Faces Pain Scale Research Articles

Effect of triamcinolone added to scalp nerve block for postoperative pain management of Moyamoya disease

nerve block failed, we gave routine medication for pain. The time when the patient first complained of pain was recorded. The anesthesiologist visited the children and parents at 8 and 16 hours after the operation to evaluate visual analogue scale (VAS 0-10, > 8 years) or faces pain scale (FPS, < 8 years). We also reviewed medical records for routine analgesics used during the hospital stay, and incidence of nausea or vomiting. Brain MRI was performed if any signs or symptoms of brain infarction were observed. Patients who recovered from the operation without complications made follow-up visits after 6 months, at which brain MRI scans were performed. Sample size was determined according to a pilot study of 13 patients performed in 2006. The time at which patients first complained of pain was 12.9 ± 5.3 hours in group T and 6.3 ± 5.2 hours in group R. If we hypothesize that a difference in block times between groups exists, we would need at least 9 subjects in each group at a significance level of 5% and power of 80%. We used SPSS 12.0 for statistics analysis; the unpaired T-test was used to compare continuous variables between two groups. Pearson’s Chi square was used to determine difference of frequency of nausea, vomiting or brain infarction after the operation. P < 0.05 was considered statistically significant. There was no difference in demographic characteristics, preoperative infarction history, operation time, anesthesia time, PACU stay time, or medication during the postoperative period. Group R patients first complained of pain at 9.2 ± 9.4 hours and Group T patients at 14.2 ± 10.0 hours (P = 0.11). VAS at 8 hours after surgery was 1.2 ± 1.5 in group R and 1.5 ± 2.4 in group T (P = 0.56); at 16 hours it was 1.2 ± 1.7 in group R and 2.3 ± 2.8 in

Is palatal injection mandatory prior to extraction of permanent maxillary tooth: A preliminary study

Even after the invention of the modern injection techniques, palatal injection still remains a painful experience for patients, and this pain is attributed to the presence of rich nerve complement and displacement of palatal mucosa during anesthesia. The aim of the present study was to demonstrate if lidocaine HCl could provide palatal anesthesia if given buccally during maxillary tooth removal without the need for a palatal injection. The study group consisted of 75 patients, and 25 were controls. All the patients in the study group had unilateral extractions. In 75 patients, 2 ml of 2% lidocaine HCl with 1:80,000 epinephrine was injected into the buccal vestibule of tooth indicated for extraction without palatal injection. After 8 min, the extraction of maxillary tooth was carried out. Twenty-five subjects in the control group underwent same protocol with palatal injection. All the patients completed a faces pain scale (FPS) and a 100 mm visual analog scale (VAS) after extraction. Unpaired t test and Chi-square test. According to VAS and FPS scores, when comparison was carried out between permanent maxillary tooth removal with and without palatal injection, the difference in the pain levels were not statistically significant (P>0.05). The extraction of permanent maxillary tooth is possible by depositing 2 mL of lidocaine to the buccal vestibule of the tooth without the need for palatal anesthesia.

Validating English- and Spanish-language patient-reported outcome measures in underserved patients with rheumatic disease

