognition offers a valid alternative to manual annotation with growing evidence across species. This study applied machine learning (ML) methods, using a pre-trained VGG-16 base and a Support Vector Machine classifier to automate pain recognition in caprine patients in hospital settings, evaluating different frame extraction rates and validation techniques. The study included goats of different breed, age, sex, and varying medical conditions presented to the University of Florida’s Large Animal Hospital. Painful status was determined using the UNESP-Botucatu Goat Acute Pain Scale. The final dataset comprised images from 40 goats (20 painful, 20 non-painful), with 2,253 ‘non-painful’ and 3,154 ‘painful’ images at 1 frame per second (FPS) extraction rate and 7,630 ‘non-painful’ and 9,071 ‘painful’ images at 3 FPS. Images were used to train deep learning-based models with different approaches. The model input was raw images, and pain presence was the target attribute (model output). For the single train-test split and 5-fold cross-validation, the models achieved approximately 80% accuracy, while the subject-wise 10-fold cross-validation showed mean accuracies above 60%. These findings suggest ML’s potential in goat pain assessment.

A Qualitative Exploration of Healthcare Workers' Experiences of End of Life Care for People With an Intellectual Disability.

To explore healthcare workers' experiences of end of life care for people with an intellectual disability. A descriptive qualitative study. Semi-structured interviews were conducted with 28 healthcare workers who cared for older people with an intellectual disability at their end of life. Data were analysed using thematic analysis and reported according to the COREQ guidelines. Three major themes emerged: not joining up the dots, living the life desired in one's last days and dealing with death and beyond. Gaps emerged in the care of the person with intellectual disability. Pain assessment and pain management were particular challenges. End of life care was not always effectively planned, and earlier intervention, including end of life conversations, were needed. More needs to be done in terms of education for healthcare workers, and especially those in the acute care setting and palliative care services who may be unfamiliar with the needs of this cohort. There is little consensus or understanding about the palliative care needs of those with intellectual disability. There are often specific challenges around providing palliative care particularly in relation to healthcare staffs' knowledge and confidence in understanding palliative care needs of this group and indeed communicating and assessing particular needs. Staff require educational preparation and training in palliative care to address the particular needs of this cohort. This study revealed that there are gaps emerging in the care of the person with intellectual disability at the end of life. Pain assessment and pain management are particular challenges that require urgent attention. There was no patient or publication contribution in this specific study, although IDS-TILDA has a client representative and advisory committee that advise on all aspects of project design and management.

Self-reported pain assessment, core competence and practice ability for palliative care among Chinese oncology nurses: a multicenter cross-sectional study

ObjectiveThe study was to survey the current situation and explore the relationship between pain assessment ability, palliative care core competence and palliative care practice ability among oncology nurses in mainland China.MethodsA multicenter cross-sectional study design was employed. Study data were collected in 26 tertiary hospitals among 1198 registered oncology nurses in the oncology department in Hubei province, China. A web-based survey was conducted using a stratified random integral sampling method to obtain data. All variables were measured using standardized instruments. Data was analyzed using SPSS 26.0 and AMOS 26.0 statistical software. All statistical tests were two-sided, with the significance level set at P < 0.05. The structural equation model was utilized to test the mediation effect of pain assessment ability on the pathway from palliative care core competence to palliative care practice ability.ResultsThe mean scores for pain assessment, core competence and practice ability were 125.68 (SD = 31.16), 76.67 (SD = 19.59) and 67.17(SD = 12.57), respectively. Pearson correlation analysis revealed significant positive correlations among the PCPS, EPCS, and Self-PAC scores of the oncology nurses (P < 0.01). The association between core competence and palliative care practice ability was mediated by pain assessment ability (ES = 0.125, 95%CI: 0.090–0.168).ConclusionsTo enhance the effectiveness of palliative care practice, managers need to strengthen the core competencies of palliative care nurses and their ability to assess patients’ pain, as these two factors will promote the practical abilities of oncology nurses.

Pain Assessment in Older Adults After Traumatic Injury

This cross-sectional study analyzes how pain assessment frequency and pain score magnitude and variability differ by age among trauma patients admitted in hospitals.

