Pain Assessment Scale Research Articles

A Study to Assess the Effectiveness of Lamaze Method in terms of Labour Pain Perception, Anxiety and Progress of Labour among Primi Mothers in active first stage of Labour

Background: Natural childbirth is a beautiful experience. Women dream of the perfect birth with less pain. But severe pain is a phenomenon embedded in the very nature of human existence. Though experiencing pain during labour is a universal feature of childbirth, the degree of pain perception can be reduced using many simple, effective, low cost non-pharmacological methods which also helps in improving labour progress and patient satisfaction. The concept of painless child birth gave rise to many scientific discoveries and research findings. Among that Lamaze method is one, which prepares mother for child birth and to tackle Labour pain. Objective: The objective of this study are to evaluate the effectiveness of Lamaze method in terms of pain perception, anxiety and progress of labour among primi mothers in first stage of labour admitted at Christian fellowship Hospital, Oddanchatram. Method: The research design used for the study was quasi experimental nonequivalent control group posttest only design. The sample size was 60 samples. Out of which 30 were in experimental group and 30 were in control group. The Samples were selected by using Non probability purposive sampling technique. Primi mothers at their term was selected and was given antenatal teaching on “Normal labor process and non-pharmacological labour pain management” in antenatal OPD for about 30 minutes. The same primi mothers who attended teaching were selected for experimental group during their labour period. During the first hour of active first stage of labour Lamaze intervention of visual stimuli was provided by showing natural sceneries during each contraction for the second hour auditory stimuli was provided by making the mother to listen to light music by using ear phone. During the 3rd hour of active first stage of labour abdominal effleurage stroke was done during each painful contractions. Followed by that hot water bag application on the sacral region was provided and was continued till delivery. Primi gravid mothers who did not undergo Lamaze teaching and interventions were selected for control group. Posttest was done on both experimental and control group after four hours of active stage of labor to assess the level of labor pain perception, the level of anxiety and progress of labor by using Universal pain assessment scale, modified Max Hamilton anxiety rating scale and Labor progress assessment scale. The level of satisfaction on Lamaze method among experimental group was assessed by using Likert scale on satisfaction of Lamaze method. Total time taken to perform posttest in both groups was 30 minutes. The gathered data were analyzed by using descriptive and inferential statistics. Results: Results: Independent “t” value for level of pain perception was 16.08(table value=2.001) which was significant at P<0.05 level. The independent “t” value for level of anxiety was 5.08(table value=2.001) which was significant at P<0.05 level. The independent “t” value for progress of labour was 9.86 (table value=2.001) which was significant at P<0.05 level. Regarding the level of satisfaction on Lamaze method of experimental group all 30(100%) primi mothers were adequately satisfied. There was no significant association existing between pain perception, anxiety and progress of labour with demographic variables such as age, education, occupation, monthly income and residence except for pain perception and demographic variables such as religion (χ2 = 45.44) and family type (χ2 = 4.33) among experimental group. The study findings revealed that Lamaze method was effective in reducing labor pain perception, anxiety and promote labour progress among primi mothers in active first stage of labour.

EVALUATION OF THE THERAPEUTIC EFFECTS OF TRANSCUTANEOUS INTERFERENTIAL CURRENT THERAPY AND THERAPEUTIC EXERCISES ON MUSCULOSKELETAL SYMPTOMS IN PATIENTS WITH POST COVID-19

