Observational Pain Assessment Scale Research Articles

The effect of aromatherapy with Lavender-Neroli oil and music in management of pediatric dental anxiety: a randomized control trial

AimThis study aimed to evaluate the efficacy of aromatherapy with Lavender-Neroli essential oil combined with background music in reducing dental anxiety and pain during anesthesia in children.Materials and methodsA total of 56 children aged 6–10 years old who needed dental treatment with inferior alveolar nerve injection (IANB) were randomly divided into two groups: Group 1 (Experimental, n = 28) aromatherapy with music group, and Group 2 (Control, n = 28) the placebo group. Children in the group 1 were asked to inhale the aromatic blend of Lavender-Neroli essential oil using a nasal mask similar to one that is used for nitrous oxide after modifying it by adding a 3D printed box on its circle hole and listening to their favorite music as a background before 5 min and during anesthesia, meanwhile in the placebo group children were asked to wear an empty nasal mask. Anxiety and pain were been assessed before and after anesthesia using the self-report anxiety scale Facial image scale (FIS), Observational pain assessment scale Face-Legs-Activity-Cry-Consolability (FLACC), heart rate, SPO2 saturation, diastolic and systolic blood pressure.ResultsDental anxiety and vital signs except SPO2 saturation were significantly lower in the aromatherapy with music group when compared to the control group (p < 0.05), with no differences in pain perception between groups (p = 0.176).ConclusionsAromatherapy with Lavender-Neroli oil combined with music seems to be a useful and safe non-pharmacologic technique for managing dental anxiety in children.

Chapitre 5. Évaluer le confort du patient en contexte de pratiques sédatives : enjeux éthiques des innovations en médecine palliative

In the context of end of life, palliative care offers support for the patient and his family, from a global perspective. This means paying attention to pain and difficult symptoms, but also to psychological, social and spiritual issues. Some situations confront healthcare teams with the difficulty of providing support to the end of life, not only in terms of relieving pain and suffering, but also when communication is impaired or even impossible. This is particularly the case with sedative practices. These situations involve providing comprehensive support by different evaluations of the patient&#8217;s pain and discomfort. This is therefore carried out by hetero-evaluation, by following observational pain assessment scales. Monitoring devices, such as ANI, usually used in anesthesia services, are experimented, for clinical purposes but also for research. In this article, we propose to analyze a clinical situation in which the use of ANI raised a whole series of questions about the use of the technical approach in palliative medicine and its integration into a care team. We will question some issues, in context, on the use of techniques and technologies in palliative medicine.

Interrater Variability in Pain Assessment of Long-term Care Residents with Dementia

PurposePeople with dementia are at great risk of their pain being undetected. In long-term care facilities, certified nursing assistants are on the front-line to detect whether a resident with dementia is experiencing pain, but research on certified nursing assistants' abilities to accurately assess pain are scarce. This study aims to examine certified nursing assistants’ pain assessment skills using a simulated standardized video context. DesignA cross-sectional study was conducted. MethodsFifty certified nursing assistants and 40 individuals with no professional experience in the field of care (controls) watched the same video of an older adult woman with dementia experiencing pain. Afterwards, they completed visual analog scales (pain intensity, affective distress), an observational pain assessment scale (Algoplus), and a set of questionnaires. ResultsIn both groups, pain intensity assessment and empathic reaction scores showed important interrater variability. Moreover, certified nursing assistants and controls did not differ in detecting the presence of pain or assessing its intensity. But certified nursing assistants displayed lower empathic reactions and dispositions. Certified nursing assistants pain assessment scores decreased with experience and expertise. ConclusionsThe practice of pain assessment is challenging for certified nursing assistants in long-term care facilities. Their professional status does not prevent inter-personal inconsistency and tends to lower their empathic dispositions. Personal determinants may interfere with their assessment behaviors and must be considered to enhance pain management for residents with dementia.

The Pain Assessment in Impaired Cognition scale (PAIC15): A multidisciplinary and international approach to develop and test a meta‐tool for pain assessment in impaired cognition, especially dementia

Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)," "reliability" and "validity." This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale. Using a meta-tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).

Pragmatic evaluation of an observational pain assessment scale in the emergency department: The Pain Assessment in Advanced Dementia (PAINAD) scale

BackgroundPain assessment is challenging in older people with cognitive impairment who present to the emergency department and may result in suboptimal management. Therefore, the usefulness of the Pain Assessment in Advanced Dementia (PAINAD) tool for older people with cognitive impairment presenting with a painful injury was evaluated. MethodsIn this multi-centre observational sub-study, older people (≥65 years) suspected of a long bone fracture were screened for cognitive impairment using the Six Item Screening (SIS) tool. Patients with SIS≤4 were assessed using the PAINAD. Descriptive and correlation statistical analyses were performed. Cronbach's alpha was used to estimate the reliability of the PAINAD. ResultsThis predominantly female (63%) sample had a mean age of 85.5±7.5 years and a moderately urgent Australian Triage code (mode: 3). Median pain intensity was low (numerical reporting scale: 5.5 [3.0–8.0]). Median PAINAD score was ‘mild’ (1.0 [0.0–3.2]) with wide variability (range: 0–9). The PAINAD demonstrated good reliability (Cronbach's α=0.80). Most PAINAD items appeared worthy of retention. ConclusionsThe PAINAD has potential as an effective pain assessment tool for older people with cognitive impairment in emergency departments. Strategies such as partnering with carers and family to collaboratively assess pain require further investigation in this setting.