IntroductionRheumatic diseases are among the most common and debilitating health problems in the United States. These diseases are chronic, can result in severe decrements of physical and psychosocial functioning and affect patients' overall quality of life. A consensus regarding the best patient outcomes to be measured in randomized, controlled trials and prospective natural history studies is essential to provide best estimates of efficacy and safety of interventions across diverse patient populations.MethodsFace-to-face English- and Spanish-language cognitive interviews were conducted among urban Hispanic and African American patients with rheumatic disease to develop a questionnaire booklet. Six measures validating patient-reported outcomes were included: the Arthritis Self-Efficacy Scale, the Stanford Health Assessment Questionnaire Disability Index, the Wong-Baker Faces Pain Scale, the Short Acculturation Scale, the Center for Epidemiologic Studies Depression Scale and the Inventory of Complementary and Alternative Medicine Practices. A sample of patients (n = 15) attending the National Institute of Arthritis and Musculoskeletal and Skin Diseases Community Health Center participated in the initial interviews. Revised measures were further tested for reliability in a separate sample of patients (n = 109) upon enrollment at the health center.ResultsCognitive interviews provided feedback for questionnaire modifications and methods to enhance content validity and data quality, including discarding redundant questions, providing visual aids and concrete examples when appropriate and increasing the use of racially and ethnically concordant interviewers. The cognitive interviews further elucidated that some contextual assumptions and language usage in the original questionnaires may not have taken each respondent's environmental and sociocultural context into consideration. Internal reliability for previously tested measures remained high (Cronbach's α = 0.87-0.94).ConclusionsCognitive interviewing techniques are useful in a diverse sample of racial and ethnic minority patients with rheumatic disease as a method to assess the content validity of the specific outcome measures selected. The data collection approaches and methods described here ultimately enhance data quality. Vigilance is required in the selection of outcome measures in studies or in practice, particularly with each new language translation and/or culturally unique or diverse sample.

The utility of the Faces Pain Scale in the assessment of shoulder pain in Turkish stroke patients: its relation with quality of life and psychologic status

This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.Thirty stroke patients (group I) and 30 controls (group II),all suffering from shoulder pain were included in the study.The patients with subacute shoulder pain and with no other known diseases and impairments were recruited as a control group. Shoulder pain was evaluated by the commonly used pain scales including the Visual Analogue Scale, Likert Pain Scale and 0–10 Numerical Rating Scale besides FPS. Depression was screened using Beck Depression Inventory (BDI) and quality of life was evaluated using Short Form-36 (SF-36). FPS showed good correlations with the other pain scales in both the groups(r= 0.950–0.972 and 0.674–0.926, respectively). In group I,there were significant correlations between FPS and physical functioning, pain and emotional role subscales of SF-36 (r= – 0.432, 0.707 and – 0.461, respectively).Although there was a low correlation between the FPS and BDI scores, it was not statistically significant. In group II,FPS showed significant correlations with the BDI scores and all subscales of SF-36 except social functioning and vitality (r= – 0.679 to 0.848). FPS had a high degree of convergent validity and can be used in the assessment of shoulder pain in stroke patients. It may be a good alternative for pain assessment especially in patients with speech disorders and illiterate patients.

A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children

Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference. To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility. Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0-6); Faces Pain Scale-Revised (FPS-R) (0-10); Oucher pain scale (0-10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0-10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori. From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS. For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.

1251 Assessment of Pain During Endotracheal Suctioning in Pediatric Intensive Care Unit (PICU)

Background and aims: This research is planned as a two leveled definitive and comparative; one that evaluates pain during the endotracheal aspiration in PICU. Universe of the study is composed of patients and nurses who applied. Methods: Cases are selected trough PICU patients who filled the study criteria and nurses who give care them in a time interval of 1 January-2 July 2008. Rutine endotracheal aspiration was applied as the first level of study. For the second level inquiry on knowledge of nurses about aspiration is applied to nurses and then they are asked to do aspiration according to guideline of aspiration they were told. Data was obtained with questionnaire. Both FLACC pain and Wong-Baker facial determination pain scales were used to evaluate the patient's pain. All the optained data were evaluated Results: %33,8(22) of patients are between 1 month to 1 year old and %64,2 (42) of them are male. During the endotracheal aspiration, oxygen saturation of %83, 1(54) patients was decreased, %81,5(54) retched, %67,7(44) was troubled. Although group 1 patients had higher scores on Wong-Baker pain facial determination scale and FLACC scale no statistical difference was found amount two groups(p>0,05). Patients who had bolus dozes of analgesic and sedative drugs had lower Wong-Baker facial pain determination score (4,38+_ 0,96 (4)) and FLACC score(4,61+- 1,94(4)) (p>0,05)According to these; patients are troubling because of pain and pain is slightly but related with aspiration. Conclusions: So aspiration guideline is recommended to be used in PICU during the endotracheal suction.

