Pain Assessment Tools Research Articles

Measuring pain intensity through physical interaction in an experimental model of cold-induced pain: A method comparison study.

Assessment of pain is challenging given its subjective nature. Standard pain assessment tools have limitations. We aimed to compare the verbal numeric rating scale (NRS) and Grasp, a novel handheld electronic device that reports pain by squeezing. To compare Grasp and NRS, healthy adult volunteers were invited to undergo two subsequent standardised tests of cold-triggered pain using a cold pressor test (CPT) at a temperature of 3°C. Pain intensity was in a randomised manner reported by NRS (scale 0-10) or by squeezing Grasp (0-3 V) during the two CPTs. A third CPT was performed 1 to 14 days later where subjects reported pain by Grasp a second time in order to study the association of repeated Grasp measurements. Acceptable association was a priori considered as mean Kendall's τ-b coefficient (τ-b) ≥ 0.7. The subjects reported their experience of using Grasp in a purpose-made questionnaire. In total, 102 subjects were included, and 96 subjects (56 females) completed all three tests. The association of pain intensity reported by Grasp and NRS was moderate with a mean τ-b of 0.53 (95% confidence interval [CI] 0.47-0.58). The association between the repeated Grasp measurements was weak with a mean τ-b of 0.43 (95% CI 0.37-0.48). Most subjects reported that Grasp was intuitive and easy to use. Pain intensity reported by squeezing Grasp did not show acceptable association with pain intensity reported by NRS during CPTs. The association between pain intensity reported by Grasp during two CPTs on separate days was weak. Further improvements of the Grasp ball are needed before use in clinical settings.

Pain in Dementia: An Empirical Test of a Common Assumption

Numerous, and often largely overlapping, observational pain assessment tools have been developed specifically to assess pain in older adults with dementia under the assumption that a specialized approach is necessary to evaluate pain in this population. However, this assumption has never been tested empirically. As an empirical test of this implicit assumption, our goal was to compare existing tools for people living with dementia (with respect to psychometric properties), not only against each other, but also against a tool developed for a different population with cognitive impairments. Videos of older adults with severe dementia recorded in long-term care settings were coded for pain behaviors in the laboratory. Trained coders coded pain behaviors in video segments of older adults with dementia during a quiet baseline condition as well as during a physical examination (designed to identify painful areas), using various observational pain assessment tools. An observational measure of agitation was employed to facilitate the assessment of discriminant validity. Consistent with our expectations, all pain tools (including the tool developed for younger people with cognitive impairments) successfully differentiated between painful and nonpainful states, with large effect sizes. This was the first study to compare tools specifically developed to assess pain in people living with dementia to a tool developed for a different population. Given that all tools under study showed satisfactory psychometric properties when tested on persons with dementia, this study suggests that the assumption that different tools are necessary for different populations with cognitive impairments cannot be taken for granted. PerspectiveThis article challenges an implicitly held assumption that specialized tools are needed to assess pain in different populations with cognitive impairments. Given commonalities in pain expression across populations, further research is needed to determine whether population-specific tools are needed.

Knowledge, Attitudes, and Practices regarding Pain Assessment among Nurses Working at Public-Sector Pediatric Oncology Units in Pakistan

Abstract Introduction Pain in pediatric oncology patients is often undertreated due to a lack of timely assessment and inefficient communication between health care workers. Improper pain assessment is a leading cause of poorly managed pain in children. In high-income countries, pediatric oncology nurses play a key role in developmentally appropriate pain assessment measures to identify potential management strategies. However, nurses in low- and middle-income countries (LMICs) face a deficit of knowledge about pain assessment tools and management. Owing to differences in availability of resources, a disparity exists between health-related quality of life of cancer patients treated at public- and private-sector hospitals in Pakistan. Methodology The Indus Hospital and Health Network partnered with nine public-sector hospitals nationwide to improve pediatric oncology practices. Supported by the My Child Matters grant, training sessions were conducted for nurses at each public-sector pediatric oncology unit (POU) from March to December 2021. Pain assessment tools were provided. To assess retention and implementation of practices, a knowledge, attitudes, and practices questionnaire was distributed online to nurses at each POU. All responses remained anonymous. Results Fifty-four responses were recorded, 85% were female and most were between 26 and 30 years of age. Most of the participants held a diploma in nursing and were designated charge nurses with more than 6 years of experience. Forty nurses reported routinely assessing pain; the most common reason for not doing so was increased workload. Correlations were observed between routinely performing pain assessment and the number of patients per nurse, availability of formal credentialing or certifications at the institution and routinely performing pain assessment, availability of trainings focused on pain assessment and routinely performing pain assessment, and qualification of nurses and knowledge of nonpharmacological pain assessment methods. Conclusion Strategies to improve pain assessment knowledge and practices among pediatric oncology nurses in LMICs must be developed to improve patient care and clinical outcomes.