266 Evaluation of Satisfaction and Clinical Improvements of Healing Touch Services in a Burn and Surgery Hospital for Children

Healing Touch (HT), credentialed by the National Commission of Certifying Agencies, is a professional, holistic, non-pharmacological therapy purported to promote relaxation, pain management and reduce stress. Since April 2013, 279 HT treatments were provided to three groups of recipients experiencing discomfort: pediatric patients, their guardians and employees. The purpose of this evaluation was to assess the satisfaction and clinical improvements this service provides. IRB exempt review and approval was obtained for a prospective de-identified survey evaluation of data from 105 HT recipients, guardians and clinicians who observed their patients, from 2015–2017. Guardian and recipient surveys consisted of questions to evaluate calmness, relaxation, interest in repeat sessions and whether HT had a positive effect. Clinicians who observed their patients documented changes in heart rate, blood pressure and respiratory rate. A validated observational pain assessment scale (OPAS) was used to compare pre- and post- treatment pain status and was analyzed by the nonparametric Wilcoxon signed rank test. Practitioners were HT certified or level 1–5 trained staff. For the recipient survey findings, 96% (n=29) of responders indicated that HT was beneficial, 100% said they would return for additional sessions, and 100% reported improved relaxation and calmness. Ninety-four percent of guardians (n=32) found HT to be beneficial by documenting that they strongly agree or agree that HT had a positive effect. The clinician survey (n=44) revealed that heart rate either decreased or was neutral 100% of the time as did blood pressure, O2 saturation and respiratory rate most of the time for whom it was assessed. Eighty-two percent of clinicians found HT to be beneficial. There were statistically significant differences in OPAS scores from pre-HT to post-HT for both the clinician (p<.0001) and HT practitioner (p<.0001). No adverse effects were reported. HT provided by a well-organized program and an interdisciplinary team of credentialed providers represents an effective means to improve clinical and satisfaction measures for patients, guardians and employees, especially when applied during times of anxiety and pain. This HT evaluation forms the basis for continuing the use of HT in a burn and surgery hospital for children. HT is a helpful modality to enhance patient and guardian satisfaction.

Reliability of the Faces, Legs, Activity, Cry, and Consolability Scale in Assessing Acute Pain in the Pediatric Emergency Department.

The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is one of the most widely utilized observational pain assessment scales in clinical practice. Although designed and validated to assess postoperative pain, the tool is currently applied to assess acute pain in multiple settings, including the emergency department. Scarce literature exists evaluating the reliability of the FLACC scale in the nonsurgical population and none in the emergency department. We sought to investigate the reliability of the FLACC scale in assessing acute pain in the pediatric emergency department and to examine the sensitivity of FLACC scores after the administration of analgesia. In phase 1 of this prospective study, a series of 2 independent evaluators, blinded to each other's evaluations, scored 66 patients using the FLACC tool. Degree of concordance among the 6 dyads was used to measure interrater reliability. In phase 2, FLACC scores were obtained just before the administration of analgesia in 35 patients and measured at 30 and at 60 minutes after administration. Among the 6 dyads of evaluators, Kendall W demonstrated a strong concordance (27 of 30 measures; range, 0.63-1.00) for individual components of the scale and for the composite scores (range, 0.85-0.96). Significant mean reductions from preanalgesia FLACC scores [5.54; 95% confidence interval (CI), 4.79-6.30] were seen at 30 minutes (2.00; 95% CI, 1.61-2.39) and 60 minutes (1.14; 95% CI, 0.79-1.50) postanalgesia (P < 0.0001 for all comparisons). The FLACC scale demonstrated high interrater reliability for both individual FLACC items and total scores in a convenience sample of patients aged 6 months to 5 years in a pediatric emergency department. It seems to be an appropriate observational tool to assess acute pain in this population.

Evaluation of two observational pain assessment scales during the anaesthesia recovery period in Chinese surgical older adults.

