Multidimensional Pain Assessment Research Articles

IL1A rs1800587 associates with chronic noncrisis pain in sickle cell disease.

Pain is prevalent in sickle cell disease (SCD) patients who display great heterogeneity in pain severity and frequency. Hypothesizing that inflammatory factors are involved in the pathogenesis of SCD pain, we focused on the IL1A C/T polymorphism rs1800587 that is an SNP located in a cis-transcriptional regulatory region. We genotyped IL1A rs1800587 and performed association studies with phenotype data obtained by a multidimensional pain assessment tool using the PAINReportIt® Questionnaire. Each T allele was associated with a 3.9 increase in composite pain index score (p = 0.04) as determined by multiple linear regression. IL1A rs1800587 may influence chronic pain in SCD.

Features of pain syndromes in patients with multiple sclerosis in the aspect of comorbidity

We studied the prevalence of pain syndromes (РS) in patients with multiple sclerosis (MS) in order to clarify the characteristics of their occurrence and the extent of impact on quality of life, level of fatigue and depression in terms of comorbidity. The study involved 207 MS patients with different forms of course. Evaluated the clinical and demographic characteristics of the patients with MS due to comorbidity, conducted multidimensional assessment of pain using the McGill Pain Questionnaire, determines the level of EDSS, the severity of pain (VAS), the severity of fatigue (FSS), depression (BDI-II), quality of life (SF-36). The average prevalence of РS in all our study patients with MS was 76,3%. It was found that a РS in MS patients are more prevalent in patients with comorbid pathology.

Dutch Pain Specialists' Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study.

Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.

Chronic pain in elderly caregivers at different levels of frailty.

To determine whether there are differences in the intensity of chronic pain of elderly caregivers who are frail, pre-frail and non-frail. Quantitative, descriptive and cross-sectional study. The subjects were 187 elderly caregivers evaluated with a Multidimensional Pain Assessment Scale and the Fried Frailty Phenotype Assessment Components. Descriptive and comparative analyzes, Pearson's chi-square test and Kruskal-Wallis test were used. 24.1% of the caregivers were frail, 55.1% pre-frail and 20.9% non-frail. The only socio-demographic variable that differed between the three groups was age (p=0.03). Mean pain intensity values were as follows: frail elderly (6.98), pre-frail (6.38) and non-frail (5.85). However, these differences were not significant (p=0.150). The present study did not find a significant difference in the intensity of chronic pain in elderly. Nevertheless, it is essential that health professionals and health care public policies give special attention to older caregivers.

Construct validity and reliability of a real-time multidimensional smartphone app to assess pain in children and adolescents with cancer.

We evaluated the construct validity (including responsiveness), reliability, and feasibility of the Pain Squad multidimensional smartphone-based pain assessment application (app) in children and adolescents with cancer, using 2 descriptive studies with repeated measures. Participants (8-18 years) undergoing cancer treatment were drawn from 4 pediatric cancer centers. In study 1, 92 participants self-reported their level of pain twice daily for 2 weeks using the Pain Squad app to assess app construct validity and reliability. In study 2, 14 participants recorded their level of pain twice a day for 1 week before and 2 weeks after cancer-related surgery to determine app responsiveness. Participants in both studies completed multiple measures to determine the construct validity and feasibility of the Pain Squad app. Correlations between average weekly pain ratings on the Pain Squad app and recalled least, average, and worst weekly pain were moderate to high (0.43-0.68). Correlations with health-related quality of life and pain coping (measured with PedsQL Inventory 4.0, PedsQL Cancer Module, and Pain Coping Questionnaire) were -0.46 to 0.29. The app showed excellent internal consistency (α = 0.96). Pain ratings changed because of surgery with large effect sizes between baseline and the first week postsurgery (>0.85) and small effect sizes between baseline and the second week postsurgery (0.13-0.32). These findings provide evidence of the construct validity, reliability, and feasibility of the Pain Squad app in children and adolescents with cancer. Use of real-time data capture approaches should be considered in future studies of childhood cancer pain. A video accompanying this abstract is available online as Supplemental Digital Content at http://links.lww.com/PAIN/A169.

1740 Cancer patients multidimensional post-operative pain assessment: An observational study

1740 Cancer patients multidimensional post-operative pain assessment: An observational study

Adaptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study.