Diagnostic overshadowing: self-injurious behaviour as a manifestation of pain in the head and neck.

In the healthcare domain, diagnostic overshadowing is a concerning issue involving the erroneous attribution of physical symptoms to a patient's mental health, behavioural intricacies, or pre-existing disabilities. Individuals facing learning and communication challenges are particularly susceptible to this phenomenon, struggling to articulate or comprehend their experienced symptoms. Likewise, patients with autism spectrum disorder can have an escalated risk due to possible challenges in interpreting bodily cues. This article delves into the specialised care required for individuals with learning disabilities and/or autism, highlighting the pervasive risk of diagnostic overshadowing and the potential manifestation of pain as self-injurious behaviour in these patient groups. By underscoring the need to mitigate diagnostic overshadowing within dental practice, we advocate for reasonable adjustments in care delivery and comprehensive education of the dental team. Proficient tools for pain assessment and effective communication are emphasised to collectively improve the healthcare experience for these vulnerable patient cohorts.

Global-local combined features to detect pain intensity from facial expression images with attention mechanism

The estimation of pain intensity is critical for medical diagnosis and treatment of patients. With the development of image monitoring technology and artificial intelligence, automatic pain assessment based on facial expression and behavioral analysis shows a potential value in clinical applications. This paper reports a framework of convolutional neural network with global and local attention mechanism (GLA-CNN) for the effective detection of pain intensity at four-level thresholds using facial expression images. GLA-CNN includes two modules, namely global attention network (GANet) and local attention network (LANet). LANet is responsible for extracting representative local patch features of faces, while GANet extracts whole facial features to compensate for the ignored correlative features between patches. In the end, the global correlational and local subtle features are fused for the final estimation of pain intensity. Experiments under the UNBC-McMaster Shoulder Pain database demonstrate that GLA-CNN outperforms other state-of-the-art methods. Additionally, a visualization analysis is conducted to present the feature map of GLA-CNN, intuitively showing that it can extract not only local pain features but also global correlative facial ones. Our study demonstrates that pain assessment based on facial expression is a non-invasive and feasible method, and can be employed as an auxiliary pain assessment tool in clinical practice.

Beyond measurement: a deep dive into the commonly used pain scales for postoperative pain assessment.

This review explores the essential methodologies for effective postoperative pain management, focusing on the need for thorough pain assessment tools, as underscored in various existing guidelines. Herein, the strengths and weaknesses of commonly used pain scales for postoperative pain-the Visual Analog Scale, Numeric Rating Scale, Verbal Rating Scale, and Faces Pain Scale-are evaluated, highlighting the importance of selecting appropriate assessment tools based on factors influencing their effectiveness in surgical contexts. By emphasizing the need to comprehend the minimal clinically important difference (MCID) for these scales in evaluating new analgesic interventions and monitoring pain trajectories over time, this review advocates recognizing the limitations of common pain scales to improve pain assessment strategies, ultimately enhancing postoperative pain management. Finally, five recommendations for pain assessment in research on postoperative pain are provided: first, selecting an appropriate pain scale tailored to the patient group, considering the strengths and weaknesses of each scale; second, simultaneously assessing the intensity of postoperative pain at rest and during movement; third, conducting evaluations at specific time points and monitoring trends over time; fourth, extending the focus beyond the intensity of postoperative pain to include its impact on postoperative functional recovery; and lastly, interpreting the findings while considering the MCID, ensuring that it is clinically significant for the chosen pain scale. These recommendations broaden our understanding of postoperative pain and provide insights that contribute to more effective pain management strategies, thereby enhancing patient care outcomes.