The aim of this research was to investigate the therapeutic effectiveness of a multi-component rehabilitation program including: transcutaneous interferential current therapy and therapeutic exercises in patients with musculoskeletal symptoms in post COVID-19 syndrome. Materials and Methods: 62 patients, mean age 55.9(13.99), aged 21 to 79 years, with persistent musculoskeletal symptoms in the recovery phase after experiencing COVID-19 were included in this study. All patients underwent a ten-day treatment course in an outpatient setting, including transcutaneous application of interferential current with four electrodes. The therapeutic parameters were selected with analgesic, trophic and stimulating effects (90-100 Hz, 5min and 0-100 Hz, 15min). Immediately after electrotherapy, kinesitherapy was performed including: breathing exercises, aerobic training, active and resistance exercises for the limbs, postural control exercises and exercises to improve the mobility of the peripheral joints and the axial skeleton. Results were evaluated by: Visual Analogue Scale (VAS) for assessment of back pain, Numerical Rating Scale (NRS) for arthralgia and myalgia assessment, Brief Fatigue Inventory (BFI) – fatigue assessment, functional tests of mobility, Goniometry in the spine, Ott Sign- for measuring the range of motion (ROM) of the thoracic spine, Schober’s test to determine a lumbar spine range of motion (flexion), Tom Meyer’s test for total hip joint and spine flexion mobility. The results were reported before and after the rehabilitation. The statistical significance level was specified as (p<0.05). Results: Musculoskeletal symptoms in the observed patients persisted for an average of 12 weeks, ranging from 7 to 20 weeks, and included: myalgia in 46.8% (29), arthralgia 29.0% (18), pain in various back departments 79.0% (49), fatigue 66.1% (41). Inpatient treatment for acute COVID-19 was performed in 35.5% (22) of patients, and home and outpatient treatment in 64.5% (40). There was a statistically significant reduction (Mean (SD)) after therapy in back pain (VAS) from 4.88(1.5) to 1.93(1.1), myalgia (NRS) from 3.66(1.2) to 1.29(1.1), arthralgia (NRS) from 3.27(1.2) to 0.89 (0.8), and fatigue index (BFI) showed a reduction from 5.73(1.4) to 3.22(1.4). There was an increase in mobility in Ott’s symptom from 2.24(1.2) to 2.86(0.9) cm, Schober’s test 1.41(1.2) to 2.38(0.9) cm, Tom Meyer’s test from - 8.23(6.5) to - 2.46(3.7) cm. Conclusion: In the recovery phase post COVID-19, some of the patients had long-time persistent musculoskeletal symptoms (fatigue, myalgia, arthralgia, back pain). These are a common reason for these patients to be referred for outpatient rehabilitation. In order to design a multi-component rehabilitation programme, it is necessary to take into account individual characteristics and comorbidities. The inclusion of physical modalities such as electrotherapy requires an accurate assessment of the rehabilitation potential and the presence of any counterindications. Therapeutic exercises have been proven to be effective in post COVID-19 patients. The results of this study show that the combination of interferential current therapy and therapeutic exercise can effectively reduce back pain, myalgia, arthralgia, and perception of fatigue. On the other hand, this multicomponent program resulted in improvement in functional tests in the studied patients. Due to the small sample size, it is advisable to continue the study in the future, covering a larger number of patients with long-standing musculoskeletal symptoms as part of post-COVID-19 syndrome, in order to design an effective strategy that can efficiently reduce negative health consequences and improve functional activity in these patients.

A Comparative Study of Epidural Butorphanol and Fentanyl as Adjuvants with 0.5% Bupivacaine for Postoperative analgesia in Lower Abdominal Surgeries

The pain is considered as sixth vital sign. Achieving adequate peri-operative and post -operative analgesia is of paramount importance to the anesthesiologist. This can be done by multiple approaches. One such technique is use of Epidural opioids. This study evaluates the analgesic efficacy of epidural fentanyl and butorphanol in lower abdominal surgeries for post -operative analgesia. Aims: To compare the degree of post-operative analgesia using butorphanol and fentanyl administered by epidural route. Settings and Design: Study setting: Tertiary care Hospital Study Design: A Prospective Double Blinded Randomised Clinical Study Methods and Material: A total of 60 Patients posted for elective lower abdominal surgeries were randomly selected for the study. The patients aged 20-60 years of ASA grade one and two posted for elective lower abdominal surgery were selected for the study. Drugs used were explained to the patients and also educated about Verbal numerical scale for assessment of pain. Patients were divided into two groups: Group A: receives Butorphanol 1mg mixed with 15 ml Bupivacaine 0.5%diluted upto 20 ml. Group B: receives Fentanyl 100 microgram mixed with 15 ml Bupivacaine 0.5% diluted upto 20 ml. Statistical analysis used: Statistical data was analysed using • Chi-square test • Student t-test (Paired and unpaired t-test) • A P value of < 0.05 is significant and >0.05 is not significant Results: The demographic variables were comparable in both groups. Both inj. Butorphanol 1 mg and Inj. Fentanyl 100 mcg given epidurally with Inj. Bupivacaine 0.5% as a single shot provided excellent operative conditions and satisfactory post-operative analgesia in both the groups. However, the duration of post-operative analgesia was much longer in the butorphanol group than Fentanyl group and was statistically significant. No serious side effects were noted in both groups. The method is economical, safe, convenient and acceptable and also poly pharmacy is avoided. Conclusions: Both fentanyl and butorphanol are safe and effective as epidural agents for postoperative analgesia with little side effects.

