Patient Self-reporting Of Pain Research Articles

Congruency of nurse-patient pain scoring in the emergency department: a cross-sectional observational study.

Aim: To examine the congruency between patient self-reporting and nurse assessment of pain in the emergency department (ED) through the use of the numerical rating scale (NRS) and visual analogue scale (VAS). Materials & methods: Patient self-reporting of pain and nurse assessments were concurrently conducted using the NRS and VAS. Results & conclusion: Self-reported pain assessment was collected from 200 ED patients in parallel with their corresponding nurse-reported pain scores, conducted by 67 ED nurses. Although nurse-patient pain scoring was associated with a high congruency using both NRS and VAS (88.2 and 91.5%, respectively), nurses still underestimated patients' pain intensity using both tools (t=2.37 and 2.60; p=0.007 and 0.010 and CI: 0.17-1.1 and 0.06-0.46, respectively). Some nurse-patient characteristics showed relationships with a discrepancy in pain scoring.

Sensitivity to Change of Subdomain Question 6 of the Urogenital Distress Inventory Short Form After Sling Removal for Pain

To determine the sensitivity to change of question 6 (Q6) of the modified short form version of the Urogenital Distress Inventory (UDI-6) before and after synthetic sling removal (SSR). Following IRB approval, a prospectively maintained database of mid-urethral sling (MUS) complications identified women with UDI-6 Q6 data before and after SSR. Q6 were compared pre- and postoperatively and against patient self-report of pain in women undergoing -SSR for pain (SSR-P) and in a control group when pain was not the primary indication for SSR (SSR-C). Women with missing pre-SSR or insufficient (<6 months) follow-up measures of pain were excluded. Three hypotheses were tested. (1) Correlation of Q6 scores with patients' self-reported pain pre- and post-SSR, (2) Higher pre-SSR Q6 scores in the SSR-P group than in the SSR-C group, and (3) Decrease in Q6 scores in the SSR-P group. Between 2005 and 2017, 116 of 435 women referred to our institution met study criteria. Q6 scores were significantly (P <.0001) associated with self-reported pain with increasing likelihood of self-reporting pain as Q6 score increased. Mean pre-SSR Q6 scores in SSR-C (n=42) was 1.0 ± 1.2 while mean pre-SSR Q6 scores in SSR-P (n=74) was 2.3 ± 1.1 (P <.0001). Mean improvement in Q6 score after SSR was -0.19 ± 1.2 (P=0.3) in SSR-C and -0.88 ± 1.4 (P <0.0001) in SSR-P. In women undergoing SSR for MUS-related complications, Q6 scores were correlated to self-reported pain and responsive to surgical intervention for pain relief.

Skin Conductance Response to Gradual-Increasing Experimental Pain.

Patient self-reporting of pain is not always possible, in those cases automated objective pain assessment could lead to reliable pain assessment. In this context, physiological measurements have been studied and one of the promising signals is skin conductance (SC). In this study, 1Hz SC signal acquisition is performed while gradually increasing heat and electrical pain stimuli are induced. Three labeled study periods are defined based on pain stimuli presence, self-reported pain threshold and pain tolerance. Different classification and regression models are compared, together with selected SC features. The model performances are evaluated using c-index. Results show good predictability, especially for the slow tonic component decomposed from the SC signal.

Validation of The Critical-care Pain Observation Tool (CPOT) for the detection of oral-pharyngeal pain in critically ill adults

