Pain Measurement Tools Research Articles

Comparing sucrose solution with distilled water for pain management in premature infant venipuncture: randomized clinical trial.

Managing pain is critical, especially for premature infants undergoing frequent painful procedures. Uncontrolled pain can lead to lasting harm in growth, cognitive development, and future pain responses. A double-blinded clinical investigation involving 150 premature infants was performed in a neonatal intensive care unit. They were randomly divided into three groups: Sucrose 20% (50 infants), distilled water (50 infants), and a control group (50 infants). The infants' behavioral responses were assessed using an infant pain measurement tool before, at 2, and 7 min after the intervention through direct observation. The study revealed that mean pain scores before, 2 min after, and 7 min after the intervention in the sucrose group were (4.78±0.91), (3.18±1.15), and (2±1.02), respectively. In the distilled water group, scores were (4.66±0.89), (3.04±1.15), and (3.08±1.10), while in the control group, they were (4.0±0.79), (4.94±0.79), and (4.72±0.96). The trend of pain scores varied among the groups over time, with a significant difference in mean pain scores at different time points (P<0.001). Initially comparable, pain scores notably decreased after 2 min in the sucrose and distilled water groups (P<0.001), differing from the control group. The study indicated that 20% sucrose and distilled water equally reduce infant pain post-venipuncture, suggesting their viability for clinical pain management. Distilled water, however, provides additional benefits, including economic considerations and ease of preparation.

The Effect of Ultrasound and Neuromuscular Taping Interventions on Reducing Pain in Non-Specific Low Back Pain Patients

Low back pain (LBP) is a musculoskeletal disorder caused by poor ergonomics. LBP is defined as pain localized between the costal margin and the inferior gluteal fold that lasts for more than one day. The purpose of this study was to determine the effect of Ultrasound and Neuromuscular Taping interventions on reducing non-specific low back pain. This study used a quasi-experimental method with a one-group pre-and post-test design, and the research sample was given Ultrasound and Neuromuscular Taping interventions. The pain measurement tool used was the Visual Analog Scale (VAS). The normality test was performed using the Shapiro-Wilk test, and the effect test was performed using the Wilcoxon test. The results of this study showed that the pre-and post-intervention mean VAS scores were 6.7±1.766 and 1.7±0.674, respectively. With a value of p = 0.005 (p &lt; 0.005), which indicates a significant difference between the VAS scores before and after Ultrasound and Neuromuscular Taping interventions. This value can be interpreted as evidence that the combination of these two interventions can reduce the degree of pain in non-specific low back pain conditions. In conclusion, the study found that there was a significant effect of Ultrasound and neuro-muscular taping (NMT) interventions on reducing pain in cases of non-specific low back pain.

Pain Scales: What Are They and What Do They Mean.

It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.

Tools for assessing labour pain: a comprehensive review of research literature.

The experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for "no pain," and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.

The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis.

Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. CRD42021266826.

Digital tools for assessing chronic pain in children (5-11 years): Systematic review.

Pediatric chronic pain places a significant burden on children, their families, and healthcare services. Effective pain measurement is needed for both clinical management and research. Digital pain measurement tools have been developed for adult and adolescent populations however less is known about measurement in younger children. In this systematic review, we aimed to identify, describe, and evaluate (in terms of acceptability) digital tools for the assessment of chronic pain in children (5-11 years). We searched five databases (Cochrane Library, EMBASE, MEDLINE, PsycINFO, and CINAHL), between January 2014 and January 2022. We included empirical studies which included digital tool/s to assess pain in children aged between 5-11 years with chronic pain conditions. We independently double-screened the papers to determine eligibility. We followed PRISMA guidelines for reporting. A total of five papers, covering four digital tools, were included. The digital tools used ranged from a static online survey to a highly interactive, personalized tablet application. Two studies were cross-sectional and two collected longitudinal pain data via electronic devices outside the clinical setting. Digital features of the tools included: dynamic testing (n = 2), notifications/prompts (n = 1), data transmission (n = 1), remote monitoring (n = 1), accessibility (n = 1), data visualization/feedback (n = 1), personalization/customization (n = 1), gamification (n = 1) and data labeling (n = 1). Qualitative usability data was only available for one of the tools, which indicated its acceptability and highlighted preferred features/functions by child users (creative and personalizable features, gamification features), and parental users (symptom tracking). This review has highlighted the limited number of digital assessment tools available for children with chronic pain aged 5-11. This review identified some examples of technology enabling the capture of longitudinal, repeated measurement of multiple dimensions of pain (intensity, location, quality). We suggest directions for future research.