Cerebral cortical hemodynamic metrics to aid in assessing pain levels? A pilot study of functional near-infrared spectroscopy.

Establishing an accurate way to quantify pain is one of the most formidable tasks in neuroscience and medical practice. Functional near-infrared spectroscopy (fNIRS) can be utilized to detect the brain's reaction to pain. The study sought to assess the neural mechanisms of the wrist-ankle acupuncture transcutaneous electrical nerve stimulation analgesic bracelet (E-WAA) in providing pain relief and altering cerebral blood volume dynamics, and to ascertain the reliability of cortical activation patterns as a means of objectively measuring pain. The participants (mean age 36.6 ± 7.2 years) with the cervical-shoulder syndrome (CSS) underwent pain testing prior to, 1 min following, and 30 min after the left point Jianyu treatment. The E-WAA was used to administer an electrical stimulation therapy that lasted for 5 min. A 24-channel fNIRS system was utilized to monitor brain oxyhemoglobin (HbO) levels, and changes in HbO concentrations, cortical activation areas, and subjective pain assessment scales were documented. We discovered that HbO concentrations in the prefrontal cortex significantly increased when CSS patients were exposed to painful stimuli at the cerebral cortex level. The second pain test saw a considerable decrease in the average HbO change amount in the prefrontal cortex when E-WAA was applied, which in turn led to a reduction in the amount of activation and the size of the activated area in the cortex. This study revealed that the frontal polar (FP) and dorsolateral prefrontal cortex (DLPFC) were linked to the analgesic modulation activated by the E-WAA.

The effect of spinal magnetic stimulation on the management of functional constipation in adults

BackgroundFunctional constipation is a type of functional bowel disorder characterized by difficult defecation with a sense of incomplete evacuation. It is a common disorder with an increasing prevalence, and the underlying cause is poorly identified. Nonpharmacological management of functional constipation includes lifestyle and dietary modification, regular physical activity, advice about toileting posture, and behavioral therapy. Biofeedback training as part of the behavioral training showed great efficacy with long-term results. Spinal magnetic stimulation is the application of extracorporeal magnetic stimuli to the spinal nerves and deep pelvic muscles to enhance bowel evacuation without surgical drawbacks. This study was designed to enhance bowel elimination in functional constipation patients through the dual effect of biofeedback and spinal magnetic stimulation. This work aimed to study the efficacy of spinal magnetic stimulation and biofeedback training versus biofeedback alone in the management of functional constipation.ResultsThere was a statistically significant difference between before and after the intervention in both studied groups regarding the mean weekly spontaneous bowel movement, a Numerical Rating Scale for pain assessment, and the Patient Assessment of Constipation Quality of Life questionnaire. When comparing the two groups after the intervention, the spinal magnetic stimulation showed superiority in the mean weekly spontaneous bowel movement and manometric anal pressure at rest.ConclusionsSpinal magnetic stimulation in addition to biofeedback pelvic floor muscle training could increase the mean weekly complete spontaneous bowel movements and manometric anal pressure at rest in patients with functional constipation. It did not show any additive benefits in improving pain during defecation or patient quality of life.Trial registrationClinicalTrials.gov, 0305398. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BQ0H&selectaction=Edit&uid=U0004JW0&ts=2&cx=-xmnims

Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services

BackgroundSomatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services. AimWe focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service. MethodsA cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied. ResultsOf all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ2 = 18.4, p < .001), as well as more severe (t = –4.6, p < .001), and prolonged (χ2 = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms. ConclusionsIn this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale - short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05). The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