ObjectiveMechanically ventilated patients experience pain at rest and during daily care procedures. Our objective was to test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oral-pharyngeal pain in intubated and tracheostomised adults during routine oral care procedures. Materials and MethodsTwo trained research team members independently observed patients during two non-painful (rest and gentle touch) and three potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) procedures. Conscious patients were asked if they experienced pain during each procedure (yes/no) and to rate their pain intensity on a 0 to 10 numeric rating scale. ResultsA total of 98 patients, primarily intubated (92.9%) and male (63.3%) participated. Criterion validation was supported by patient self-report of pain during tooth brushing (AUC=.80; P<0.5) and oral suction (AUC=.72; P<0.3) but not for oral swabbing (AUC=.68; P=0.16). Discriminative validation was demonstrated for all oral care procedures compared to rest (P<.001). Intra-class correlation coefficients between raters ranged from .78 to .91 (P<.001) for total CPOT scores, indicating excellent inter-rater reliability. ConclusionsThe CPOT is reliable and valid for the detection of oral-pharyngeal pain during oral care procedures indicated as painful by critically ill adults.

038. Pain experts’ and healthcare professionals’ prioritisation and interpretation of multi-dimensional patient-reported pain data from children with Juvenile Idiopathic Arthritis

Background: Patient self-report of pain is regarded as the gold standard of assessment. There is increased recognition of the importance of using electronic, real-time data capture with multi-dimensional methods for children who have chronic pain. Notable advantages of these approaches include reductions in recall bias and improved compliance and engagement. However, the utilisation of the outputs of these tools in paediatric rheumatology settings may be impeded by the uncertainty that exists about which pain facets should be prioritised in guiding pain management decisions. Aims: To determine which features of multidimensional pain information from individuals with Juvenile Idiopathic Arthritis (JIA) were viewed as most salient by pain experts and paediatric rheumatology healthcare professionals. Methods: Participants were recruited via online advertisements posted by their professional organisations. Two separate group workshops were hosted at an international conference on pain and a national conference on paediatric rheumatology. Participants were asked to rank order nine vignette scenarios from highest pain to lowest pain using real patient data collected with an electronic multidimensional pain assessment tool (My Pain Tracker). The pain components collected by the tool were developed by children and included pain intensity, severity, location, pain quality descriptors (including symbols such as fire and sharpness) and emotions. Participants were asked to explain their individual reasoning for their rankings of pain experiences aloud within workshops. Recordings were transcribed and analysed using content analysis. Results: Nineteen participants took part: nine paediatric pain experts and ten paediatric rheumatology healthcare professionals. The high prioritisation of pain intensity was apparent for pain experts whereas pain intensity and severity together were most salient for healthcare professionals. Differences between groups emerged in the prioritisation of specific pain location information. For pain experts, the number of sites affected was important. However, for rheumatology healthcare professionals, localised pain around specific joints and number of joints affected were seen as high priority. Spread of pain around a particular joint, for example (demonstrated by the extent of shading) was not important for pain experts. Descriptors of pain quality were generally high prioritisations. For both groups, pain labels and pain colour (in particular, red) were salient in their interpretations. For rheumatology professionals only, use of the fire symbol was significant. Other than this, symbol chosen was not important. For the majority of both groups, pain emotion was a high priority. Conclusions: From this study it appears that pain experts and rheumatology healthcare professionals extract and use different combinations of pain information to interpret pain reports. The next step of this work is to develop useful visualisation tools that will enhance clinicians’ ability to assess and manage pain effectively.

The Effectiveness of a Self-Reporting Bedside Pain Assessment Tool for Oncology Inpatients

Pain is common during cancer treatment, and patient self-reporting of pain is an essential first step for ideal cancer pain management. However, many studies on cancer pain management report that, because pain may be underestimated, it is often inadequately managed. The aim of this study was to evaluate the effectiveness of bedside self-assessment of pain intensity for inpatients using a self-reporting pain board. Fifty consecutive inpatients admitted to the Oncology Department of Chungbuk National University Hospital were included in this observational prospective study from February 2011 to December 2011. The medical staff performed pain assessments by asking patients questions and using verbal rated scales (VRS) over 3 consecutive days. Then, for 3 additional days, patients used a self-reporting pain board attached to the bed, which had movable indicators representing 0-10 on a numeric rating scale (NRS) and the frequency of breakthrough pain. Patient reliability over the medical staff's pain assessment increased from 74% to 96% after applying the self-reporting pain board (p=0.004). The gap (mean±standard deviation [SD]) between the NRS reported by patients and the NRS recorded on the medical records decreased from 3.16±2.08 to 1.00±1.02 (p<0.001), and the level of patient satisfaction with pain management increased from 54% to 82% (p=0.002). This study suggests that the self-reporting bedside pain assessment tool provides a reliable and effective means of assessing pain in oncology inpatients.