Pain is a major problem in all cancer stages. Cancer pain guidelines are developed to improve management of pain. It is unclear whether these recommendations are applied in daily practice. Therefore, the objective of this study was to assess medical oncologists' adherence to an evidence-based clinical practice guideline in cancer pain management and their confidence in treatment choices. A cross-sectional case vignette survey describing a patient with intractable pancreatic cancer and pain was sent to all 268 medical oncologists registered at the Netherlands Association of Internal Medicine. Descriptive statistics were conducted. Sixty-three of 268 medical oncologists (24 %) completed the survey. Adherence to the different recommendations of the guideline ranged from 18 to 100 %. Confidence for treatment choice ranged from 5.6 to 9.5 on a Numeric Rating Scale (0-10). Most of the responding oncologists (94 %) adhered to prescribing paracetamol as first-line pain treatment, and all prescribed a laxative in combination with opioids to prevent constipation. However, only 24 % of the respondents adhered to the guideline when first-line treatment had insufficient effect. Additionally, only 35 % adhered to the recommendation for insomnia treatment providing psychosocial support or using a multidimensional pain questionnaire besides pharmacological treatment. Finally, only 18 % adhered to the recommendation to perform a multidimensional pain assessment when disease worsens and pain increases. The recommendations of the guideline have been partly adopted in cancer pain practice by medical oncologists. Particularly, pain assessment is not applied in the recommended manner. Therefore, implementation strategies should focus on adequate pain assessment in patients with cancer.

Improving pain assessment in the NICU: a quality improvement project.

Pain assessment documentation was inadequate because of the use of a subjective pain assessment strategy in a tertiary level IV neonatal intensive care unit (NICU). The aim of this study was to improve consistency of pain assessment documentation through implementation of a multidimensional neonatal pain and sedation assessment tool. The study was set in a 60-bed level IV NICU within an urban children's hospital. Participants included NICU staff, including registered nurses, neonatal nurse practitioners, clinical nurse specialists, pharmacists, neonatal fellows, and neonatologists. The Plan Do Study Act method of quality improvement was used for this project. Baseline assessment included review of patient medical records 6 months before the intervention. Documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and documentation of pain assessment were reviewed. Literature review and listserv query were conducted to identify neonatal pain tools. Survey of staff was conducted to evaluate knowledge of neonatal pain and also to determine current healthcare providers' practice as related to identification and treatment of neonatal pain. A multidimensional neonatal pain tool, the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), was chosen by the staff for implementation. Six months and 2 years following education on the use of the N-PASS and implementation in the NICU, a chart review of all hospitalized patients was conducted to evaluate documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and documentation of pain assessment in the medical progress note. Documentation of pain scores improved from 60% to 100% at 6 months and remained at 99% 2 years following implementation of the N-PASS. Pain score documentation with ongoing nursing assessment improved from 55% to greater than 90% at 6 months and 2 years following the intervention. Pain assessment documentation following intervention of an elevated pain score was 0% before implementation of the N-PASS and improved slightly to 30% 6 months and 47% 2 years following implementation. Identification and implementation of a multidimensional neonatal pain assessment tool, the N-PASS, improved documentation of pain in our unit. Although improvement in all quality improvement monitors was noted, additional work is needed in several key areas, specifically documentation of reassessment of pain following an intervention for an elevated pain score.

FRI0582-HPR A Critical Review on Measurement Properties of Instruments Used to Evaluate Body Function in People with Knee Osteoarthritis

BackgroundWith the increasing prevalence of knee osteoarthritis (KOA) today1, it is imperative to use valid and reliable instruments to evaluate the effectiveness of interventions and to understand the pathology's impact...

Pain assessment using the adolescent pediatric pain tool: a systematic review.

The Adolescent Pediatric Pain Tool (APPT) is a multidimensional pain assessment tool designed to assess pain location (body outline diagram), intensity (word graphic rating scale) and quality (list of pain descriptors) in hospitalized children eight to 17 years of age. To identify the age range, health conditions, settings and purpose for which APPT has been used; the components of the APPT that have been used; and the reported clinical and research utility of the APPT. A systematic review of published studies using the APPT was performed. Studies were identified through electronic searches in CINAHL, Medline, PubMed, SciELO and PsycInfo. Twenty-three studies were analyzed. APPT has been used in patients between two and 68 years of age, with various acute and chronic conditions, in and out of hospital. All but six studies used the three components of the APPT. Most of the studies used the total number of sites marked, mean pain intensity and mean number of pain descriptors selected as main outcome measures; however, scoring methods varied. Studies report that the use of the APPT is relevant for clinical practice and for research. Obtaining self-report of pain using the APPT may help clinicians to tailor pain management interventions. It may also be used in studies to provide a deeper understanding of the pain experience and to examine the effectiveness of pain management interventions. However, outcome measures and methods of scoring the different components of the APPT need to be clearly identified.