EFFECTIVENESS OF EXERCISE PROGRAM ON LOW BACK PAIN AMONG NURSES WORKING AT A MEDICAL COLLEGE HOSPITAL IN DHAKA, BANGLADESH

Background: Low Back pain (LBP) is one of the most thought-provoking health conditions among the health professionals, especially nurses and it is considered as a significant health problem around the world. The aim of this study was to examine the effectiveness of exercise programs to reduce LBP among nurses working at Mugda Medical College Hospital in Dhaka. Methods: A Quasi Experimental one group pre-posttest study design with 5 weeks’ exercise program and one week follow up session was used. A total of 60 nurses were conveniently recruited from Mugda Medical College Hospital. Data collection period was from January to March 2020. Nurses’ characteristics were described by using Socio-Demographic Questionnaire (SDQ) and their LBP status was examined by Nordic Musculoskeletal Questionnaire (NMQ) and 11 points of Verbal Rating Scale for pain (VRSP) assessment. Descriptive statistics such as frequency, percentage, mean and standard deviation was used to describe the demographic characteristics and LBP of nurses. Inferential statistics such as matched paired t-test and independent sample t-test were used to examine the relationship between the variables. Results: Finding shows that the mean pre-test LBP score of nurses was 5.40 (SD = 0.74) and post-test LBP score was 1.51 (SD = 1.27). The mean differences were 3.89 (SD = 0.53) which indicates significant difference between pre and post-test score. In matched paired t-test, it was found that there was a significant mean difference between pre and post-test of LBP (p&lt; 0.001). Conclusion: There was a significant mean difference after exercise program among the nurses with LBP. It indicates that exercise program was effective to reduce LBP. This finding can be recommended to develop educational modules for nurses to provide appropriate care to the patients.

Validation of the PAINAD-K Scale for Nonverbal Pain Assessment in the Post Anesthesia Care Unit

Purpose: This study aimed to verify the reliability and validity of the Pain Assessment in Advanced Dementia Scale-Korean version (PAINAD-K) for assessing pain in patients unable to communicate in the post-anesthesia care unit (PACU).Methods: The study included 205 patients, aged &gt;65 years, admitted to the PACU following general surgery. Reliability was assessed using Cronbach’s ⍺, test-retest, intraclass correlation coefficient (ICC), and kappa coefficients. Criterion validity was evaluated with concurrent validity, and receiver operating characteristic (ROC) analysis assessed sensitivity and specificity. Convergent and discriminant validity were analyzed to verify the construct of the scale.Results: The Cronbach’s ⍺, ICC, and test-retest correlation values were .78, .95~.98, and .56~.74, respectively, indicating good reliability. At baseline, the correlation coefficient was .93 with the Algoplus scale in the non-communicative group and .82 with the numeric rating scale in the communicative group. Further establishing criterion validity in the nonverbal group, the area under the ROC curve was 0.995 (sensitivity=98.4%, specificity=97.5%) at baseline and .95 (sensitivity=96.4%, specificity=93.2%) at the 30-minute follow-up. The correlation coefficient with the Critical-Care Pain Observation Tool was .69~.96, showing convergent validity, and there was a significant interaction effect between time and group, indicating discriminant validity.Conclusion: The study findings suggest that the PAINAD-K is a psychometrically valid scale for assessing pain in PACU patients aged &gt;65 years who are unable to communicate.

Knowledge and the Use of Pain Assessment Among Critical Care and Surgical Nurses in the Management of Pain in Usmanu Danfodiyo University Teaching Hospital, Sokoto

