Pain Assessment In Patients Research Articles

Pain assessment and management: An audit of practice at a tertiary hospital.

BackgroundIn spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood.AimThe aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa.SettingThe study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities.MethodsA cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan.ResultsA total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based.ConclusionPain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.

Drug utilization pattern of analgesics among post-operative patients in a tertiary care hospital: A prospectve study

Drug utilization pattern of analgesics among post-operative patients in a tertiary care hospital: A prospectve study - IJPP- Print ISSN No: - 2393-9079 Online ISSN No:- 2393-9087 Article DOI No:- 10.18231/j.ijpp.2019.030, Indian Journal of Pharmacy and Pharmacology-Indian J Pharm Pharmacol

Instruments for pain assessment in patients with advanced dementia: A systematic review of the evidence for Latin America.

Pain treatment is an essential component of care for elderly patients with advanced dementia. The objective of this study was to identify and analyze the different scales used for pain assessment in elderly persons diagnosed with dementia, in the literature available at the Latin American level. A systematic review was performed on the existing scales for pain assessment in elderly people diagnosed with Alzheimer's disease, vascular dementia, and dementia with Lewy bodies. 226 articles were retrieved from the PUBMED, BIREME, and Scielo databases, of which a total of 10 articles entered the systematic review. The instruments identified in these publications were PAINAD, Abbey, McGill, and PACSLAC, while the Colored Pain Scale, Faces Pain Scale, and VAS scales were used as the silver standard. In Spanish, the Abbey scale, and in Portuguese, the PACSLAC scale showed the best reliability and validity coefficients. It is concluded that there are only two appropriate scales for the assessment of pain in people with dementia in the region of interest of this study. It is recommended to generate more evidence for a more accurate assessment of pain in people with dementia.

The Relationship Between Serum Angiogenic Factor Levels and Disease Activity in Rheumatoid Arthritis.

Objectives This study aims to evaluate the relationship between serum angiogenic factor levels and disease activity in patients with rheumatoid arthritis (RA) using both clinical and dynamic wrist magnetic resonance imaging (MRI) data.Patients and methods Simultaneous serum angiogenesis markers [vascular endothelial growth factor (VEGF), angiopoietin-1 (ANG1), ANG2, and tyrosine-protein kinase receptor for angiopoietin (Tie-2)] were studied in 40 patients with RA (13 males, 27 females; mean age 51.1±10.8 years; range, 23 to 69 years) and 20 healthy controls (11 males, 9 females; mean age 47.3±12.8 years; range, 29 to 69 years) and dynamic contrast-enhanced wrist MRI was performed in 40 RA patients and seven controls. Rate of early in 55th second (REE) and Relative enhancement (REt) values were calculated from the signal time curve values obtained from the analysis of images. In clinical assessment, duration of morning stiffness, patient pain assessment [visual analog scale (VAS)], physician and patient global assessments (VAS) were recorded. The number of tender joints and swollen joints were determined. Disease activity score 28 and Ritchie scores were calculated. Health assessment questionnaire was used for functional evaluation. Anti-cyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and high sensitive C-reactive protein analyses were performed. Results Serum VEGF, REE and REt values were significantly higher in RA patients than healthy controls (p=0.002, p=0.00, p=0.00, respectively). There was no significant correlation between serum angiogenesis markers and clinical parameters or REE and REt (p>0.05). VEGF value correlated positively with disease duration (p=0.024).Conclusion Serum VEGF was higher in RA patients. While its level was associated with disease duration, no significant correlation was found with disease activity. As a diagnostic test, dynamic contrast-enhanced MRI was a valuable method for showing disease activity.

Experience of Intensive Care Nurses in Assessment of Postoperative Pain in Patients with Hip Fracture and Dementia.

Introduction:Patients with hip fracture are one of the most demanding groups in the health-care system. One of the most important tasks for nurses is to assess pain and ensure the patients are pain free. Pain assessment in patients with dementia is a well-known challenge for health-care professionals due to the patients’ difficulties in verbalising pain problems.Aim:The aim of this study was to explore the experience of intensive care nurses in assessment of pain in patients with hip fracture and dementia in the postoperative setting.Methods:Data were collected through five focus group discussions using open-ended questions and qualitative content analysis. Twenty-one intensive care nurses (6 men and 15 women) participated in the focus group interviews.Results:Analysis of the data resulted in three main categories: “Communication”, “Visual assessment of pain”, and “Practical issues” including a number of subcategories. Some of the factors which influence assessment of pain in patients with dementia are the lack of information and knowledge about the patients, which causes loss of time and increased stress. The different forms of communication and ways of assessing pain in these patients were other factors mentioned by nurses as hindrances regarding assessment of the pain.Conclusion:In order to improve assessment of pain, more knowledge and information about the patients are needed and better coordination between the pre- and postoperative departments regarding these patients. In this context, different intervention studies on patient’s hip fracture and dementia are needed to increase knowledge and awareness regarding this group of patients.