Chronic Pain - Perceptions, Limitations and Implications. A Social Perspective

Chronic pain (CP) is a complex phenomenon that affects the lives of individuals at the level of well-being, family relationships and social and professional life, causing biological and psychosocial changes, and in most cases, suffering. CP is associated with physical, professional and social limitations, and compromises quality of life (QOL) provoking insecurity which results in considerable social and material losses. In this context a multidimensional pain assessment is fundamental in order to find a swift and appropriate response to the needs of each individual. The evaluation should take into account psychological and social factors in addition to physical factors. pain (CP) is a complex phenomenon that affects the lives of individuals at the level of well-being, family relationships and social and professional life, causing biological and psychosocial changes, and in most cases, suffering. CP is associated with physical, professional and social limitations, and compromises quality of life (QOL) provoking insecurity which results in considerable social and material losses. In this context a multidimensional pain assessment is fundamental in order to find a swift and appropriate response to the needs of each individual. The evaluation should take into account psychological and social factors in addition to physical factors. The authors of this paper reinforce the idea that any evaluation and / or intervention that is made in people with CP must always take into account the internal and external factors of the environment in which the individual belongs, and which influence how they perceive and assess their pain

Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer

BackgroundPain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent’s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary.ObjectiveOur objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer.MethodsWe used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app.ResultsThematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete.ConclusionsA multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing.

Measuring Pain in Non-Communicative Patients in the Inpatient Hospice Setting: Psychometric Evaluation of the Multidimensional Objective Pain Assessment Tool (MOPAT) (SA517-A)

Measuring Pain in Non-Communicative Patients in the Inpatient Hospice Setting: Psychometric Evaluation of the Multidimensional Objective Pain Assessment Tool (MOPAT) (SA517-A)

Differences between uni- and multidimensional scales for assessing pain in term newborn infants at the bedside

OBJECTIVES:This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus.METHODS:This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points.RESULTS:The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (p<0.001). The frequencies of the detection of pain using the Behavioral Indicators of Infant Pain and the Neonatal Facial Coding System were similar. The characteristics of the neonates were not associated with the level of agreement between the scales.CONCLUSION:The Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain behavioral scales are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional Premature Infant Pain Profile scale.

Assessing Pain in Nonresponsive Hospice Patients: Development and Preliminary Testing of the Multidimensional Objective Pain Assessment Tool (MOPAT)

Accurate assessment in hospice patients who cannot communicate their pain is almost impossible, increasing their risk for unrecognized and inadequately managed pain. The purpose of this article is to describe a series of small-scale projects aimed at developing and refining an instrument to assess acute pain in noncommunicative hospice patients. Project 1 was a clinical project in which focus groups with hospice nurses yielded an adaptation of an existing pain assessment measure that was named the Multidimensional Objective Pain Assessment Tool (MOPAT) and had behavioral and physiological subscales. Projects 2 and 3 tested the MOPAT in 30 cognitively impaired/nonresponsive hospice inpatients and 28 alert and oriented hospice inpatients, with study nurses and hospice nurses rating pain with the MOPAT before and after a pain-relieving intervention and rating its clinical usefulness. Projects 3 and 4 analyzed the reliability, validity, and clinical utility of the MOPAT. Overall internal consistency reliability of the MOPAT was demonstrated with Cronbach's α coefficients of 0.79 before and 0.84 after the pain-relieving intervention. The behavioral and physiological subscale scores changed significantly (p < .035) after pain medication, demonstrating sensitivity to changes in pain. Principal components factor analysis revealed two factors matching the subscales and accounting for 66% of the variance. Nearly all the hospice nurses found the MOPAT helpful, easy to use and understand, and conducive to use in daily practice. The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.