Aim: The purpose of the study was to examine the use of pain assessment scale in pain management among nurses in critical care and surgical areas of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Method: This study employed descriptive cross-sectional design. A stratified random sampling technique was used to select 148 nurses across 5 units within the area of study. Descriptive statistics like frequency, mean, standard deviation and percentage were used to describe distribution of data. Descriptive statistics were utilized in data assessing the distribution of data. Pearson‟s rank correlation was used in determining the relationship between knowledge and level of utilization of pain scales in pain management at the p=0.05 level of significance. A total of 148 study participants were involved in this study. Result: More than half of the nurses, 79 (58.5%), were females; 53 (39.3%) of them were in the age category of 34-39 years. The magnitude of good knowledge towards pain management among nurses was 67.4% with a mean score of 16.41 ± 3.902. The magnitude for the level of utilization of pain assessment scale in pain management was 80% with a mean score of 4.30 ± 0.381. There is a positive relationship between knowledge and utilization of pain assessment scale in pain management with r=0.215. Conclusion: Nurses working in critical care and surgical areas of Usmanu Danfodiyo University Teaching Hospital, Sokoto had good knowledge, and utilize pain assessment tool in pain management than those reported in previous studies in southern Nigeria.

A tactile pain evaluation scale for persons with visual deficiencies.

Pain evaluation scales often rely on the sense of sight. There is so far no pain assessment scale designed specifically for persons with visual impairment. This study aims to validate a tactile pain evaluation scale, Visiodol (Copyright Prof Pickering), in blind or visually impaired persons, by correlation with a numeric pain scale. The study took place at University Hospital Clermont-Ferrand, France. Pain intensity for a range of thermal stimuli (Pathway Medoc) was evaluated with Visiodol and a numeric pain scale. Secondary outcomes, including pain thresholds, catastrophizing, emotion, and quality of life, were compared in persons who were blindor visually impaired and in sighted persons. Lin's concordance correlation coefficient was estimated. Weighted Cohen's κ accounted for degrees of disagreement between scales with 95% confidence intervals (95%CI). Sixteen healthy sighted and 21 healthy nonsighted volunteers (n = 13 congenital, n = 8 acquired) were included. Lin's correlation coefficient for repeated data was 0.967 (95%CI, 0.956-0.978; P < 0.001) for visually impaired participants, with a good agreement at each temperature plateau. A weighted Cohen's κ of 0.90 (95% CI, 0.84-0.92) and 92.9% percentage of agreement for visually impaired participants were satisfactory. Pain perception, psychological components, and quality of life were more impaired in persons who were blind or visually impaired than in sighted persons. This study validates Visiodol, a tactile scale for persons who are blind or visually impaired, and addresses health care inequalities in the context of pain evaluation. Visiodol will now be tested in a larger population of patients to give the millions of persons worldwide who are blind or visually impaired an option for pain intensity evaluation in clinical situations. French National Agency for the Safety of Medicines and Healthcare Products (2018-A03370-55) and www.ClinicalTrials.gov (NCT03968991).

Evaluation of pain in the paediatric patient admitted to sub-intensive care: a scoping review protocol.

pain is considered as the 5th vital sign thus it's paramount that healthcare professionals are equipped with validated tools for his correct assessment. There are different paediatric pain assessment scales that take into account patients' age. Actually, the "Face, Legs, Activity, Cry, Consolability" (FLACC), Wong-Baker and NRS scales are regarded as the gold standard in low intensity clinical areas, while the COMFORT-Behavior (COMFORT-B) and Behavioral Pain Scale (BPS) ones are used for high intensity clinical areas where paediatric patients are sedated/intubated. It's unclear which pain assessment scale should be used in sub-intensive areas such as Sub-Paediatric Intensive Care Unit (Sub-PICU) e Sub-Neonatal Intensive Care Unit (Sub-NICU). The aim of this protocol is to map the literature in order to identify what evidences are available regarding the assessment of pain in the paediatric sub-intensive clinical areas. "What is the literature available on pain assessment in paediatric patients in sub-intensive clinical areas such as Sub-PICU and sub-NICU?". literature search will be performed through the following databases: PubMed, Scopus, CINAHL, Cochrane Library, Open Dissertations (EBSCO) and DOAJ. Furthermore, Cochrane CENTRAL and ClinicalTrials.gov will also be included. this scoping review will be conducted in accordance to the Joanna Briggs Institute guidelines and the results presented through a PRISMA flowchart. Open Science Framework https://doi.org/10.17605/OSF.IO/8KBRQ.

A study on the Comparison of Pain Assessment Scales used in a Tertiary Care Centre

A study on the Comparison of Pain Assessment Scales used in a Tertiary Care Centre

Neonatal pain assessment: Do we have the right tools?