Knowledge, attitudes and practices of neurologists regarding the management of chronic non-cancer pain in the Republic of Moldova

Background: Chronic pain is a public health problem due to its high prevalence, disability, and associated comorbidities. In the Republic of Moldova, there are no health policies or strategies regarding chronic pain, and the burden on the population is not known because it is not registered nor monitored by the state. The aim was to analyze the knowledge, attitudes, and practices of neurologists regarding the management of chronic pain in the Republic of Moldova. Material and methods: Mixed observational study (qualitative and quantitative) was designed and carried out using a Knowledge, Attitudes, Practices research questionnaire. The study includes 50 neurologists, average age of 47.4±9.52 years, women (82%), and urban area (80%), interacting with chronic pain patients on a daily basis (86%). Results: 42% of neurologists know about pain measurement tools, 40% of them use these pain measurement tools, 40% of neurologist know clinical guidelines, 92% of them practice pharmacological and non-pharmacological treatments. The neurologists (62%) presented negative attitudes about chronic pain patients. Just 18% of them have sufficient knowledge and skills to deal with such a patient, 64% of neurologists received training on chronic pain issues. Conclusions: Neurologists have little knowledge of pain measurement tools and guidelines and don’t use them, which makes chronic pain poorly addressed, evaluated, and treated at the national level. They recognize the right of the patient to live without suffering and to benefit from quality services focused on their needs, but consider patients difficult to approach, communicate and work with.

The Effect of Sandbag and Ice Bag on the Pain After Percutaneous Coronary Intervention: A Randomized Clinical Trial

Background and Purpose: One of the significant complications of angioplasty is the pain at the catheterization site. These complications will increase the hospitalization duration and hospital costs. The objective of this study is to investigate the combined impact of using sand and ice bags on mitigating pain following percutaneous coronary intervention (PCI). Materials and Methods: In this clinical trial research, we recruited 60 patient candidates for femoral PCI who were referred to Imam Reza Hospital of Mashhad City, Iran, in 2017. The patients were assigned to the control and intervention groups by simple randomization. The statistical analyst was blind to the study. The arterial sheath was removed 4 hours after coronary intervention. Then, a sandbag was placed on the site in control group subjects for up to 4 hours. The ice and sand bags were placed on the site for 15 minutes in the intervention group. Using a numerical pain measurement tool, the pain intensity was recorded at the beginning of the patient’s admission and 3, 6, and 12 hours after the sheath removal. The obtained data were analyzed by descriptive statistics (mean &amp; SD) and inferential statistics (The Chi-Square, Fisher exact, Mann-Whitney, Friedman, and t-tests). Results: The mean score of pain intensity in the sandbag combined with the ice bag group (1.1±1.0) was significantly lower than the sandbag group (2.4±0.9) at the 3 hours after the sheath removal (P&lt;0.001). The mean pain intensity scores at the 6 hours after the sheath removal were 0.7±0.7 in the sandbag combined with the ice bag group and 1.0±0.8 (P=0.407) in the sandbag group. Also, 12 hours later, the pain difference between groups was not significant (0.2±0.4 in the sandbag combined with the ice bag group and 0.4±0.6 in the sandbag group (P=0.482). Conclusion: Although both interventions reduced the patient’s pain, the group with the combination of ice bag and sandbag tolerated less pain 3 hours after removing the sheath. Thus, this method can be applied as an available, effective, and cost-effective technique in angiography units of hospitals for reducing local pain.

Real-Time Classification of Pain Level Using Zygomaticus and Corrugator EMG Features

The real-time recognition of pain level is required to perform an accurate pain assessment of patients in the intensive care unit, infants, and other subjects who may not be able to communicate verbally or even express the sensation of pain. Facial expression is a key pain-related behavior that may unlock the answer to an objective pain measurement tool. In this work, a machine learning-based pain level classification system using data collected from facial electromyograms (EMG) is presented. The dataset was acquired from part of the BioVid Heat Pain database to evaluate facial expression from an EMG corrugator and EMG zygomaticus and an EMG signal processing and data analysis flow is adapted for continuous pain estimation. The extracted pain-associated facial electromyography (fEMG) features classification is performed by K-nearest neighbor (KNN) by choosing the value of k which depends on the nonlinear models. The presentation of the accuracy estimation is performed, and considerable growth in classification accuracy is noticed when the subject matter from the features is omitted from the analysis. The ML algorithm for the classification of the amount of pain experienced by patients could deliver valuable evidence for health care providers and aid treatment assessment. The proposed classification algorithm has achieved a 99.4% accuracy for classifying the pain tolerance level from the baseline (P0 versus P4) without the influence of a subject bias. Moreover, the result on the classification accuracy clearly shows the relevance of the proposed approach.

