Pain Scales For Use Research Articles

An investigation into how accurately UK rabbit owners identify pain in their pet rabbits

BackgroundRabbits are popular family pets. They are prey species and so have evolved to hide signs of illness and pain. Recent research has developed robust pain scales for use in a clinical setting, but to date none has examined rabbit owners’ ability to recognise pain in their animals. This study investigated how owners identify pain in their pet rabbits and their ability to correctly identify different levels of pain, in order to determine any need for owner education in this area.MethodsOwners were recruited via Facebook and a two-part online survey was distributed. Part one collected data on demographics, owners’ knowledge of pain signs and beliefs about pain in rabbits. Part two asked respondents to pain score eight videos of rabbits in different levels of pain for comparison to pain scores made by three experts. We used a simplified version of the Bristol Rabbit Pain Score (BRPS) which involved a single 0 to 3 scale. We explored the number of pain signs each respondent could list, the total score given to the videos, and their deviation from the experts’ scores.ResultsA total of 500 respondents completed part one of the survey and 345 additionally completed Part two. Respondents were on average able to state five signs of pain (range 0–12), but females stated significantly more (p = 0.018), as did those who worked with rabbits (p = 0.004) and those with experience of their rabbit having an operation (p = 0.01). Overall, 98.6% of respondents thought rabbits felt pain as much or more that dogs and cats. In Part two, respondents more frequently agreed with the experts when identifying rabbits in no pain (88.8%) and severe pain (65.2%), but there was lower agreement when identifying mild (28.4%) and moderate pain (43.2%). Respondents overall rated pain lower than experts with an average total pain score of 11.9 compared to 18 given by the experts.ConclusionsMost rabbit owners are able to list numerous pain signs and are generally able to identify pain-free rabbits and those in severe pain. Owners’ ability to differentiate between mild and moderate pain is more limited and could benefit from training in the subtler signs of pain. Veterinary professionals are well placed to educate owners about signs of pain in rabbits and should be aware of areas where owners’ knowledge can be improved.

An Objective Pain Score for Chronic Pain Clinic Patients.

Objectives Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16–0.50) and 0.47 (95% CI 0.31–0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56–0.77) and 0.67 (95% CI 0.55–0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2–6) and 6 (4–8)) and postprocedure (1 (0–2) and 3 (0–5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.

Assessing pain in critically ill brain-injured patients: a psychometric comparison of 3 pain scales and videopupillometry.

Three clinical scales (the Nociception Coma Scale adapted for Intubated patients [NCS-I], its Revised version [NCS-R-I], and the Behavioral Pain Scale [BPS]) and videopupillometry were compared for measuring pain in intubated, noncommunicating, critically ill, brain-injured patients. Pain assessment was performed before, during, just after, and 5 minutes after 3 procedures: the reference non-nociceptive procedure (assessment of the Richmond Agitation Sedation Scale) and 2 nociceptive procedures (turning and tracheal suctioning). The primary endpoint was construct validity (discriminant and criterion validation), determined by comparing pain measurements between different times/procedures. Secondary endpoints were internal consistency, inter-rater reliability, and feasibility. Fifty patients (54% women, median age 63 years [56-68]) were included 13 [7-24] days after brain injury (76% hemorrhagic or ischemic strokes). All tools increased significantly more (P < 0.001) during the nociceptive procedures vs the non-nociceptive procedure. The BPS was the only pain tool that did not increase significantly during the non-nociceptive procedure (P = 0.41), suggesting that it was the most discriminant tool. The BPS, NCS-I, and NCS-R-I were good predictors of nociception with areas under the curves ≥0.96, contrary to videopupillometry (area under the curve = 0.67). The BPS, NCS-I, and NCS-I-R had high inter-rater reliabilities (weighted kappa = 0.86, 0.82 and 0.84, respectively). Internal consistency was moderate (>0.60) for all pain scales. Factor analysis represented a majority of information on a first dimension, with motor domains represented on a second dimension. Scale feasibility was better for the NCS-I and NCS-R-I than for the BPS. In conclusion, the BPS, NCS-I, and NCS-R-I are valid, reliable, and acceptable pain scales for use in intubated critically ill, brain-injured patients, unlike videopupillometry. Future research requires tool design centered on domains of observation adapted to this very specific population.