Cost and outcomes after cold and mixed adenotonsillectomy in children1

To compare cold and mixed (electrocautery tonsillectomy with curettage adenoidectomy) adenotonsillectomies in children in terms of hospital medications' and materials' costs, surgical time, aspirated blood volume, and postoperative pain. Randomized clinical trial in community hospitals. Seventy-two patients aged 3 to 12 years, undergoing adenotonsillectomy, were randomized in two groups through sealed envelopes that were opened just prior to the procedure. Surgical time and aspirated blood volume were measured by a staff nurse. Hospital medication and material costs were supplied by the hospital's accounting department. A validated facial pain scale was used from the day of surgery to the 10th postoperative day to quantify pain. Bicaudal t test showed that materials' cost was lower in the mixed technique. Surgical time and aspirated blood volume were also lower with the mixed technique. The postoperative pain was more intense in the cold technique on the day of surgery, but was more intense in the mixed technique from the 4th day to the 6th day. Linear regression showed a weak association between materials' cost and aspirated blood volume. Mixed technique reduces the costs of materials while offering the patient and the surgeon a safer and faster method to perform adenotonsillectomy, although it is slightly more painful than the cold technique in the latter part of the postoperative period.

Is a Non Verbal Pain Assessment Tool a Reliable Method of Assessing Pain during Colonoscopy?

Purpose: To determine whether a Non Verbal Pain Assessment Tool (NVPAT) composed of 5 variables (emotion, movement, verbal cues, facial cues and position) is an accurate and reliable predictor of patient pain during colonoscopy under conscious sedation; as opposed to the more traditional methods of pain rating such as the numerical pain rating scale or facial pain scale. Methods: Inpatient and outpatient colonoscopies at our facility between 3/1/09 and 6/1/09 (n=372) were retrospectively reviewed. The average pain score reported by our endoscopy nurses during the procedure for patients with known risk factors for painful colonoscopies were compared to patients without the risk factors. The risk factors for a more painful colonoscopy were obtained from current literature and include women with a low BMI, younger patients, women status post hysterectomy, poor bowel preparation and caucasian race. The literature also suggests that further indicators of painful colonoscopy include changing a patient's position, a longer time taken to reach the cecum or the application of abdominal pressure during colonoscopy. Our data was also expanded to include endoscopist experience (fellows in training vs. attending physicians) and endoscope diameter (adult vs. pediatric scope). Results: No significant age difference was noted between male and female genders. Nonetheless, pain perception was noted to be greater in women when compared to men (p=0.006) using the NVPAT. When fellows in training were compared to attending physicians, the difference in the NVPAT score was not significant (p=0.095). However, the time taken to reach the cecum had a statistically significant difference in NVPAT score (p=0.002). Age of the patient, BMI, personal history of intra-abdominal surgeries, indications for colonoscopy, bowel preparation, scope diameter and completion of colonoscopies did not significantly affect the NVPAT score. However, patients who had to be repositioned for the procedure did have a significantly higher score based on the NVPAT (p=0.006). Upon assigning scoring (one point each to the risk factors for painful colonoscopy outlined above), the NVPAT score was higher in patients with more risk factors (p=0.016). Conclusion: A NVPAT can be used as a reliable tool to quantify patient pain during colonoscopy under conscious sedation. However, given the very subjective nature of pain and the inherent complications in objectively quantifying it, further research is needed to determine more accurate and reliable predictors of patient pain during endoscopy, so as to maximize patient comfort during these procedures.

Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China

Background Western studies have shown that patients with mild or moderate cognitive impairment (CI) can use pain intensity scales to report pain reliably and validly, however, the qualities of pain intensity scales use in various age groups including elderly with CI are varied. In China, there is a lack of studies. Objective To compare psychometric properties of five evidence-supported pain intensity scales including the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), the Faces Pain Scale (FPS), the Numeric Box-21 Scale (BS-21), and the Colored Analogue Scale (CAS) in postoperative adults varying in ages including elderly with mild CI. Design Descriptive comparative study. Setting A university-affiliated hospital in China. Participants Two hundred surgical patients were recruited purposively with 50 for each group: young adults, middle-aged adults, elderly without CI, and elderly with mild CI. Methods Participants rated the vividly remembered, current, worst, least, and average pain, and indicated scale preference and simplicity. Scale face validity, concurrent validity, convergent validity, and test–retest reliability were assessed. Fisher's exact tests were used to investigate whether face validity was related to different age groups and levels of CI. One-way ANOVA and Kruskal–Wallis test were used to test the differences of concurrent validity, convergent validity, and test–retest reliability coefficients of each pain scale among the four groups. Results Regarding face validity, the FPS was ranked best as nearly half of the patients selected it as both the most preferred and simplest scale and it had low errors; the VDS and the NRS were ranked following the FPS; however, the BS-21 and the CAS were ranked last. The concurrent validity, convergent validity, and test–retest reliability of all five pain scales were supported in use with the four groups. The differences in psychometric properties among the four groups were only found in face validity and test–retest reliability. Conclusion The findings support the psychometric properties of all five pain scales for pain assessment in Chinese adults including elderly with mild CI. However, the FPS appears to be the best, followed by the VDS and the NRS.

Ketamine versus propofol for strabismus surgery in children

To compare the effects of intravenous infusion of ketamine and propofol anesthesia in children undergoing strabismus surgery. Sixty pediatric patients aged 4-11 years were enrolled for the study. Patients in Group K were infused ketamine 1-3 mg/kg/hr (n = 30) and patients in Group P were infused with propofol 6-9 mg/kg/hr (n = 30). After giving fentanyl 1 mug/kg and rocuronium bromide 0.5 mg/kg, patients were intubated. The consumption of anesthetics (P = 0.0001) and antiemetics (P = 0.004), the incidence of oculocardiac reflex (P = 0.02) in Group K were significantly lower than in Group P. The recovery time (P = 0.008), postoperative agitation score (P = 0.005), Face Pain Scale (P = 0.001), Ramsay Sedation Score (P = 0.01) during awakening and at postoperative 30th min (P = 0.02) in Group K were significantly lower than in Group P. The postoperative agitation score during awakening was significantly lower than the preoperative values in Group K (P = 0.0001). The infusion of ketamine is more advantageous than the infusion of propofol in children for use in strabismus surgery.

Effects of Reiki on Anxiety, Depression, Pain, and Physiological Factors in Community-Dwelling Older Adults

The purpose of this study was to evaluate the effect of Reiki as an alternative and complementary approach to treating community-dwelling older adults who experience pain, depression, and/or anxiety. Participants (N = 20) were randomly assigned to either an experimental or wait list control group. The pre- and posttest measures included the Hamilton Anxiety Scale, Geriatric Depression Scale-Short Form, Faces Pain Scale, and heart rate and blood pressure. The research design included an experimental component to examine changes in these measures and a descriptive component (semi-structured interview) to elicit information about the experience of having Reiki treatments. Significant differences were observed between the experimental and treatment groups on measures of pain, depression, and anxiety; no changes in heart rate and blood pressure were noted. Content analysis of treatment notes and interviews revealed five broad categories of responses: Relaxation; Improved Physical Symptoms, Mood, and Well-Being; Curiosity and a Desire to Learn More; Enhanced Self-Care; and Sensory and Cognitive Responses to Reiki.

Prospective Evaluation of a Single Incision Sling for Stress Urinary Incontinence