A National Study on the Association of Abdominal Ultrasound with CT Utilization and Disposition in the Emergency Department

Background Ultrasound and CT imaging have distinct and overlapping roles in the assessment of undifferentiated abdominal pain in the emergency department (ED). CT imaging is the gold standard for many pathologies, ranging from bowel obstruction to aortic pathology whereas ultrasound benefits from less radiation exposure and the ability to employ at bedside. In this pilot study, we utilize nationally representative data to identify associations between ultrasound use in ED patients with a primary complaint of abdominal pain with abdominal CT imaging use and disposition. Methods We analyzed retrospective, cross-sectional data on ED patient visits obtained from the National Hospital Ambulatory Medical Care Survey from 2016-2020. This dataset utilizes a weighed multistage, probability sample of ED patient visits involving a four-stage sampling design, including data at county-level geographic regions, hospitals within these regions, emergency service areas in these hospitals, and patient visit records. The study population includes adult patient ED visits with an age of 18 and up presenting with a primary complaint of atraumatic abdominal pain. Descriptive statistics was utilized to describe the sample population. Survey-weighted multivariate logistic regression analysis with calculated odds ratios evaluated for differences between the binary dependent variable of abdominal pain visits with versus without ultrasound use with independent variables of disposition and abdominal CT imaging use while controlling for visit acuity and adjusting for demographic information. Results A total of 7563 patient visits met inclusion criteria, representing approximately 60 million patient visits from 2016-2020. In this study population, 18.5% of visits involved ultrasound, whereas 39.8% of visits involved CT imaging use. 14.6% of visits resulted in hospital admission. On weight-adjusted regression analysis, visits involving ultrasound were less likely to require CT imaging and more likely to be admitted, with ORs of 0.49 (95% CI: 0.37, 0.64) and 1.97 (95% CI: 1.44, 2.68), respectively. Visits involving ultrasound were more likely to be associated with an emergency medicine residency program and an emergent acuity level, with ORs of 1.40 (95% CI: 1.01, 1.94) and 1.53 (95% CI: 1.01, 2.31), respectively. Conclusion In this national pilot study, abdominal pain visits involving ultrasound were associated with a lower likelihood of CT imaging use and a highly likelihood admission and an emergent acuity level.

Retrospective Review of Spinal Cord Compression Occurrences and Management in Children With Relapsed, Progressing, or Refractory Malignancies.

Spinal cord compression (SCC) is a severe complication in pediatric patients with relapsed, progressing, or refractory solid malignancies. This study aims to report the presentation, treatment, and role of proactive radiation therapy in these patients. This retrospective study reviewed 28 patients with relapsed, progressing, or refractory solid tumors who were referred for radiation therapy consultation due to potential (impending) or actual spinal cord compression (pSCC and aSCC, respectively) over a 12-year period. Collected data included disease characteristics, details of SCC events, management approaches, and patient outcomes. Among the 28 patients, 34 SCC events were identified (18 pSCC, 16 aSCC), with neuroblastoma being the most frequent diagnosis (46.4%). No significant differences were noted between pSCC and aSCC groups in pre-event imaging follow-up, age distribution, or malignancy status at SCC presentation. However, aSCC patients exhibited significantly more symptoms at diagnosis. Both groups received SCC-targeted therapy, with no significant differences in functional outcomes, event-free survival (EFS), or overall survival (OS). Pain assessments post treatment showed comparable improvements in both groups. Proactive radiotherapy for pSCC did not yield superior outcomes compared to reactive treatment for aSCC. Given the limited benefits observed, proactive RT should be considered on an individual basis, balancing potential QoL improvements against treatment burdens. Further research in larger cohorts is necessary to refine therapeutic strategies for SCC in pediatric oncology.

The NIH Pain Common Data Elements: A Great Start but a Long Way to the Finish Line.

The NIH Pain Common Data Elements (CDEs) provide a standardized framework for pain research, but their implementation and interpretation present challenges. To review the NIH CDE Program's selected pain domains, provide best practices for implementing required questions, and offer a checklist for appropriate CDE use in clinical trials and secondary data analysis. This work analyzed the ten core pain research domains selected by the NIH CDE Program and discuss their limitations and considerations for use. The manuscript provides an overview of the ten core pain research domains, including pain intensity, interference, physical function, sleep, catastrophizing, depression, anxiety, global impression of change, substance use screening, and quality of life. It offers sample scenarios for implementing required questions and presents a checklist to guide researchers in using pain CDEs effectively for clinical trials and secondary data analysis. Key challenges identified include contextual variability, lack of validation across all pain conditions and populations, and potential misuse or misinterpretation of measures. This work proposes solutions such as supplementary measures, context-specific guidance, comprehensive training programs, and ongoing refinement of the CDE framework. While NIH Pain CDEs are valuable tools for standardizing pain assessment in research, addressing challenges in their implementation and interpretation is crucial for improving the consistency, validity, and interpretability of pain research data, ultimately advancing the field and enhancing patient care.