Adaptation and Validation of the Spanish Version of the Graded Chronic Pain Scale

ObjectiveTo adapt the Graded Chronic Pain Scale for use in primary care patients in Spain, and to assess its psychometric properties. MethodsClinical measures observational study investigating the severity of chronic pain. The methodology included a process of translation and back-translation following the international guidelines. Study participants were 75 patients who experienced lower back pain for more than six months and were sent to primary care physiotherapy units. Internal consistency, construct validity, test–retest reliability, floor and ceiling effects, and answering capacity were analyzed. ResultsThe Spanish version of the Graded Chronic Pain Scale had a high internal consistency, with a Cronbach's α of 0.87 and intraclass correlation coefficient of 0.81. Regarding construct validity, it was identified that two factors explained 72.37% of the variance. Convergent validity showed a moderate positive correlation with the Visual Analog Scale, the activity avoidance subscale of the Tampa Scale of Kinesophobia, the Pain Catastrophizing Scale, the Roland-Morris Low Back Pain and Disability Questionnaire, and the Fear Avoidance Beliefs Questionnaire. A moderate negative correlation was identified with the Chronic Pain Self-Efficacy Scale. The mean time of questionnaire administration was 2min and 28s. ConclusionsThe Spanish version of the Graded Chronic Pain Scale appears to be a valid, reliable, and useful tool for measuring chronic pain at an early stage in primary care settings in Spain.

Pain evaluation in dairy cattle

Pain compromises the welfare of animals. A prerequisite for being able to alleviate pain is that we are able to recognize it. Potential behavioural signs of pain were investigated for dairy cattle with the aim of constructing a pain scale for use under production conditions. Forty-three cows were selected and fifteen different behaviours were scored, subsequently a clinical examination was performed to allocate the cows to a pain and non-pain group. The animals were then treated with an analgesic or a placebo and after a resting period the cows were re-scored by two observers blinded to the treatment. Six behaviours were found to be significantly different between the pain and non-pain group and robust enough to be included in the pain scale: ‘attention towards the surroundings’ ‘head position’, ‘ears position’, ‘facial expressions’, ‘response to approach’ and ‘back position’ (a seventh, piloerection, was also significant but seemed difficult to use as it changed rapidly; p<0.05 for all measures). The Cow Pain Scale is the sum of the score for the aforementioned behaviours. For each individual animal before and after treatment, it was significantly lower after analgesic treatment (p=0.003) in the ClinPain group but not after placebo treatment (p=0.06); the pain score did not differ significantly before compared to after treatment with analgesic or placebo for the non-pain group (p=0.2; p=0.1). A second study was conducted to further validate the Cow Pain Scale. Cows from two herds were randomly selected (n=119) and their behaviour scored by two observers. Subsequently the cows were clinically examined and allocated to a pain and non-pain group (n=96, 23 cows were excluded because of incomplete examination). The cows from the pain group scored higher on The Cow Pain Scale compared to the non-pain group for both observer I (p<0.0001) and observer II (p=0.0001). For the two observers the sensitivity of the Cow Pain Scale was calculated to 0.61/0.75 and the specificity to 0.75/0.75 with a weighted Kappa of 0.62. In conclusion the Cow Pain Scale has the potential to be applied for the assessment of pain in dairy cattle under production conditions.