Traditional Chinese Acupuncture was not superior to sham acupuncture for knee osteoarthritis but delivering treatment with high expectations of improvement was superior to delivering treatment with neutral expectations

What are the comparative effects of Traditional Chinese Acupuncture (TCA) and sham acupuncture for patients with knee osteoarthritis (OA) when controlling for the effect of the acupuncturists' communication styles. A nested 2-stage randomised clinical trial, where patients were randomised to 1 of 3 style groups, waiting list, high expectations, or neutral expectations, and nested within style, TCA, or sham acupuncture. A hospital general internal medicine department in Texas, USA. Men and women over 49 years with knee OA according to the American College of Rheumatology criteria. Additional inclusion criteria were pain in the knee in the preceding 2 weeks, > 3/10 on a visual analogue scale, no prior treatment with acupuncture, stable treatment with nonsteroidal anti-inflammatory drugs, analgesics, or glucosamine. Exclusion criterion was intraarticular injections in the knee in the previous 2 months. Randomisation of 560 participants allocated 238 to the high expectations group, 242 to the neutral expectations group, and 80 to the waiting list group. Six acupuncturists licensed in traditional Chinese medicine carried out the intervention. For the communication style intervention, providers conveyed high expectations of improvement, by using positive utterances such as 'I think this will work for you', while neutral expectations were conveyed with uncertainty utterances such as 'It may or may not work for you'. For the acupuncture intervention the procedure and specific points were standardised by a panel consisting of the acupuncturists in each of the 2 arms: TCA points on the basis of clinical practice, and sham points outside the relevant meridians. The primary outcomes were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, and Satisfaction with Knee Procedure (SKIP) measured at 4 weeks, 6 weeks (end of treatment), and 3 months. 527 (94%) participants completed the study. There were no significant differences between the TCA and sham groups in any of the outcome measures. Patients in the high expectations communication style group had statistically significant improvements in pain (J-MAP) and satisfaction (SKIP) compared with the neutral group. Mean differences (95% CI) at 3 months follow up were 0.4 (0.1 to 0.7) for J-MAP (1 to 7 scale), and 0.2 (0.03 to 0.3) for SKIP (1 to 5 scale). In patients with knee OA, needling of meridian points was not more effective than the use of sham points, whereas acupuncturists' communication styles had a small but statistically significant effect on pain reduction and satisfaction.

Assessment and expression of pain

This article, the second in a series of articles on pain, describes the importance of pain assessment. It explores the individuality of patients' pain expression and the effect of healthcare professionals' reactions to people experiencing pain. The role of the nurse is analysed, focusing on multidimensional pain assessment and the use of pain assessment scales.

A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient‐provider communication

There is conflicting evidence on the efficacy of traditional Chinese acupuncture (TCA), and the role of placebo effects elicited by acupuncturists' behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA with sham acupuncture and to examine the effects of acupuncturists' communication styles. Acupuncturists were trained to interact in 1 of 2 communication styles: high or neutral expectations. Patients were randomized to 1 of 3 style groups, waiting list, high, or neutral, and nested within style, TCA or sham acupuncture twice a week over 6 weeks. Sham acupuncture was performed in nonmeridian points with shallow needles and minimal stimulation. Primary outcome measures were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction scores. Patients (n = 455) received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP (-1.1, -1.0, and -0.1, respectively; P < 0.001) and WOMAC pain (-13.7, -14, and -1.7, respectively; P < 0.001) compared with the waiting group. Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the high expectations group. In the TCA and sham groups, 52% and 43%, respectively, thought they had received TCA (κ = 0.05), suggesting successful blinding. TCA was not superior to sham acupuncture. However, acupuncturists' styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.

The Utilization of a Computerized Pain Assessment Tool-PAINReportIt® in Adolescents with Sickle Cell Disease.