Evaluation of Pain Through a Novel Mobile Application: The Visual, Auditory, and Tactile Scale (VATAS).

Developing a validated, standardized, and easily accessible pain assessment tool is the first step toward improving pain management. Since pain measurement is often used as a primary or secondary endpoint in daily clinical practice and clinical trials, accurate and precise pain measurement is of great importance. Therefore, there is a need for a valid, reliable, safe, and low-cost method to measure and assess pain levels more objectively. Traditional measurement tools, still considered the gold standard in clinical pain research, have significant disadvantages, including low sensitivity and higher rates of false responses. Perhaps most importantly, the assumption that general pain is a one-dimensional experience that can be measured with a single-item scale is limiting. Recently, new technologies utilizing smart devices have emerged to improve existing traditional pain outcome measures. The Visual, Auditory, and Tactile Analog Scale (VATAS) was designed to address tactile, auditory, and visual senses. By including multiple senses, it is thought that errors arising from the objectification of pain solely through a single-dimensional scale, such as Visual Analog Scale (VAS), could be eliminated, providing a more standardized and repeatable pain assessment. VATAS has the potential to complement the deficiencies of standard pain measurement methods by appealing to multiple senses. It can provide a more standardized, patient-compliant, and repeatable pain assessment. Furthermore, it can be used for evaluating and recording pain in visually impaired patients and has the potential for data tracking, allowing patients' pain to be monitored even when they are at home.

Performance Evaluation of a Supervised Machine Learning Pain Classification Model Developed by Neonatal Nurses.

Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain. To develop and validate a machine learning (ML) model to classify pain. In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC. Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98. The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants.

Pain assessment tools: A literature review

Pain assessment tools: A literature review

Care home staff interventions to optimise pain assessment and management in people with advanced dementia in long-term care settings: a systematic review

Abstract Introduction As a person’s dementia symptoms worsen, they become increasingly frail and dependent on others for support,[1] which often necessitates moving into long-term care (LTC). Pain is often poorly recognised and undertreated in people with advanced dementia.[2] Aim To identify and evaluate the effectiveness of care home staff interventions involving pain assessment and management in people with advanced dementia in LTC settings. Methods This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022355487). Nine databases (Medline, Scopus, The Cochrane Library, EMBASE, Web of Science, International Pharmaceutical Abstracts, PsycINFO, CINAHL, World Health Organisation International Clinical Trials Registry Platform) were searched. The search strategy was developed in Medline and adapted as appropriate for the other databases; it comprised the following search terms: ‘dementia’, ‘Alzheimer’s disease’, ‘pain assessment’, ‘pain management’, ‘pain intervention’, ‘care home’, and ‘nursing home’. The selection of studies was limited to randomised controlled trials (RCTs) in which ≥50% of participants had advanced (moderate-severe) dementia and published in English. Electronic databases were searched from date of inception to May 2023. Two reviewers independently assessed potentially relevant articles for inclusion, completed data extraction and assessed risk of bias using the Cochrane Risk of Bias (RoB) 2.0 tool. A third reviewer was consulted when consensus could not be reached. A narrative analysis was undertaken due to the heterogeneity of outcome measures. Results In total, 3504 articles were identified, with 998 records remaining after duplicate removal. This left 2456 studies for title/abstract screening, and 22 full-text studies were assessed for eligibility; five studies met the inclusion criteria. A total of 1363 participants (mean age 83-88 years) and 123 care homes were included in the studies. The studies reported that these interventions were shown to be effective compared to control groups: the Pain recognition and Treatment (PRT) protocol in China, regular use of the PACSLAC pain assessment tool in Canada, the use of a Comprehensive Observational Pain Management Protocol in Hong Kong, the COSMOS intervention in Norway, and the STA OP stepwise multidisciplinary intervention in the Netherlands. Primary outcomes concerning pain scores measured by PACSLAC (n=2 studies), PAINAD (n=2 studies), and MOBID-2 (n=1 study) showed a statistically significant decrease. Secondary outcomes measured included several clinical outcomes associated with pain, depression, presence of neuropsychiatric symptoms and nursing staff stress. Four of the included studies were judged to be at ‘some concerns of bias’ according to RoB 2.0, due to unclear information in two or more domains (randomisation process, deviations from intended interventions, and measurement of the outcomes); one study was judged as having a ‘low risk of bias’. Conclusion The use of pain assessment tools decreased pain scores in people with advanced dementia in LTC. A limitation of this review is the exclusion of non-English language studies. Further, the clinical and methodological heterogeneity of included studies made a quantitative comparison difficult, thus, the findings are based on narrative analysis.