Adaptación y validación de la Escala de gradación del dolor crónico al español

ObjectiveTo adapt the Graded Chronic Pain Scale for use in Primary care patients in Spain, and to assess its psychometric properties. MethodsClinical measures observational study investigating the severity of chronic pain. The methodology included a process of translation and back-translation following the international guidelines. Study participants were 75 patients who experienced lower back pain for more than six months and were sent to Primary Care physiotherapy units. Internal consistency, construct validity, test-retest reliability, floor and ceiling effects, and answering capacity were analysed. ResultsThe Spanish version of the Graded Chronic Pain Scale had a high internal consistency, with a Cronbach's alpha of 0.87 and intraclass correlation coefficient of 0.81. Regarding construct validity, it was identified that two factors explained 72.37% of the variance. Convergent validity showed a moderate positive correlation with the Visual Analogue Scale, the activity avoidance subscale of the Tampa Scale of Kinesophobia, the Pain Catastrophizing Scale, the Roland-Morris Low Back Pain and Disability Questionnaire, and the FearAvoidance Beliefs Questionnaire. A moderate negative correlation was identified with the Chronic Pain Self-Efficacy Scale. The mean time of questionnaire administration was 2minutes and 28seconds. ConclusionsThe Spanish version of the Graded Chronic Pain Scale appears to be a valid, reliable, and useful tool for measuring chronic pain at an early stage in Primary Care settings in Spain.

Use of pain instruments as endpoints in regulatory submissions: implications of the US FDA's new Patient Reported Outcomes (PRO) Guidance

The goal of this poster is to review aspects of the FDA's PRO Guidance which have implications for measuring pain as an endpoint in clinical trials. This information will be of immediate interest to researchers developing or using pain instruments to evaluate pain treatments for eventual regulatory submission and subsequent approval. Pain management across therapeutic categories remains a key area for the use of PRO instruments and the interpretation of PRO endpoints to inform drug and device labeling decisions. While academic and medical recommendations exist to inform the development and use of pain instruments (e.g., IMMPACT, OARSI), it remains unclear as to how these recommendations harmonize with emerging regulatory guidelines. In 2009 the US FDA finalized a guidance for the use of PROs for regulatory submissions/approval (FDA, 2009). This guidance outlines criteria for the development, implementation, and interpretation of PROs when used to support primary and secondary endpoints in clinical trials. Moreover, the FDA has indicated that PRO instruments will not be “grandfathered” (i.e., accepted for present or future use based on previous regulatory approvals) and, therefore, will require the same level of validation and documentation to defend and support their use to regulators. To meet regulatory expectations, researchers will have to substantiate their measurement strategy decisions within the context of the PRO Guidance. We will cite the salient aspects of the PRO Guidance, summarize methods and provide citations that can be used to help researchers successfully achieve these new standards set by the FDA. Specific areas of focus will include, but not be limited to: - Recall period and retrospective recall issues - Frequency and timing of assessments - Validation or psychometric evaluation of existing pain scales for use in other pain therapeutic areas - Translation and linguistic validation requirements - Paper to electronic platform migration.

Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats

To refine and test construct validity and reliability of a composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. 40 cats that underwent ovariohysterectomy in a previous study. In a previous randomized, double-blind, placebo-controlled study, a composite pain scale was developed to assess postoperative pain in cats that received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). In the present study, the scale was refined via item analysis (distribution frequency and occurrence), a nonparametric ANOVA, and item-to-total score correlation. Construct validity was assessed via factor analysis and known-groups discrimination, and reliability was measured by assessing internal consistency. Respiratory rate and respiratory pattern were rejected after item analysis. Factor analysis resulted in 5 dimensions (F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]). Internal consistency was excellent for the overall scale and for F1, F2, and F3; very good for F4; and unacceptable for F5. Except for heart rate, the identified factors and scale total score could be used to detect differences between the analgesic and placebo groups and differences among the analgesic treatments. Results provided initial evidence of construct validity and reliability of a multidimensional composite tool for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy.