Pain, emotion, cognition. Pathogenetic relationships and effects of therapy with nonsteroidal anti-inflammatory drugs

To study the dynamics of pain intensity in comparison with changes in the severity of depression and cognitive deficits when using non-steroidal anti-inflammatory drugs and/or central muscle relaxants in patients with chronic non-specific back pain. Sixty patients (26 men and 34 women), aged 42 to 59 years, with chronic non-specific back pain were examined. All patients were divided into three groups. In the first group, dexketoprofen was used at a dose of 75-100 mg per day for 10 days. Patients of the second group received dexketoprofen according to a similar scheme, as well as tolperisone (200-450 mg per day) for 30 days. Patients of the third group took diclofenac sodium (100 mg per day) for 10 days. The intensity of pain, its affective component, the severity of asthenic, depressive, anxiety manifestations and cognitive disorders were tested at baseline and on the 10th and 30th days. Pain significantly decreased in all patients, more significantly in the first and second groups. The analgesic effect in the first and third groups was unstable, and the improvements achieved by the last test were partially reduced. In patients of the first and second groups, regression of anxiety and depressive symptoms was observed from day 10 to the end of observation. At the same time, the emotional assessment of pain in patients of the first group decreased by the 10th and increased by the 30th day of observation. By the end of the study, patients of the second group showed positive dynamics of indicators of asthenia and cognitive disorders. The most effective analgesic therapy using a combination of dexketoprofen and tolperisone was accompanied by a positive dynamics of depressive manifestations and cognitive disorders. The choice of an algorithm for treating pain should take into account the need and possibility of treatment its biological and psychological (affective, cognitive) components.

Strengthening Post-Operative Pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.

Pain in dementia.

The ageing revolution is changing the composition of our society with more people becoming very old with higher risks for developing both pain and dementia. Pain is normally signaled by verbal communication, which becomes more and more deteriorated in people with dementia. Thus, these individuals unnecessarily suffer from manageable but unrecognized pain. Pain assessment in patients with dementia is a challenging endeavor, with scientific advancements quickly developing. Pain assessment tools and protocols (mainly observational scales) have been incorporated into national and international guidelines of pain assessment in aged individuals. To effectively assess pain, interdisciplinary collaboration (nurses, physicians, psychologists, computer scientists, and engineers) is essential. Pain management in this vulnerable population is also preferably done in an interdisciplinary setting. Nonpharmacological management programs have been predominantly tested in younger populations without dementia. However, many of them are relatively safe, have proven their efficacy, and therefore deserve a first place in pain management programs. Paracetamol is a relatively safe and effective first-choice analgesic. There are many safety issues regarding nonsteroidal anti-inflammatory drugs, opioids, and adjuvant analgesics in dementia patients. It is therefore recommended to monitor both pain and potential side effects regularly. More research is necessary to provide better guidance for pain management in dementia.

A Cross-Sectional Assessment of Neuropathic Pain in Patients with Psoriasis and Psoriatic Arthritis

A Cross-Sectional Assessment of Neuropathic Pain in Patients with Psoriasis and Psoriatic Arthritis

Clinical utility of the DN4 questionnaire in the assessment of neuropathic pain in patients with type 2 diabetes: experience from a newly-created diabetes clinic in Cameroon

INTRODUCTION: Early diagnosis of peripheral neuropathy in people with diabetes mellitus is important. Screening tools are either expensive or cumbersome, and thus impractical in low-resource settings. The DN4 questionnaire is a simple alternative. We assessed the performance of the DN4 Questionnaire in detecting neuropathic pain associated with diabetic peripheral neuropathy in patients with type 2 diabetes.