Physical Activity Level and Time of Participation in a Water Aerobics Project for the Elderly: Analysis of the Association with Quality of life, Musculoskeletal and Osteoarticular Disorders, Chronic Pain and Body Mass Index

The objective was to analyze the association between the physical activity level (PAL) and time of participation in the practice of water aerobics with the variables successful aging (SA), quality of life (QOL), musculoskeletal and osteoarticular disorders (MOD), chronic pain (CP) and body mass index (BMI). The method has a quantitative, descriptive and cross-sectional design. The non-probabilistic sample, for convenience, comprised 101 elderly people over 60 years of age, of both genders, who regularly participate in water aerobics activities in the city of Dois Irmãos, in the state of Rio Grande do Sul. The following instruments were used: Multidimensional Pain Assessment Scale, EUROHIS-QOL, IPAQ, SOC and Body Mass Index. Descriptive analyses of frequency, comparison, correlation and multiple linear regression were used. The results showed that the irregularly active group has adequate perception of QOL and longer participation in water aerobics activities associated with lower intensity of pain perception. Likewise, better QOL and control attitudes are associated with lower prevalence of MOD.

Comparative study between effect of preoperative multimodal analgesia and pregabalin as unimodal analgesia in reduction of postoperative opioids consumption and postoperative pain in laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy is a popular abdominal surgery and the most common problem for patients undergoing laparoscopic cholecystectomy is the postoperative pain, and associated side effects due to opioids use for pain management and multimodal analgesia is suggested to reduce postoperative pain and need for postoperative opioids. This controlled clinical trial compares the effects of multimodal analgesia and pregabalin as unimodal analgesia on postoperative pain management, postoperative opioids consumption, and reduction of opioids accompanied adverse effects in patients undergoing laparoscopic cholecystectomy where large multicenter studies evaluating specific analgesic combinations are lacking.MethodThis comparison randomized controlled trial between multimodal analgesia approach and pregabalin as unimodal analgesia included 95 laparoscopic cholecystectomy patients that were randomly allocated to three groups using a simple randomization method where multimodal and pregabalin groups included 30 patients in each and the drugs was administered orally one hour before the incision and control group included 35 patients that did not receive any preoperative analgesia. Multimodal analgesic therapy included acetaminophen 1 g, pregabalin 150 mg and celecoxib 400 mg while pregabalin group received pregabalin 150 mg only.ResultsMultimodal group showed a significantly lower need for total opioid analgesics mean ± SD (1.33 ± 1.918) as compared to the control group mean ± SD (3.31 ± 2.784) with p-value 0.014. Pregabalin and multimodal groups showed significantly lower postoperative visual analogue scale used for pain assessment mean ± SD (3.50 ± 2.543) and mean ± SD (3.70 ± 2.231), respectively, compared to the control group mean ± SD (5.89 ± 2.857) with p-value 0.001.ConclusionMultimodal analgesia reduced postoperative opioids consumption more than pregabalin alone when used preoperatively in laparoscopic cholecystectomy and consequently reduced opioids associated adverse effects, but they have the same efficacy in reducing postoperative pain, so pregabalin can be used alone preoperatively in patients with contraindications for using some analgesics included in multimodal analgesia protocol. The study was registered retrospectively in clinical trials; Trial registration ID: NCT05547659.

Outcome, Complications, and Follow-Up in Dogs Treated with Pancarpal Arthrodesis Stabilized with Orthogonal Plates.

Pancarpal arthrodesis was performed in 21 dogs, using orthogonal (cranial/dorsal and medial) plates without postoperative rigid external coaptation. Short-term and long-term outcomes, arthrodesis progression, and complications were assessed using a retrospective review of case records and radiographs. Three of 21 (14.2%) dogs required a revision surgery: 2 had total implant explantation and 1 had a screw removed. Other complications were managed successfully medically. One of 21 (4.8%) dogs had confirmed deep surgical site infection requiring implant removal, and 4 of 21 (19%) had suspected (not confirmed on microbiology) superficial surgical site infections that resolved with medical management. Long-term outcomes were assessed via owner questionnaire (Canine Brief Pain Inventory) and were available for nine dogs at a mean of 26.78 mo after surgery. The mean score for the first part (assessment of pain) was 7.83/40, which is classified as no pain to mild pain. The mean score for the second part (assessment of function) was 12.67/60, which is classified as very good. The last part (overall impression) was defined as excellent in four dogs (44.44%), very good in one dog (11.11%), and good in the other four dogs (44.44%). This retrospective study documents a suitable technique for pancarpal arthrodesis in dogs with carpal injuries.

Effect of individualized anesthesia and analgesia on postoperative pain in patients stratified for pain sensitivity: A study protocol for the PeriOPerative individualization trial randomized controlled trial.

Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP. Adult patients scheduled for laparoscopic surgery undergo pain-sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain-sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain-tolerant) are randomized to opioid-free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery. Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain. Prospectively posted at ClinicalTrials.gov, identifier NCT04751812.

Pain Assessment in the Patient Unable to Self- Report: Clinical Practice Recommendations in Support of the ASPMN 2024 Position Statement

Recognizing and managing pain is especially challenging for vulnerable populations who cannot communicate their discomfort. Because there is no valid and reliable objective measure of pain, the American Society for Pain Management Nursing advocates for comprehensive assessment practices articulated in a Hierarchy of Pain Assessment. These practices must gather relevant information to infer the presence of pain and evaluate a patient's response to treatment. Nurses and other healthcare providers must be advocates for those who cannot communicate their pain experience.

Orofacial pain and dysfunction in patients with special needs, with a focus on interdisciplinarity

Abstract People with special needs, like those with Down syndrome, Parkinson disease, or dementia, frequently suffer from orofacial pain conditions and dysfunction of the masticatory system. However, the accurate assessment of orofacial pain and dysfunction in such individuals is challenging. In this review, the complexities of assessing and managing orofacial pain and dysfunction in special needs populations will be described, along with their comorbid orofacial conditions like impaired oral health, salivary problems, and movement disorders of the masticatory system. In addition, the importance of maintaining or restoring a good quality of life will be highlighted, while the urgent need for oral care as part of palliative care will be stressed as well. To accomplish all this, interdisciplinary collaboration between medical doctors and dentists should be promoted in research, education, prevention, and care provision. Therefore, this review focuses specifically on this important topic.

Influence of the Olfatín Project on the reduction of pain related to intranasal influenza vaccination, as part of a school influenza vaccination program

PurposeTo evaluate the influence of viewing the Olfatín Project video on the assessment of school LAIV-associated pain in three and four-year-old children through the Wong Baker Faces® pain classification scale. Design and methodsA three-arm randomized multicenter clinical trial with a placebo control group was carried out. The main variable measured was pain, assessed through the score on the Wong Baker Faces® Pain Rating Scale. There were a total population of 4591 children three and four-year-olds (born in 2019 and 2020) and who attended the 1st and 2nd year of early childhood education. Before the school vaccination, researchers randomly assigned participant schools corresponding to each of the basic health areas to each of the three study groups: Olfatín's video viewing, a control video viewing not related to influenza and no video viewing. ResultsNo significant differences according to sex, age or the minor's grade according to the assigned intervention were detected. 72.3% of those vaccinated assigned a 0 from the Wong Baker Faces® scale: 75.4% of those who watched Olfatín's video, 68.3% for those in Drilo's group and 72.8% for those who didn't watch any video, but without significant differences (p = 0.08). There were no significant differences either stratifying by sex. ConclusionLAIV is a painless vaccine for children, which has to be taken into account by the health authorities when planning the pediatric influenza vaccination campaign. Practice implicationsOlfatín's cartoon video can be used by professionals to create a greater experience for children and therefore a better acceptance.

The effects of training on Feline Grimace Scale scoring for acute pain assessment in cats

The effects of training on Feline Grimace Scale scoring for acute pain assessment in cats

Physiological Time-Series Fusion With Hybrid Attention for Adaptive Recognition of Pain.

Automatic pain assessment is an application in healthcare serving personalized pain care, and patients cannot self-report pain. Pain at the present is inferred from physiological dynamics at the present and in the near past. However, heterogeneous pain responses cross-subject and cross-type hinder accurate recognition of pain. This work solves the adaptive pain recognition problem across pain types. We concrete the adaptivity problem into recognizing both phasic/short and tonic/long pain from the physiological sequences of the same length. The adaptivity of the proposed solution (TCAtt-PainNet) was ensured by hybrid temporal-channel attention when fusing multivariate time-series of electrocardiogram (ECG) and galvanic skin response (GSR) features. The attention was obtained by learning the dependencies between the point at present and the sequence in the near past, where sequence point temporal attention was constructed via modified self-attention, and the following feature channel attention was constructed by squeeze-and-excitation temporal attention weighted deep feature sequence. The proposed solution successfully enhanced recognition adaptivity by addressing relevant information only from long input sequences when testing with tonic and phasic pain databases, making progress towards automatic pain assessment for real application scenarios with attributes unknown pain.

Psychometric properties of the Bovine Pain Scale developed for postoperative pain assessment in the hospital setting

Psychometric properties of the Bovine Pain Scale developed for postoperative pain assessment in the hospital setting