Mention Of Pain Research Articles

Development of a generalizable natural language processing pipeline to extract physician-reported pain from clinical reports: Generated using publicly-available datasets and tested on institutional clinical reports for cancer patients with bone metastases

Objective:The majority of cancer patients suffer from severe pain at the advanced stage of their illness. In most cases, cancer pain is underestimated by clinical staff and is not properly managed until it reaches a critical stage. Therefore, detecting and addressing cancer pain early can potentially improve the quality of life of cancer patients.The objective of this research project was to develop a generalizable Natural Language Processing (NLP) pipeline to find and classify physician-reported pain in the radiation oncology consultation notes of cancer patients with bone metastases. Materials and Methods:The texts of 1249 publicly-available hospital discharge notes in the i2b2 database were used as a training and validation set. The MetaMap and NegEx algorithms were implemented for medical terms extraction. Sets of NLP rules were developed to score pain terms in each note. By averaging pain scores, each note was assigned to one of the three verbally-declared pain (VDP) labels, including no pain, pain, and no mention of pain. Without further training, the generalizability of our pipeline in scoring individual pain terms was tested independently using 30 hospital discharge notes from the MIMIC-III database and 30 consultation notes of cancer patients with bone metastasis from our institution’s radiation oncology electronic health record. Finally, 150 notes from our institution were used to assess the pipeline’s performance at assigning VDP. Results:Our NLP pipeline successfully detected and quantified pain in the i2b2 summary notes with 93% overall precision and 92% overall recall. Testing on the MIMIC-III database achieved precision and recall of 91% and 86% respectively. The pipeline successfully detected pain with 89% precision and 82% recall on our institutional radiation oncology corpus. Finally, our pipeline assigned a VDP to each note in our institutional corpus with 84% and 82% precision and recall, respectively. Conclusion:Our NLP pipeline enables the detection and classification of physician-reported pain in our radiation oncology corpus. This portable and ready-to-use pipeline can be used to automatically extract and classify physician-reported pain from clinical notes where the pain is not otherwise documented through structured data entry.

Charted Records of Dizzy Patients Suggest Emergency Physicians Emphasize Symptom Quality in Diagnostic Assessment

Charted Records of Dizzy Patients Suggest Emergency Physicians Emphasize Symptom Quality in Diagnostic Assessment

Pain Management in the Last Six Months of Life Among Women Who Died of Ovarian Cancer

Previous studies indicate that the symptoms of many dying cancer patients are undertreated and many suffer unnecessary pain. We obtained data retrospectively from three large health maintenance organizations, and examined the analgesic drug therapies received in the last six months of life by women who died of ovarian cancer between 1995 and 2000. Subjects were identified through cancer registries and administrative data. Outpatient medications used during the final six months of life were obtained from pharmacy databases. Pain information was obtained from medical charts. We categorized each medication based on the World Health Organization classification for pain management (mild, moderate, or intense). Of the 421 women, only 64 (15%) had no mention of pain in their charts. The use of medications typically prescribed for moderate to severe pain (“high intensity” drugs) increased as women approached death. At 5–6 months before death, 55% of women were either on no pain medication or medication generally used for mild pain; only 9% were using the highest intensity regimen. The percentage on the highest intensity regimen (drugs generally used for severe pain) increased to 22% at 3–4 months before death and 54% at 1–2 months. Older women (70 or older) were less likely to be prescribed the highest intensity medication than those under age 70 (44% vs. 70%, P < 0.001). No differences were found in the use of the high intensity drugs by race, marital status, year of diagnosis, stage of disease, or comorbidity. Our finding that only 54% of women with pain were given high intensity medication near death indicates room for improvement in the care of ovarian cancer patients at the end of life.

Living in blisters and pain

Assya is almost 15 years old and has junctional epidermolysis bullosa, an autosomal recessively inherited condition. A defect caused by gene mutations within the components of the skin allows tissue to separate and blisters to form whenever there is friction or trauma to an area. In many instances, the blistering is spontaneous. Each day begins painstakingly unwrapping the bandages that have been protectively enveloping Assyas blisters for the past day. Stuck to the weeping skin beneath, the last layer is stripped off while she grits her teeth. As I try to imagine a well adhered plaster being ripped from a partial thickness burn, Im surprised she makes no sound or mention of pain. Its difficult to imagine what the experience of pain might be for someone who has been experiencing it almost continually since birth, and even Assya finds it hard to find a description that fits: “I met a man once, who wanted me to try laughing gas for pain relief. He kept questioning me on whether I felt like I had been burnt everywhere, but I just burst out laughing in annoyance. I …

CLINICAL CONFERENCE

WE HAVE recently seen two youngsters whose presenting complaints were highly suggestive of spinal cord disease but whose lesions were far removed from this area. We believe this deserves emphasis. CASE REPORTS Case 1 The first patient was seen initially when he was 14½ years old, complaining of vague pains in his night knee and thigh. This pain was intermittent, slightly worse at night, but did not interfere with the patient's activities. Physical examination was entirely negative. There was no local tenderness, limitation of motion or limp. Roentgenograms of the knee, thigh and hip were interpreted as negative, and the patient was advised to limit activity temporarily. Although he was subsequently seen for minor respiratory infections, there was no further mention of pain. Eighteen months later, the patient's mother called to say that she had just noticed that the right leg was thinner than the left. When seen, however, the patient, now 16 years old, reported that pain in the leg had continued during the 18-month period. There was no specific localization of the pain; it was worse at night and responded to heat, massage and aspirin. He had pain occasionally during the day and had limped for the preceding several months. This however did not stop him from playing football and baseball. He reported further that he first became aware of the thinness of the right leg about 4 months previously but had not told anyone. Furthermore, he reported an 11-lb weight loss during this 4-month period. On examination, there was marked atrophy of the entire right leg, as shown in Figure 1.