Validation of the Adult OMNI Pain Scale for Young Men Performing Cycle Exercise

Naturally occurring muscle pain and exertional perceptions are independent but concurrent sensory constructs experienced during exercise. The concurrent assessment of pain and ratings of perceived exertion may be facilitated by a category metric that employs a common core format (i.e. OMNI) with construct specific descriptors. PURPOSE: To examine concurrent and construct validity of the Adult OMNI Pain Scale for use with young men. METHODS: Thirty-one recreationally active males with a mean age of 20.8 ± 2.0 yrs and mean VO2peak of 39.1 ± 6.1 ml·kg−1·min−1 participated in this investigation. Concurrent validity was established by correlating the ratings of leg muscle pain (RMP−Legs) with oxygen uptake (VO2), relative oxygen uptake (%VO2peak), ventilation (VE), and heart rate (HR), during a load incremented perceptual estimation cycle ergometer test. Construct validity was established by correlating RMP-Legs from the Adult OMNI Pain Scale with responses from the Cook Pain Scale. RESULTS: Ranges for the responses to the cycle protocol were: OMNI Pain = 0 to 10, Cook Pain = 0 to 10, VO2 = 0.67 to 3.75 L·min−1, %VO2peak = 20.9 to 99.8, VE = 16.4 to 111.8 L·min−1, and HR = 90 to 194 b·min−1. Regression analyses indicated that RMPLegs from the Adult OMNI Pain Scale distributed as a positive function (p < 0.05) of all criterion variables (see table). OMNI RMP-Legs was positively related to RMPLegs derived from the Cook Pain Scale (p < 0.05, see table).Table: Caption not availableCONCLUSIONS: These results demonstrate both concurrent and construct validity for the Adult OMNI Pain Scale to measure leg muscle pain during load incremented cycle ergometer exercise in young men. These conclusions are consistent with the findings of a similar study in young women (Bolgar et al., 2007).

The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia

The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.

Age-related differences in the qualities but not the intensity of chronic pain

Age differences in the experience of chronic pain remain unclear. A serious barrier to progress in the field of pain and aging arises from the lack of data regarding the psychometric properties of pain scales for use with the elderly. The present study was designed to assess age differences in pain intensity and quality and to compare the psychometric properties of the McGill Pain Questionnaire (MPQ) in young and elderly chronic pain patients. Young ( n=139, mean age=42.93±9.41 years) and elderly ( n=139, mean age=70.12±7.51 years) pain center patients, matched on primary diagnosis or pain location, duration, and sex, completed the MPQ, numeric ratings (0–10) of pain intensity, a Pain Map, and the Hospital Anxiety and Depression Scale (HADS). A Pain Management Index (PMI) score was calculated for each patient. Age differences on the measure of pain qualities were found. The elderly group had significantly lower MPQ total and sensory scores and chose fewer words than the young group. However, there were no significant differences between the groups on numeric ratings of highest, usual, and lowest pain intensity. Similarly, there were no age differences on PMI, Pain Map, or the HADS Depression or Anxiety Subscales. Finally, the latent structure, internal consistency, and pattern of subscale correlations of the MPQ were very similar in the young and elderly groups. Possible explanations for the discrepancy in the pattern of age differences on measures of pain intensity and quality are explored. The implications of this pattern of age differences for basic pain mechanisms and pain management should be given serious empirical attention.

Validation of 2 pain scales for use in the pediatric emergency department.

To determine the construct, content, and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department (ED). A prospective study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained. Children were excluded if they were intoxicated, had altered sensorium, were clinically unstable, did not speak English, or had developmental delays. Children marked their current pain severity on a standardized Color Analog Scale (CAS) and a 7-point Faces Pain Scale (FPS). They were then asked whether their pain was mild, moderate, or severe. Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements. For assessing content validity, the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions. Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales. A total of 60 children were enrolled, 30 with pain and 30 without, with a mean age of 9.3 +/- 3.3 years. Boys accounted for 38 of the enrollees (63.3%). The median score before analgesic administration was 6.0 cm (interquartile range [IQR]: 4.0-8.0) on the CAS and 3.0 faces (IQR: 2.0-5.0) on the FPS; after analgesic administration, the median scores decreased to 3.1 cm (IQR: 1.1-4.3) and 2.0 faces (IQR: 1.0-3.0), respectively. As the reported pain intensity increased, so did the scores on the 2 pain scales. The 30 children with no pain had a median score on the CAS of 0.0 (IQR: 0.0-1.0) and on the FPS of 0.0 (IQR: 0.0-1.0), whereas the 13 children with severe pain had a median CAS of 7.0 (IQR: 6.0-8.0) and a median FPS of 5.0 (IQR: 4.0-6.0). The Spearman correlation coefficient between the CAS and the FPS was positive and strong (r = 0.894). The CAS and the FPS exhibit construct, content, and convergent validity in the measurement of acute pain in children in the ED.