Abstract 1535Poster Board I-558 IntroductionPain in sickle cell disease (SCD) is a common acute and chronic complication across the life span, but a single multidimensional pain assessment tool is not available that can be used in children, adolescents and adults. The Adolescent Pediatric Pain Tool (APPT) is a self-administered, paper and pencil tool that has been validated in children and adolescents with SCD; the McGill Pain Questionnaire (MPQ) is valid for adolescents and adults. To begin to create a multidimensional pain assessment tool that is valid across the life span, we compared the APPT to the PAINReportIt®, a self-administered computerized version of the MPQ in adolescent outpatients with SCD. The use of a computer/web based system would allow for ease of storage and retrieval of data. The utilization of a computerized pain assessment tool may provide clues to treatment of the multidimensional pain experience of pediatric patients with SCD. Patients and MethodsPatients with sickle cell disease (Hb SS, Hb SC, Hb Sβ0 and Hb Sβ+ thalassemia) aged 14 years of age and older were eligible for this study. A convenience sample of patients attending comprehensive sickle cell clinics were recruited for enrollment. In random order, on the same day, patients completed the PAINReportIt® and the APPT in an outpatient clinic. The number of pain sites, pain intensity, qualitative pain descriptors (sensory, affective, and evaluative), pain pattern, as well as nociceptive and neuropathic descriptors were analyzed with descriptive, correlation, and independent t-test statistics. ResultsA total of 49 patients completed both pain assessment tools. 26 were female (53%) and 23 were male (47%). 41 (84%) patients had Hb SS, 7 (14.3%) had Hb SC, and 1 patient (2%) had Hb SB0 thalassemia. 46 (94%) of the patients described themselves as African American, 2 (4%) as Hispanic, and one (2%) as other. The mean number of pain sites with PAINReportIt® was 3.65 +/- 3.4; the mean number of pain sites with the APPT was 4.71 +/- 4.87 (r= 0.76, p= 0.01). Pain sites where more than 25% of the patients had pain included the chest, abdomen and forearm. More than 35% of the patients had pain in the thighs, knees and lower legs, and 59% of the patients reported pain in the lower back. The pain intensity with PAINReportIt® was 3.76 +/- 2.53 (on a 10-point scale) and with the APPT was 4.63 +/- 3.12 (on a 10-point scale) (r= 0.29, p= 0.05). In terms of qualitative pain descriptors between the tools, sensory (r= 0.69, p= 0.01), affective (r= 0.69, p= 0.01), and evaluative (r= 0.48, p= 0.001) terms each had a statistically significant correlation. There also was a statistically significant correlation between tools with the patient's pain pattern (r= 0.35, p= 0.01). There was a statistically significant difference by gender with the number of pain sites (females: 4.88 +/- 4.07, males: 2.26 +/-1.60, p= 0.005), and with the following qualitative pain descriptors: neuropathic (females: 4.31 +/- 3.08, males: 2.04 +/- 1.89, p= 0.03), nociceptive (females: 6.58 +/- 3.97, males: 3.91 +/- 2.71, p= 0.008), sensory (females: 17.54 +/- 8.29, males: 12.69 +/- 7.11, p= 0.03) and affective (females: 4.65 +/- 4.08, males: 2.27 +/- 2.70, p= 0.02). There was a statistically significant correlation with both tools regardless of which tool was completed first for the number of pain sites and with the use of sensory and affective qualitative descriptive terms (data not shown). ConclusionThere were significant, moderate to strong correlations between the PAINReportIt® and the APPT with regard to pain location, intensity, quality and pattern, validating the use of PAINReportIt® in adolescent patients with SCD. This is the first study utilizing this important tool in pediatric patients with SCD. The minor differences in scores between the two tools may reflect differences in instructions. This computerized pain assessment tool may become an important diagnostic tool to assist pediatric practitioners in the management of the multidimensional components of pain in SCD. DisclosuresNo relevant conflicts of interest to declare.

Identification and Validation of Brazilian Chronic Pain Descriptors

Appropriate pain assessment is very important for managing chronic pain. Given the cultural differences in verbally expressing pain and in psychosocial problems, specific tools are needed. The goal of this study was to identify and validate Brazilian pain descriptors. A purposive sample of health professionals and chronic pain patients was recruited. Four studies were conducted using direct and indirect psychophysical methods: category estimation, magnitude estimation, and magnitude estimation and line-length. Results showed the descriptors which best describe chronic pain in Brazilian culture and demonstrated that there is not a significant correlation between patients and health professionals and that the psychophysical scale of judgment of pain descriptors is valid, stable, and consistent. Results reinforced that the translations of word descriptors and research tools into another language may be inappropriate, owing to differences in perception and communication and the inadequacy of exact translations to reflect the intended meaning. Given the complexity of the chronic pain, personal suffering involved, and the need for accurate assessment of chronic pain using descriptors stemming from Brazilian culture and language, it is essential to investigate the most adequate words to describe chronic pain. Although it requires more refinement, the Brazilian chronic pain descriptors can be used further to develop a multidimensional pain assessment tool that is culturally sensitive.