Assessment of musculoskeletal pain in rheumatoid arthritis patients and its relation to vitamin D levels

Vitamin D is associated with musculoskeletal function in our body, and its deficiency is a common health problem all over the world. The role of Vitamin D in rheumatoid arthritis (RA) is well established due to its immunomodulatory effect. The aim of this study was to assess the musculoskeletal pain in patients with RA in relation to Vitamin D levels. We found a negative correlation and found an increase in the pain intensity among RA patients with low levels of Vitamin D.

Pain Assessment and Interventional Analgesia in Patients with Herpes Zoster

In order to evaluate the pain of patients with herpes zoster and to study the analgesic treatment, 100 patients with herpes zoster are enrolled in this study. Patients with herpes zoster are classified and admitted to the hospital using oral descriptive scoring. The pain is assessed on a graded basis, and the visual analog scale is used to assess the pain before and after treatment. It is found that patients with herpes zoster are mainly middle-aged and elderly, and the course of disease is usually 2-3 w. After age grouping studies, there is no significant difference in pain levels between different age groups, and the VRS scores at admission are basically 3-4, showing that the pain caused by herpes zoster is very intense. After treatment, the VAS scores of patients before and after treatment are statistically found to greatly improve the pain of the patients, and to avoid the patient’ s normal life due to pain.

Pain Assessment in Indian Parkinson's Disease Patients Using King's Parkinson's Disease Pain Scale.

Background:Pain is a common symptom in Parkinson's disease (PD) patients. Scales to rate pain in PD are marred by several flaws, either not being available in other languages or not specific for PD.Objectives:To assess the frequency of pain among bilingual Indian PD patients using “King's Parkinson's disease pain scale” (KPPS) and to validate it.Methods:We randomly administered KPPS in Hindi/English to all consecutive bilingual persons with PD. The results were appropriately analyzed.Results:A total of 119 PD patients were enrolled with a mean age of 64.34 (± 9.57) years. Median Hoehn and Yahr stage was 2 (42.85%). Pain was present in 62 (52.1%) PD patients. The most common type was musculoskeletal (74.19%). The mean total KPPS score was 16.02 ± 10.57. KPPS score was significantly higher in women and correlated positively with unified Parkinson's disease rating scale (UPDRS) part 2 and 4 scores (r = 0.27 and r = 0.25). Risk factors for pain were female gender, higher H and Y stage, total UPDRS score, and individual UPDRS part 3 and 4 scores. Difficulty falling asleep (P = 0.01), frequent awakenings (P = 0.01), diminished smell sensation (P = 0.003), diminished speech volume (P = 0.02), gait freezing (P = 0.03), and falls (P = 0.001) correlated with the presence of pain. The interclass correlation coefficient between the Hindi and English versions of KPPS was 0.835, while Bland–Altman analysis showed 96.7% agreement suggesting excellent correlation and validation.Conclusions:KPPS is an easy tool for characterization, scoring, and follow-up of pain in PD patients. The Hindi version has good agreement with the original English version.

Factors Influencing Performance of Pain Assessment and Pain Intervention for Dementia Patients among Long-term Care Hospital Nurses

Factors Influencing Performance of Pain Assessment and Pain Intervention for Dementia Patients among Long-term Care Hospital Nurses

Pain assessment in pediatrics.

to investigate how the pain assessment and management process in pediatric patients is performed and suggestions for its improvement. exploratory, qualitative study. Nine professionals from the nursing team of a pediatric hospital unit in Porto Alegre/RS participated in the study. A sociodemographic questionnaire and semi-structured interviews were used with content analysis. the results reinforced the importance of pain assessment with family participation and the need to use tools and process improvements in the training and sensitization of professionals. Final Considerations: after the study was concluded, there was a clear need to address the issue, highlighting its relevance for pain resolution in pediatric patients.

Use of Mobile Health Apps and Wearable Technology to Assess Changes and Predict Pain During Treatment of Acute Pain in Sickle Cell Disease: Feasibility Study.