How to choose the right pain measurement tools

Assessing acute and chronic pain can be difficult, particularly when caring for patients with dementia or communication issues. Here, we look at some of the tools to aid your nursing practice

Validation of the Indonesian Version of the Face, Legs, Activity, Cry, Consolability (FLACC) Scale in Postoperative Cleft Lip and/or Cleft Palate Patients

Background: The face, leg, activity, cry, and consolability (FLACC) scale is a validated pain measurement instrument that is used on postoperative patients with limited verbal ability, including postoperative cleft lip and/or cleft palate patients. Objective: This research aimed to test the validity and reliability of the Indonesian version of the FLACC scale as a measuring instrument for pain intensity experienced by postoperative cleft lip and/or cleft palate patients. Methods: The procedure was initiated by a back-translation process of the FLACC. Once the back-translation process is completed, a calibration process of the field researchers was conducted. Twenty-eight participants that went through a cleft lip and/or cleft palate surgery at the Unpad Dental Hospital were then enrolled. Two calibrated field researchers measured the postoperative pain intensity in three different time points, shortly after the patients regained full consciousness (T0), four hours (T1), and eight hours after the first measurement (T2). The collected data were analysed by SPSS version 23. The Spearman correlation analysis was performed to test the validity, while a Cronbach’s alpha value was calculated to test the reliability. Results: Based on the results of the Spearman correlation analysis, the Indonesian version of the FLACC scale was considered to be valid as the r values of each sub-scale were all higher than the r table value (r value &gt; 0.317). Reliability was marked by the obtained Cronbach’s alpha value of 0,875. Conclusion: The Indonesian version of the FLACC scale was considered to be valid and reliable to be used as a pain measurement tool in postoperative cleft lip and/or cleft palate patients.

Physical therapy within US HTCs: A multicentre survey of utilization, practice patterns and pain management approaches.

Practice patterns and utilization of physical therapists (PTs) affiliated with Hemophilia Treatment Centers (HTCs) in the United States (US) are not well known. Describe utilization, role responsibilities and practice patterns of US HTC PTs. Identify practice patterns specifically focusing on assessment and treatment of pain. Recognize gaps in utilization and role responsibilities of PTs as part of the multidisciplinary team and suggest guidelines for PT involvement within the HTC. Respondents were a subset of a convenience sample of healthcare providers who responded to a non-validated survey developed by a multi-disciplinary panel of haemophilia experts. A 33.0% response-rate (n=59) representing all regions of US HTCs was achieved. Those working ≥10hours per week were more likely to provide nutrition education (P=.026) and surgical options education (P<.001). Those who billed insurance for their services during comprehensive visits were more likely to provide education regarding surgical options (P=.046). The majority of PTs (95.0%) evaluated pain regardless of time spent in clinic and felt comfortable treating pain. Fifty-eight percent used a formal pain measurement tool and more likely to use a formal pain measurement tool if billing insurance (P=.004). Top five non-pharmacologic treatments recommended for pain management included splints/braces (84.8%), aquatic therapy (74.6%), orthotics (71.2%), surgical options (47.5%) and yoga (32.2%). This study demonstrated PT utilization across HTC centres varies widely. Gaps in care may be addressed through salary support, funded education, greater regional/national collaboration of PTs specializing in bleeding disorders and advocacy for insurance coverage for appropriate services.

Measurement of Pain and Related Symptoms in Irritable Bowel Syndrome: The Use of Validated Pain Measurement Tools

This paper reviews the tools available to assess outcomes of treatment in irritable bowel syndrome, especially the effect on abdominal pain. Tools were identified through a wide-ranging scrutiny of PubMed and Google Scholar, together with a review of further references quoted in those publications. It critically considers their development, relevance and reliability. The Irritable Bowel Severity Scoring System (IBS-SSS) was the first simple method of monitoring the progress of the disease and its treatment. It led on to other instruments, such as The Irritable Bowel Syndrome Quality of Life (IBS-QOL). It is easier to read and faster to complete than the IBS-SSS., However, these and other tools were developed for English speaking populations. This review considers the impact of ethnicity and gender, together with the lack of information on the effect of age on the potential validity of these tools in other populations. Issues with the adequacy and appropriateness of translations of such tools are discussed. The overall conclusion is that there are few tools which meet the criteria necessary to place confidence in their validity as appropriate measures of patient outcomes.

Is Shoulder Pain and Disability Index a Prognostic Factor for Neuropathic Shoulder Pain?