To evaluate the reliability and validity of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators in Chinese older adults post surgery during the anaesthesia recovery period. Pain assessment in older surgical patients is complicated by factors such as anaesthesia and opioid administration. Although observational pain behavioural assessment tools have been validated for those unable to self-report, research on their application during the anaesthesia recovery period is limited. A prospective correlational design. Ninety-three older patients admitted for scheduled abdominal surgery were recruited in a university-affiliated hospital. The two observational scales were used to conduct pain assessments during the anaesthesia recovery period. On the first and the third postoperative day, participants recalled their pain intensity during the recovery period using the Numeric Rating Scale or the Faces Pain Scale-Revised. The internal consistency reliability of the Pain Assessment in Advanced Dementia scale and the Checklist of Nonverbal Pain Indicators was 0·81 and 0·69 respectively. The correlation between scores of the two observational scales was 0·95. The recalled self-reports of pain intensity were significantly correlated. The correlation of the Pain Assessment in Advanced Dementia scale and patients' recalled self-reports was 0·55, 0·54, and the correlation between the Checklist of Nonverbal Pain Indicators and the two recalled pain scores was both 0·60. Both the two observational scales had good reliability and validity when used to assess pain in Chinese surgical older adults during the anaesthesia recovery period. Observational pain scales can be useful as a tool for patients unable to self-report. Accurate use of one of the observational pain tools can help identify pain during the anaesthesia recovery period, when patients are unable to self-report, to support effective pain management during this period.

Pain management in intellectually disabled children: Assessment, treatment, and translational research

The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of intellectually disabled children and almost all children with intellectual disability have comorbidities that need to be addressed. The scope of research has started to broaden. In this review we aim to answer the question: Can we integrate validated ways of pain assessment and postoperative pain treatment in intellectually disabled children to develop specific analgesic algorithms? Regrettably there is little knowledge on possible interaction effects and other relevant pharmacological issues. Possible genotype-phenotype associations related to pain in children with Down syndrome have several promises as six possible candidate genes are located on chromosome 21. In conclusion, the pain assessment tools for intellectually disabled children are there. We should now focus on tailoring the pain treatment. To this aim we need to perform pharmacokinetic and pharmacodynamic studies of analgesics and obtain information about the genotype-phenotype relationships for pain. This can lead to the development of specific analgesic algorithms.

Observational pain assessment scales for people with dementia: a review

Dementia may alter the experience of pain and the ability to communicate it; this will, in turn, result in poor pain detection and inadequate treatment. The aim of this literature review is to identify the observational pain scales that have clinical utility and feasibility for use with people living with dementia in the community by district nurses in their daily practice. It was found that a consensus could not be reached on which tool to use in clinical practice. A further evaluation of the Non-communicative Patients Pain Assessment Instrument has improved its feasibility for use in the community environment, as it can be administered by family carers. This literature review concludes that observational pain scales need to be validated for use in the community and that there is a need to consider the involvement of the informal carer in the assessment of pain.

Improving pain management in elderly patients with dementia: validation of the Doloshort observational pain assessment scale

Improving pain management in elderly patients with dementia: validation of the Doloshort observational pain assessment scale

Psychometric Properties of the Doloplus-2 Observational Pain Assessment Scale and Comparison to Self-assessment in Hospitalized Elderly

Self-report is the "gold standard" for pain assessment, however, observational pain scales, such as Doloplus-2 must be used for patients who cannot communicate. In this follow-up study, we report the psychometric properties of the observational Doloplus-2 scale using the visual analog scale (VAS) pain score as a gold standard and evaluate its performance. Prospective clinical study of 180 hospitalized older patients who demonstrated good comprehension and reliable use of the VAS: 131 participants with dementia and 49 without. All participants assessed their chronic pain using the VAS. Doloplus-2 was independently completed by the nursing team. Mean age of patients (133 women, 47 men) was 83.7+/-6.5. Median mini-mental state examination of patients with diagnosis of dementia was 18.0+/-7.7. Nearly half of the patients (49%) reported that they experienced pain in response to a direct question. The administration of Doloplus-2 was possible in all 180 patients. Doloplus-2 correlated moderately with self-assessment (Spearman coefficient: 0.46). In a multiple regression model, Doloplus-2 predicted 41% of the variability in pain intensity measured by VAS. The somatic dimension alone explained 36% of the variance, the psychosocial bloc 5% with no better contribution of the psychomotor bloc. To shorten Doloplus-2, we constructed a version with only the 5 items that were significantly associated with the VAS score in the multiple regression models. The observational Doloplus-2 scale correlates moderately with self-assessment pain score and has adequate internal consistency. Our data also suggest that Doloplus-2 could be substantially shortened as the brief version performed similarly to the complete Doloplus-2.

Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

BackgroundPain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. Since assessment of pain is an important step towards the treatment of pain, there is a need for manageable, valid and reliable tools to assess pain in elderly people with dementia.MethodsThis systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales.ResultsTwenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities.ConclusionBased on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility.

The Development of an Observational Pain Assessment Scale (OPAS) for Pediatric Burns

The Development of an Observational Pain Assessment Scale (OPAS) for Pediatric Burns