We report 12-month outcomes of the MiniArc single incision sling for stress urinary incontinence in women. We performed a multicenter, prospective, single arm institutional review board/ethics committee approved study evaluating the effectiveness of the MiniArc sling after implantation via qualitative (Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form) and quantitative (1-hour pad weight test and cough stress test) measurements. Secondary outcome measures included procedural variables (procedure time and estimated blood loss), length of stay, perioperative complications, Wong-Baker Faces Pain Scale and adverse events. A total of 188 women with a mean age of 51.1 +/- 10.6 years (median 50.4, range 25.9 to 79.6) were enrolled in the study. At 1 year 157 patients were available for analysis. Mean procedure time, estimated blood loss and length of hospital stay were 11.0 +/- 6.7 minutes (median 10, range 2 to 55), 41.7 +/- 47.0 ml (median 25, range 0 to 250) and 9.5 +/- 14.1 hours (median 3.2, range 0.5 to 77.2), respectively. At discharge from hospital the mean Wong-Baker pain score was 1.3 +/- 2.0 (range 0.0 to 10.0). Of the patients 90.6% had a negative cough stress test and 84.5% had a 1-hour pad weight test less than 1 gm at 12 months. Median Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form scores showed a statistically significant decrease (p <0.001). Adverse events included urinary tract infection (4.3%), constipation (3.7%), temporary urinary retention (3.2%), dyspareunia (2.1%) and vaginal extrusion (1.6%). The MiniArc single incision sling is a safe and effective first line surgical procedure for the treatment of female stress urinary incontinence. It demonstrated excellent patient tolerability with minimal pain, early return to normal activity and low morbidity. In addition to sustained efficacy outcomes at 12 months patients treated with the MiniArc experienced a significant improvement in quality of life.

Yoga for Pain and Anxiety in Pediatric Hematology- Oncology Patients: Case Series and Review of the Literature

In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, and the mean reduction in anxiety T-score was 9.62 (SD ± 6.74), p = .0001. Patient quotes suggest that yoga was benefi cial, especially for relaxation. Literature review offers preliminary support for the use of yoga for anxiety in children. Our data suggest that further research on yoga as an effective intervention for pediatric hematology-oncology patients for pain and anxiety is needed.

The Effect of Programmed Distraction on the Pain Caused by Venipuncture among Adolescents on Hemodialysis

Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. The purpose of this quasi-experimental study was to test the effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. All of the pediatric hemodialysis centers in Tehran (three centers) were assigned to case group (one center with 21 patients) and control groups (two centers with a total of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three first sessions were held without intervention (pretest) and the next nine sessions were held with distraction intervention (posttest). To cause distraction, the adolescents were asked to look at two similar pictures and tell the number of differences between them during venipuncture. Results showed that case and control groups matched in demographic variables and pain intensity. After distraction, pain intensity during venipuncture significantly decreased ( p = .003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.

Postoperative pain control in the elderly

Background Older adults are a heterogeneous group but generally have a higher peak and longer duration of action from opioids. Monitoring cumulative effects from analgesics is particularly important for older adults [1]. Older adults should be first asked to describe their hurting or pain in their own words. Pain intensity should be measured with a consistent scale, after making sure that the individual understands the scale [2]. The pain thermometer, verbal description scale, and faces pain scale have all been used successfully with older adults, but older adults tend to have difficulty accurately reporting their pain with the 100-millimeter visual analog scale. Postoperative pain assessment during movement provides a more accurate pain measure than assessment at rest. Cognitively impaired older adults capable of verbal communication are generally able to report their pain and report pain intensity similar to cognitively intact individuals [3]. It might be necessary to try different pain scales if the older adult does not respond to the initial pain scale. Cognitively impaired older adults demonstrate more nonverbal pain behaviour on movement than those who are cognitively intact [4]. Family members can often identify behaviours indicative of pain in cognitively impaired older family members.

Linguistic Validation of the Korean Version of the Faces Pain Scale among Children with Leukemia

Linguistic Validation of the Korean Version of the Faces Pain Scale among Children with Leukemia

Postoperative Self‐Report of Pain in Children: Interscale Agreement, Response to Analgesic, and Preference for a Faces Scale and a Visual Analogue Scale