IntroductionSo far, investigations in patients with rotator cuff diseases have used pain measurement tools such as visual analog scale (VAS) for nociceptive pain as well as neuropathic pain (NeuP) specialized ones like Douleur Neuropathique 4 Question (DN4) and Pain Detect. The study’s goal was to look at the existence of NeuP in patients with chronic shoulder pain, as well as variables that may be predictive of its progression.MethodsThere were 112 outpatients in all. Current and previous pain intensity levels were documented with the numerical rating scale (NRS), the Shoulder Pain and Disability Index (SPADI) was used to assess pain and disability levels, and the S-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale) was used to diagnose NeuP. The Pearson Chi-Square test was employed to check for any relationships between variables. The Mann-Whitney U test was also employed to check for between-group differences (with or without NeuP). To investigate factors that may be utilized as a prognostic for NeuP, logistic regression was performed, with those components (from the univariate analysis) that were statistically significant being included.ResultsAccording to the S-LANSS questionnaire for NeuP diagnosis, 21 patients had NeuP. According to S-LANSS, chi-square test findings revealed that NeuP is independent of sex, smoking, size, and location or rotator cuff tear. Univariate analysis with Mann-Whitney U test revealed statistically significant differences in SPADI and NRS scores between the two patient groups (p < 0.001). Α multivariate analysis using S-LANSS as the binary dependent variable and NRS currently, NRS average last month and SPADI total score as independent variables (with statistical significance) revealed that total SPADI score may be considered as an independent prognostic factor for NeuP (odds ratio = 1.189, p < 0.001).LimitationsDue to the limited number of patients who participated in the study, the findings were deemed insufficient in terms of statistical power. In particular, the power analysis of the study (type I error probability being [a] = .05) was less than 80% (for the total SPADI score), hence relatively small. As a result, there is a limited probability of a type I error.ConclusionsUsing S-LANSS, we discovered that 18.8% of patients with rotator cuff tears had NeuP. The SPADI scores (pain and disability) in the NeuP group were substantially greater than in the nociceptive pain group. As previous studies have suggested utilizing certain levels of the VAS for pain assessment and specialized questionnaires for NeuP evaluation, we recommend that SPADI be included as a tool for emphasizing the neuropathic features of shoulder pain.

Autosomal dominant polycystic kidney disease: possibly the least silent cause of chronic kidney disease.

Pain is the highest prioritized patient-reported outcome in people with autosomal dominant polycystic kidney disease (ADPKD) but it remains infrequently and inconsistently measured across countries, studies and trials. The study by El-Damanawi et al. integrated a network of ADPKD expert clinicians, pain specialists, researchers and patient representatives from the national UK PKD charity, with the aim of addressing the lack of validated ADPKD-specific pain assessment tools (APATs). The APAT designed by the authors included several pain measurement tools and was tested in ADPKD patients, although further validation through assessment in larger cohorts is needed. Establishing a standardized instrument for pain measurement will ensure that pain is measured and reported in a consistent way to inform decision-making and identify effective interventions aimed at managing pain and minimizing the impact pain has on patients with ADPKD. In this context, the APAT established by the authors is to be warmly welcomed.

Measuring Pain Intensity in Elderly Patients

Pain intensity is considered as the fifth vital sign. However, it is the only vital sign which is subjective, with there being many pain measurement tools for adults to rate their level of pain. Additionally, there is an increasing number of aging populations throughout the world, and pain measurement in this group of people is challenging as geriatrics have both physical and cognitive impairment.&#x0D; The most frequently utilized pain measurement tools are; the Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS); and faces scales [Faces Pain Scale (FPS) and Faces Pain Scale-Revised (FPS-R) are the faces scales studied most often] tend to be valid for measuring pain severity in cognitively intact elderly. When problems arise, the VAS is the pain measurement tool found to have more difficulties (including higher rates of failure) than the other tools. In elderly with cognitive deficits, fewer difficulties tend to occur as the tools become simpler, with the most valid and useful tools in the following order: the FPS/FPS-R, the VRS, the 0-10 NRS, and the VAS. Furthermore, simpler pain measurement tools tend to be favored over more complicated tools. Keywords: aging; elderly; geriatrics; older; pain measurement; pain measurement tools

Shedding light on pain for the clinic: a comprehensive review of using functional near-infrared spectroscopy to monitor its process in the brain.