The temporal development of fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress.

BackgroundRadiological findings associated with poor recovery following whiplash injury remain elusive. Muscle fatty infiltrates (MFI) in the cervical extensors on magnetic resonance imaging (MRI) in patients with chronic pain have been observed. Their association with specific aspects of pain and psychological factors have yet to be explored longitudinally.Materials and Findings44 subjects with whiplash injury were enrolled at 4 weeks post-injury and classified at 6 months using scores on the Neck Disability Index as recovered, mild and moderate/severe. A measure for MFI and patient self-report of pain, loss of cervical range of movement and posttraumatic stress disorder (PTSD) were collected at 4 weeks, 3 months and 6 months post-injury. The effects of time and group and the interaction of time by group on MFI were determined. We assessed the mediating effect of posttraumatic stress and cervical range of movement on the longitudinal relationship between initial pain intensity and MFI. There was no difference in MFI across all groups at enrollment. MFI values increased in the moderate/severe group and were significantly higher in comparison to the recovered and mild groups at 3 and 6 months. No differences in MFI values were found between the mild and recovered groups. Initial severity of PTSD symptoms mediated the relationship between pain intensity and MFI at 6 months. Initial ROM loss did not.ConclusionsMFI in the cervical extensors occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent PTSD in patients with persistent symptoms.

Factors Associated with Self- and Caregiver Report of Pain among Community-Dwelling Persons with Dementia

Among cognitively intact patients, self- and caregiver report of patient pain has been associated with worse psychological health for both the patient and caregiver. Little existing research examines factors associated with patient self-report of pain and caregiver report of patient pain among community-dwelling persons with dementia. To identify patient and caregiver factors associated with self- and caregiver report of patient pain among community-dwelling persons with dementia. Cross-sectional analysis of a longitudinal study using structured interviews with dementia patients and their family caregivers. Urban outpatient geriatrics clinics affiliated with a university hospital. Dyads composed of dementia patients and their family caregivers were approached prior to routine clinic visits to participate in the study. Relevant patient measurements included self-report of pain; cognitive, functional, and comorbidity assessments; a screen for depression; and demographic information. Relevant caregiver measurements included their report of patient pain and agitation, screens for depression and strain, and demographic information. Of 115 dyads, 37 patients (32%) and 57 caregivers (53%) reported the patient to be in pain. No patient or caregiver factors were significantly associated with patient self-report of pain. In the univariate analysis, caregiver reports of patient pain were associated with the patient not being depressed (p = .036), caregiver reports of patient agitation (p = .038), higher level of education in the caregiver (p = .029), and caregiver depression (p = .019). In multivariate logistic regression analyses, caregiver depression and patient agitation remained significantly associated with caregiver report of patient pain. In community-dwelling persons with dementia, self-report of pain was not associated with any other variables measured, suggesting that pain should be assessed through direct self-report and treated accordingly. Caregiver report of patient pain was associated with both caregiver report of patient agitation and caregiver depression. These findings suggest that clinicians may need to routinely assess patient pain, patient agitation, and caregiver depression. More research is needed to understand the relationship between these conditions.

Measurement of pain in the prehospital setting using a visual analogue scale.

The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients. This prospective, observational study used a VAS to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0 and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain. A total of 262 patients were enrolled in this study. The mean value for the reduction in VAS (T0-Tend) was 18.2+/-23.9 mm [+/-SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3-21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5+/-24.7 mm [+/-SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4-14.8 mm). Forty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice. The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such audits must have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.