BackgroundSickle cell disease (SCD) is an inherited red blood cell disorder affecting millions worldwide, and it results in many potential medical complications throughout the life course. The hallmark of SCD is pain. Many patients experience daily chronic pain as well as intermittent, unpredictable acute vaso-occlusive painful episodes called pain crises. These pain crises often require acute medical care through the day hospital or emergency department. Following presentation, a number of these patients are subsequently admitted with continued efforts of treatment focused on palliative pain control and hydration for management. Mitigating pain crises is challenging for both the patients and their providers, given the perceived unpredictability and subjective nature of pain.ObjectiveThe objective of this study was to show the feasibility of using objective, physiologic measurements obtained from a wearable device during an acute pain crisis to predict patient-reported pain scores (in an app and to nursing staff) using machine learning techniques.MethodsFor this feasibility study, we enrolled 27 adult patients presenting to the day hospital with acute pain. At the beginning of pain treatment, each participant was given a wearable device (Microsoft Band 2) that collected physiologic measurements. Pain scores from our mobile app, Technology Resources to Understand Pain Assessment in Patients with Pain, and those obtained by nursing staff were both used with wearable signals to complete time stamp matching and feature extraction and selection. Following this, we constructed regression and classification machine learning algorithms to build between-subject pain prediction models.ResultsPatients were monitored for an average of 3.79 (SD 2.23) hours, with an average of 5826 (SD 2667) objective data values per patient. As expected, we found that pain scores and heart rate decreased for most patients during the course of their stay. Using the wearable sensor data and pain scores, we were able to create a regression model to predict subjective pain scores with a root mean square error of 1.430 and correlation between observations and predictions of 0.706. Furthermore, we verified the hypothesis that the regression model outperformed the classification model by comparing the performances of the support vector machines (SVM) and the SVM for regression.ConclusionsThe Microsoft Band 2 allowed easy collection of objective, physiologic markers during an acute pain crisis in adults with SCD. Features can be extracted from these data signals and matched with pain scores. Machine learning models can then use these features to feasibly predict patient pain scores.

A review of interventions to reduce pain in chronic wounds.

Reduction of chronic wound pain has the potential to improve patients' quality of life, expedite the healing process and, ultimately, relieve pressure on community services. Despite this, education on pain assessment in the management of chronic wounds is lacking. This literature review seeks to provide evidence-based recommendations to reduce chronic wound pain and inform the practice of community nurses. The results of a thematic analysis indicate that a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain, and nitroglycerin ointment is especially effective. The review also highlights the need for an individualised approach to the assessment and treatment of pain in patients with chronic wounds.

A physiological assessment of patient pain during surgery with wide-awake local anesthesia

PurposePatients receiving surgery with wide-awake local anesthesia typically report little or no intraoperative pain. However, self-report assessments of pain are susceptible to bias. In the present study, patient self-report ratings were supplemented with objective physiological measures of electrodermal activity. MethodsFifteen patients receiving forefoot surgery using wide-awake local anesthesia were recruited. Pain ratings and skin conductance responses were acquired during the initial anesthetic injection (into unanesthetized tissue), during a follow-up anesthetic injection (into anesthetized tissue), and during five intraoperative procedures. ResultsThe highest ratings of self-reported pain coincided with the initial anesthetic injection, and pain ratings were similarly low at all remaining measurement points. Fourteen patients reported no pain beyond the initial injection, whereas one patient reported minimal pain during two intraoperative procedures. Skin conductance data were consistent with pain ratings such that responses to the initial injection were significantly larger than responses at any subsequent measurement point. ConclusionThese results provide further evidence that patients experience little or no pain during surgery with wide-awake local anesthesia.

Studi Kualitatif Pemahaman Perawat Intensive Care Unit tentang Pengkajian Nyeri Behaviour Pain Scale


 Assessment is the initial nursing process. In the nursing assessment obtained information about patient data used as a baseline and determine the next stage. Patients in intensive rooms with ventilators often received nursing actions that cause pain. Pain assessment in patients using ventilators must use special assessment techniques. Patients with ventilators require standardized assessment methods because they cannot communicate the pain they feel verbally. Payen in 2001 developed the Behavioral Pain Scale (BPS). Critical patients who are fitted with ventilators need a systematic and consistent assessment of pain. Understanding is the ability to explain correctly and in detail about something. Before performing an action properly one needs to understand the action. This study aimed to determine the experience and understanding of ICU nurses about pain assessment using BPS at M Yunus Bengkulu General Hospital. This study used the qualitative study that focus on disclosing nurses' understanding of pain assessment using BPS. Themes that emerged in this study were 1. use BPS, 2. Three items in the BPS assessment, 3. Indicators assessing pain, 4. Maximum minimum scoring, 5. Range of pain values. Nurse’s understanding about BPS was very necessary.

A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis

Background and aimsPain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST). MethodsThis was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization). ResultsAbsolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization. ConclusionWe show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. Clinicaltrials.gov idNCT03434392.