Complementary Approaches to Pain for Children

Pain, an unpleasant sensory and emotional experience, affects children often and is one of the most common reasons to seek care. Pain in the pediatric patient population often goes unrecognized and is not assessed appropriately and adequately, leading to mismanagement and increased use of pharmacological methods to relieve pain. Pediatric surgical nurses must understand the numerous influential factors and assessment strategies in order to contribute to pain management, ensuring the appropriate pain assessment tool is used based on the child's age, cognitive development, culture, and beliefs. Complementary approaches should be included, when possible, to aid in eliminating or controlling pain in children. Alternative options, such as distraction, skin-to-skin contact, guided imagery, and hypnosis, are effective in reducing or eliminating pediatric pain. They can be used alone or in conjunction with traditional treatment plans, even in the perioperative period. Pediatric nurses can benefit from learning, understanding, and using the complementary approaches outlined for pain management in this vulnerable population.

Current concepts in the diagnosis and management of acute pain in children

BACKGROUND: In children, injuries are the focus of attention both for the increasing incidence and necessity of pain management, and pain can be indicate the severity of injuries or serious complications that worsens the treatment results. Despite the obvious problem, information available in the literature regarding the theoretical and practical aspects of acute pain in children is often contradictory and needs to be systematized.
 AIM: To present current information about the epidemiology, physiology, diagnosis, and treatment of acute pain in children to pediatric orthopedic and trauma specialists.
 MATERIALS AND METHODS: Selective analysis and narrative review of relevant studies analyzing the epidemiology, diagnosis, and management of acute pain in children were performed.
 RESULTS: Although various pain assessment tools are available, the clinical assessment of acute pain in children remains challenging. The use of these tools depends on the child’s age, cognitive and communication skills, and pain location. The term oligoanalgesia has been used to describe inadequate pain relief in the emergency department. Oligoanalgesia in children has negative physiological and psychological effects, sometimes with long-term consequences, and may negatively affect their future pain experiences. Parents often underestimate their child’s pain level and have serious misunderstandings about how children express pain. The World Health Organization has developed recommendations for pain management in children. Ibuprofen and paracetamol are recommended as analgesics for mild-to-moderate pain in children aged 3 months. This choice considered extensive data on the effectiveness and safety.
 CONCLUSIONS: Personalized management strategies utilizing biopsychosocial approach will ensure that children are treated comprehensively according to their unique pain status.

RLWOA-SOFL: A New Learning Model-Based Reinforcement Swarm Intelligence and Self-Organizing Deep Fuzzy Rules for fMRI Pain Decoding