Evaluation of the Faces Pain Scale for use with the elderly.

The specific objective for this research was to determine initial psychometric properties of the Faces Pain Scale (FPS) as a measure of pain intensity for use with the elderly. The study was descriptive correlational in nature, with nonrandom sampling. A total sample of 168 community subjects (30-121, depending on task completed), aged 65 or older, participated in the research protocol. To determine the validity, reliability, and scaling properties of the FPS, rating and ranking procedures, placement tasks, and test-retest methods were used. Response to six Likert-type items indicated that subjects agreed that the FPS represents pain: however, it is clear that the perception of the meaning of the faces can be influenced by the context in which they are presented. Rank ordering tasks for the individual faces demonstrated near-perfect agreement between the actual expected ranking and the ranking produced by the subjects (Kendall's W = .97, p = .00). When subjects placed individual faces along a 1-m-long red wedge indicating the amount of pain represented by each face, statistically significant separation of the faces in the anticipated equal interval position was demonstrated by the lack of overlap of the 95% confidence intervals when all faces were viewed and positioned simultaneously. However, when subjects placed faces independent of others, the expected placement fell outside the 95% confidence limit for three of the five faces placed. In addition, the actual intervals between the five faces placed by subjects demonstrated substantial variances from the 167 mm expected in several instances. Rating a vividly remembered painful experience about the degree of pain perceived using the FPS initially and again 2 weeks later, the FPS demonstrated strong reproducibility over time with a Spearman rho correlation coefficient of .94 (p = .01). These results provide preliminary support for the construct validity, strong ordinal properties, and strong test-retest reliability of the FPS with a sample of elderly individuals. The equality of intervals in the FPS has not been fully supported in the older adult, but given the complexity of the task used, the results should not be considered to be refuted. Further evaluation of the FPS with experimental and clinical pain conditions and comparison with other standard pain assessment instruments in the elderly population are warranted.

Des calcifications sous-cutanées

Pain compromises the welfare of animals. A prerequisite for being able to alleviate pain is that we are able to recognize it. Potential behavioural signs of pain were investigated for dairy cattle with the aim of constructing a pain scale for use under production conditions. Forty-three cows were selected and fifteen different behaviours were scored, subsequently a clinical examination was performed to allocate the cows to a pain and non-pain group. The animals were then treated with an analgesic or a placebo and after a resting period the cows were re-scored by two observers blinded to the treatment. Six behaviours were found to be significantly different between the pain and non-pain group and robust enough to be included in the pain scale: ‘attention towards the surroundings’ ‘head position’, ‘ears position’, ‘facial expressions’, ‘response to approach’ and ‘back position’ (a seventh, piloerection, was also significant but seemed difficult to use as it changed rapidly; p < 0.05 for all measures). The Cow Pain Scale is the sum of the score for the aforementioned behaviours. For each individual animal before and after treatment, it was significantly lower after analgesic treatment (p = 0.003) in the ClinPain group but not after placebo treatment (p = 0.06); the pain score did not differ significantly before compared to after treatment with analgesic or placebo for the non-pain group (p = 0.2; p = 0.1). A second study was conducted to further validate the Cow Pain Scale. Cows from two herds were randomly selected (n = 119) and their behaviour scored by two observers. Subsequently the cows were clinically examined and allocated to a pain and non-pain group (n = 96, 23 cows were excluded because of incomplete examination). The cows from the pain group scored higher on The Cow Pain Scale compared to the non-pain group for both observer I (p < 0.0001) and observer II (p = 0.0001). For the two observers the sensitivity of the Cow Pain Scale was calculated to 0.61/0.75 and the specificity to 0.75/0.75 with a weighted Kappa of 0.62. In conclusion the Cow Pain Scale has the potential to be applied for the assessment of pain in dairy cattle under production conditions.