Pain is a complex experience that involves sensation, emotion, and cognition. The subjectivity of the traditional pain measurement tools has expedited the interest in developing neuroimaging techniques to monitor pain objectively. Among noninvasive neuroimaging techniques, functional near-infrared spectroscopy (fNIRS) has balanced spatial and temporal resolution; yet, it is portable, quiet, and cost-effective. These features enable fNIRS to image the cortical mechanisms of pain in a clinical environment. In this article, we evaluated pain neuroimaging studies that used the fNIRS technique in the past decade. Starting from the experimental design, we reviewed the regions of interest, probe localization, data processing, and primary findings of these existing fNIRS studies. We also discussed the fNIRS imaging's potential as a brain surveillance technique for pain, in combination with artificial intelligence and extended reality techniques. We concluded that fNIRS is a brain imaging technique with great potential for objective pain assessment in the clinical environment.

Location and Patterns of Persistent Pain Following Cardiac Surgery

To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population. A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively. Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time. Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population.

Indian association of paediatric anaesthesia advisory for pain management in neonates and preverbal children

In the past, management of pain in neonates was regarded as unnecessary, with the belief that neonates have an immature nervous system and do not perceive pain. Later studies confirmed that neonates certainly do feel pain, though they lack the inhibitory mechanisms that modulate excruciating stimuli, unlike in older children. Repeated painful encounters experienced in the newborn period are associated with poor cognitive and motor development by 1 year of age. Pain in preverbal infants and children is also poorly recognized and often undertreated. Neonates and preverbal children cannot verbally communicate their pain and discomfort but express them through specific behavioral, physiological, and biochemical responses. Several pain measurement tools have been developed for young children as surrogate measures of pain. To achieve optimum postoperative or procedural pain relief, easily understandable tools and a multimodal treatment module should be tailor-made for each health-care facility that cares for neonates and young infants. The aim of this advisory is to outline key concepts of pain assessment in neonates and preverbal children and suggest a rational approach to its management by all anesthesiologists, pediatricians, nursing staff, and other medical personnel caring for these children. The Indian Association of Paediatric Anaesthesia (IAPA) convened an online meeting in April 2020 to formulate the advisory on pain management in neonates and preverbal children under the chairmanship of Dr. Elsa Varghese, President IAPA, and members of the guideline committee. After several such meetings and revisions using feedback from IAPA members, the final guidelines were released in October 2020 on the IAPA website. Recommendations: Pain relief should generally be accomplished with a combination of nonpharmacologic approaches and pharmacologic techniques in a stepwise tiered manner by escalating type and dose of analgesia with anticipated increases in procedural pain. Nonpharmacological distraction measures may be sufficient for minor needle procedures like vaccination and venipuncture and may be offered as a first step and to complement other pain management remedies. An interdisciplinary approach involving pharmacologic, cognitive-behavioral, psychologic, and physical treatments should be employed whenever feasible.

Utilization of pain rating scales in pediatric care among health professionals in a children’s hospital in Kenya

BackgroundPain is the most common stimuli experienced by paediatric patients. It is mainly managed based on intensity, determined through utilization of pain rating scales. Utilization of pain measurement tools in paediatric care is vital as they indicate the level and intensity of pain in the patients. Purpose of the studyThe study assessed utilization of pain rating scales in a children’s hospital as a basis for making recommendation for their adoption by the Ministry of Health, Kenya. MethodologyThis was a descriptive cross-sectional study utilizing both quantitative and qualitative approaches. It was conducted in a children’s hospital in Nairobi-Kenya. The study population comprised of health professionals working at the hospital and patients medical records. Data was collected using semi- structured self-administered questionnaire, key informant interview guide (KII) and observation check list from a sample size of 158 Health Professionals, five key informants and 70 patients’ documents. Quantitative data was analysed using descriptive statistics whereby data was summarized using frequency tables and presented using pie chart, and bar graphs. A content analysis was performed on qualitative data based on stages of qualitative data analysis. ResultsThe study revealed that the hospital has adopted four pain rating scales which included Neonatal Guide Score, FLACC, Wong Baker faces scale, and Numerical pain scale. These tools were excellently being utilized by the Health Professionals at the hospital. Prior training of the staff on pain assessment, availability of pain management protocols and frequent auditing of the utilization of pain rating scales facilitated the utilization. Being newly employed and use of FLACC in mentally challenged patients were the main challenges in utilization of pain rating scales at the hospital. ConclusionHealth system factors play a major role in excellent utilization of pain rating scales at the children’s hospital. Staff training, protocols on pain management and frequent auditing improved utilization of pain measurement tools. Inclusion of pain assessment in the curriculum for all institutions training health professionals would address the challenge posed by the newly employed health professionals in utilization of pain rating scales. Further research on validity of FLACC in cognitively challenged children may be necessary in this setting.