Pain is highly subjective, so it is always desirable to develop objective pain assessment methods. Brain imaging techniques, such as functional magnetic resonance imaging (fMRI), have the potential to provide a physiological and quantitative pain assessment tool. However, the ultra-high-dimensional fMRI data and the nonlinear relationship between fMRI and pain greatly degrade the efficiency of fMRI-based pain decoding models. In this paper, a novel pain decoding model is proposed based on the whale optimization algorithm (WOA), reinforcement learning (RL), and self-organizing fuzzy logic (SOFL), namely RLWOA-SOFL. The new non-linear WOA method incorporates RL and repository experiences (RE), which is based on a back-propagation neural network (BPNN) to map a set of agents states to appropriate actions, to extract and select features that are highly predictive of pain. More specifically, the proposed RLWOA is self-learning and self-optimizing so it can deal with the high-dimensional and complex fMRI data. On the other hand, to establish a fMRI-based pain decoding model, a novel SOFL method is proposed as a new type of deep fuzzy rule that can learn continuously from new data and identify prototypes to construct fuzzy rules. The proposed RLWOA-SOFL model is applied to real-world pain-evoked fMRI data, and the results show that the new model can decode pain intensity more accurately and can identify pain-related fMRI patterns more reliably. Therefore, the proposed RLWOA-SOFL model has great potential to evaluate the intensity of pain perception in clinical uses.

Variation in Nurses’ Documentation When Using the Clinically Aligned Pain Assessment Tool

Variation in Nurses’ Documentation When Using the Clinically Aligned Pain Assessment Tool

Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations.

Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.

Impact of implementing the pain best practice guideline in a long-term care home using the knowledge-to-action framework

Introduction. Assessment and management of pain in older adults can be challenging, with persistent pain prevalence ranging from 25% to 80%, especially in long term care homes (LTCH), where most seniors are unable to verbalize their pain. This article describes the implementation of the Registered Nurses’ Association of Ontario (RNAO) Assessment and Management of Pain (Third Edition) best practice guideline (BPG) in a LTCH in Toronto, Canada. Methodology. Using mixed descriptive study methodology, this 391-bed home housing older adults over 80 years implemented the Pain guideline using the knowledge-to-action framework and audit procedures to evaluate the impact of implementing this guideline. Key implementation activities included educating residents, families, and staff about pain while integrating validated pain screening and assessment tools into practice. A mixed methods approach of qualitative and quantitative data was utilized to monitor improvements in clinical and organizational outcomes. Results. The impact of implementing Pain BPG is: improved utilization of pain assessment and management tools, reduced incidence of worsening pain, improved pain scores and improved resident quality of life. The structured and integrated, evidence-based approaches to pain assessment and management reflected that long-term care residents don’t have to live with pain regularly, which leads to a better quality of life and resident/family satisfaction. Discussion. In conjunction with the structured approach of the knowledge-to-action framework and the Pain BPG, the LTCH utilized tailored approaches to meet the needs of their resident population. Recognizing the unique needs of seniors in a residential setting, organizational structural facilitators, and barriers and cultural needs, the LTCH developed multi modal approaches based on a person and family centred approach. This evidence-based and resident focused approach was the key to the successful implementation and subsequent outcomes that were resultant. Conclusion. The systematic implementation of the RNAO pain BPG and the utilization of the knowledge-to-action framework was shown to improve resident outcomes, improve organizational processes and generate staff satisfaction. Participation and engagement of residents, their families and health professionals in the process was one of the greatest facilitators.

Tracheal extubation under Narcotrend EEG monitoring at different depths of anesthesia after tonsillectomy in children: a prospective randomized controlled study.

This study aims to investigate whether tracheal extubation at different depths of anesthesia using Narcotrend EEG (NT value) can influence the recovery quality from anesthesia and cognitive function of children who underwent tonsillotomy. The study enrolled 152 children who underwent tonsillotomy and were anesthetized with endotracheal intubation in our hospital from September 2019 to March 2022. These patients were divided into Group A (conscious group, NT range of 95-100), Group B (light sedation group, NT range of 80-94), and Group C (conventional sedation group, NT range of 65-79). A neonatal pain assessment tool, namely, face, legs, activity, cry, and consolability (FLACC), was used to compare the pain scores of the three groups as the primary end point. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were used to evaluate the cognitive function of children in the three groups before and after surgery as the secondary end points. Differences were observed in the awakening time and FLACC scores after awakening among the three groups (P < 0.05). Among them, Group A exhibited a significantly shorter awakening time and higher FLACC score after awakening than those in Groups B and C (both P < 0.05). The total incidence of adverse reactions in Group B was significantly lower than that in Groups A and C (P < 0.05). No significant difference was observed in MMSE and MoCA scores before the operation and at 7 days after the operation among the three groups (P > 0.05), but a significant difference was found in MMSE and MoCA scores at 1 day and 3 days after the operation among the three groups (P < 0.05). In addition, MMSE and MoCA scores of the three groups decreased significantly at 1 day and 3 days after the operation than those at 1 day before the operation (P < 0.05). When the NT value of tonsillectomy is between 80 and 94, tracheal catheter removal can effectively improve the recovery quality and postoperative cognitive dysfunction of children.