To augment available validation data for the Faces Pain Scale - Revised (FPS-R) and to assess interscale agreement and preference in comparison with the Coloured Analogue Scale (CAS) in pediatric acute pain. The present prospective, multicentre study included 131 inpatients five to 15 years of age (mean age 8.8 years; 56% male) seen in postoperative recovery. They provided CAS and FPS-R pain scores before and after administration of analgesic medication. Nurses and physicians used the same tools as observational scales. Children and health care providers indicated which scale they preferred. FPS-R scores for the intensity of postoperative pain correlated highly with the corresponding CAS scores in all age groups (0.66 <or= r <or= 0.88). There were no significant mean differences in any age group between the scales. Scores on the two scales differed by 210 or less in 81% to 91% of children, depending on age. Both scales demonstrated expected changes in postoperative pain following administration of an analgesic. Scores at the upper end point were given by approximately 20% of children five to six years of age on both scales, compared with 2% to 9% in the older age groups. Health care providers' observational ratings were significantly lower than self-ratings. The FPS-R was preferred over the CAS by most children in all age groups and both sexes. Global satisfaction of the health care providers was similar for both tools. These results support the use of the FPS-R for most children five years of age or older in the postoperative period. Further research is needed to identify young children, particularly those younger than seven years of age, who have difficulty with self-report tools, and to establish methods for training them in the reliable use of these measures.

Measuring acute pain in the prehospital setting

Severe pain is a common presenting symptom for emergency patients. One major challenge in the management of severe pain is the objective measurement of pain. Due to the subjective nature of pain, it can be very difficult for clinicians to quantify pain intensity and measure the qualitative features of the pain experience. A number of measurement tools have been validated in the acute care setting, with some appropriate for use in the prehospital setting. This paper reviews the characteristics required of a prehospital acute pain measure and appraises the relative utility of a number of currently used pain measures. At present, the verbal numerical rating scale appears the most appropriate pain measure to administer in the prehospital setting for adult patients as it is practical and valid. Either the Oucher scale or the faces pain scale is suitable for prehospital care providers to assess pain in children.

Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: A randomized controlled trial

Objective: To compare the efficacy of nebulized fentanyl (NF) with i.v. morphine (IVM) in paediatric patients presenting to the ED with clinically suspected limb fractures. Methods: A convenience sample of patients aged 4–13 years, presenting with clinically suspected limb fractures, were randomized to receive either NF at 4 µg/kg or IVM at 0.1 mg/kg. Pain scores were assessed at 0, 15 and 30 min using the Wong and Baker faces pain scale (0–10). Vital signs and adverse effects were also recorded. Results: Of the 77 patients enrolled in the study, data were available for analysis on 73 patients. Of those, 36 received NF and 37 received IVM. The two groups were similar in terms of demographics and initial pain scores. Mean pain score at 15 min was decreased by 3.06 (NF) and by 1.97 (IVM) (difference 1.09; 95% CI 2.32 to −0.32). At 30 min the decreases were 3.6 (NF) and 3.0 (IVM), respectively (difference 0.6; 95% CI 1.89 to −0.65). Decreases in pain scores for both NF and IVM were statistically significant (P < 0.0001), but the difference in the effect of NF and IVM did not reach statistical significance. There was no significant change in any vital signs or serious adverse events in either group. Conclusion: NF in a dose of 4 µg/kg given via a standard nebulizer provided clinically significant improvements in pain scores, comparable to IVM. NF should be considered as a treatment option for use in children presenting in acute pain.

Pain and fatigue consistency in adults with cerebral palsy

Purpose. To examine the consistency of pain and fatigue and describe pain interference with daily activities in ambulatory (AMB) and non-ambulatory (non-AMB) adults with cerebral palsy (CP) over a 3-month period.Method. A repeated measures design with 26 participants (12 AMB, 14 non-AMB) acting as their own controls. Pain and fatigue data were collected once per month for three consecutive months using the FACES pain scale and PedsQL™ Multidimensional Fatigue Scale. Pain interference with daily life was assessed using the Pain Disability Index (PDI).Results. No significant differences were found in maximum pain intensity. AMB reported significantly fewer pain sites in the whole body during month 1 than non-AMB. Fatigue was consistent across months; however, AMB reported significantly more General fatigue. Across groups, significant correlations were found between PDI and General, Resting, and Overall fatigue. Non-AMB exhibited significant correlations between total number of pain sites and General and Cognitive fatigue, as well as PDI and Overall fatigue. For the AMB group, PDI and total number of pain sites were significantly correlated.Conclusions. Pain and fatigue consistently and significantly affect adults with CP. Both factors impact the ability of adults, who have CP, to participate in daily life.