Pain Assessment in Cattle during Castration Using Facial Expressions as a Promising Tool

Abstract Pain is a significant welfare issue in farm animals including cattle, impacting their wellbeing and normal behaviors. The frequent occurrence of pain in cattle is due to husbandry procedures, injuries, and diseases. Cattle, as a prey species, avoid expressing pain which makes pain identification a challenging issue. Rapid pain recognition is crucial to its effective treatment. Several pain assessment tools have been developed, and some of them rely on observing alterations in animal behaviors such as activity, locomotion, feeding, play, and grooming. Moreover, changes in physiological parameters including blood biomarkers and heart rate have been used as indicators of pain. Furthermore, grimace scales, which rely on evaluating facial expressions of animals, have been developed and proven to be accurate pain assessment tool in multiple species. To reliably identify pain in cattle, it is preferred to employ a combination of diagnostic methods, as no single approach can stand alone in assessing pain accurately. Mitigation strategies become imperative when pain is anticipated during husbandry procedures such as castration. Prompt application of treatment strategies is paramount to avoid transition of acute to chronic pain which is hard to be treated. Information © The Author 2024

Beyond the Self-Reports: A Review on Objective Pain Measurement and Its Implications.

Current methods of pain measurement are inadequate in capturing the complexity of the pain experience. This limitation arises mainly because these methods tend to overlook the multiple dimensions of pain during assessment, heavily relying on self-reported measures, which inherently have their drawbacks. Self-reported measures aim to gauge the pain severity experienced by an individual, based solely on their perception of the most intense pain sensation. However, these measures are prone to various biases and may not accurately reflect the actual pain experienced. To overcome these limitations, a new system of pain assessment is necessary, which minimizes subjective involvement and provides a more accurate representation of pain. The 'Pain Calculator' is a newly developed tool that has demonstrated promising accuracy in measuring somatic pain in the low back region. This tool effectively overcomes the subjective biases characteristic of the self-reported measures and provides a reliable and clinically feasible alternative to the existing pain assessment tools.

Amyotrophic Lateral Sclerosis and Pain: A Narrative Review from Pain Assessment to Therapy.

Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive muscle weakness, spasticity, atrophy, and respiratory failure, with a life expectancy of 2-5 years after symptom onset. In addition to motor symptoms, patients with ALS have a multitude of nonmotor symptoms; in fact, it is currently considered a multisystem disease. The purpose of our narrative review is to evaluate the different types of pain, the correlation between pain and the disease's stages, the pain assessment tools in ALS patients, and the available therapies focusing above all on the benefits of cannabis use. Pain is an underestimated and undertreated symptom that, in the last few years, has received more attention from research because it has a strong impact on the quality of life of these patients. The prevalence of pain is between 15% and 85% of ALS patients, and the studies on the type and intensity of pain are controversial. The absence of pain assessment tools validated in the ALS population and the dissimilar study designs influence the knowledge of ALS pain and consequently the pharmacological therapy. Several studies suggest that ALS is associated with changes in the endocannabinoid system, and the use of cannabis could slow the disease progression due to its neuroprotective action and act on pain, spasticity, cramps, sialorrhea, and depression. Our research has shown high patients' satisfaction with the use of cannabis for the treatment of spasticity and related pain. However, especially due to the ethical problems and the lack of interest of pharmaceutical companies, further studies are needed to ensure the most appropriate care for ALS patients.