The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools. We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit. We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated. We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population. A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.

Is Cerebrolysin effective in reducing symptoms of Diabetic Peripheral Neuropathy?

Aim This is an investigator initiated observational comparative medical program, to test the efficacy of Cerebrolysin® intake for 1 month versus 2 months, in patients clinically diagnosed with type 2 diabetes mellitus (T2DM) and suffering from peripheral neuropathy. Methods Patients aged ≥ 18 years old, clinically diagnosed with mild or moderate painful diabetic polyneuropathy, received Cerebrolysin® for 1 or 2 months according to investigators’ decision. Demographic data, detailed medical history, and laboratory results were collected at baseline. All enrolled patients were evaluated for Toronto Clinical Scoring System (TCSS), Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline and end of the program (1 month/2 month). Results VAS, TCSS, and LANSS were significantly improved for all 136 enrolled patients at the end of their treatment with Cerebrolysin® for 1 or 2 months, regarding gender, duration since diagnosis of T2DM (more than or less than 10 years) and HbA1c ≤ 9% or ˃ 9%, with a very highly statistically significant difference (p-value ˂ 0.001). They were slightly improved more in patients received Cerebrolysin® for 1 month more than for 2 months. There was no statistically significant difference for gender, duration of diagnosis with diabetes mellitus less or more than 10 years, and HbA1c ≤ 9% &amp; ˃ 9% regarding the change of VAS, TCSS, and LANSS as dependent variables, using Linear stepwise regression. While there was noticed improvement in VAS, TCSS, and LANSS with use of Cerebrolysin® for 1 month more than 2 months, Regression Coefficient (B (95% of Confidence interval)) B=0.794 (0.29-1.29), B=1.472 (0.87-2.074), B=2.143 (0.45-3.83) and p-value = 0.002, p-value ˂ 0.001, p-value = 0.13 respectively. There was no adverse event (AE) or serious adverse event (SAE) reported during the program. Conclusion: Cerebrolysin® is considered effective in the management of peripheral neuropathy in patients with T2DM Abbreviations: Adverse Event (AE), Advanced Glycation End products (AGE), Contract Research Organization (CRO), Diabetic Peripheral Neuropathy (DPN), Diacylglycerol (DAG), estimated Glomerular Filtration (eGFR), Fasting Blood Sugar (FBS), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), Peripheral Vascular Disease (PVD), Pin- Prick Threshold (PPT), Protein Kinase C (PKC), Statistical Analysis Plan (SAP), Serious Adverse Event (SAE), Standard Deviation (SD), Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Toronto Clinical Scoring System (TCSS), Traumatic Brain Injury (TBI), Visual Analogue Scale (VAS).

Diagnosing Pain in Individuals with Intellectual and Developmental Disabilities: Current State and Novel Technological Solutions.

Pain assessment poses a challenge in several groups of clients, yet specific barriers arise when it comes to pain assessment of individuals with intellectual and developmental disabilities (IDD), due mostly to communication challenges preventing valid and reliable self-reports. Despite increased interest in pain assessment of those diagnosed with IDD within recent years, little is known about pain behavior in this group. The present article overviews the current state of pain diagnosis for individuals with IDD, focusing on existing pain assessment scales. In addition, it suggests technological developments offering new ways to diagnose existence of pain in this population, such as a Smartphone App for caregivers based on unique acoustic characteristics of pain-related vocal responses, or the use of smart wearable shirts that enable continuous surveillance of vital physiological signs. Such novel technological solutions may improve diagnosis of pain in the IDD population, as well as in other individuals with complex communication needs, to provide better pain treatment and enhance overall quality of life.

Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy.

Ten Nelore and nine Angus bulls were anaesthetised with xylazine-ketamine-diazepam-isoflurane-flunixin meglumine. Three-minute videos were recorded at -48 h, preoperative, after surgery, after rescue analgesia and at 24 h. Two evaluators assessed 95 randomised videos twice one month apart. There were no significant differences in the pain scores between breeds. Intra and inter-rater reliability varied from good (>0.70) to very good (>0.81) for all scales. The criterion validity showed a strong correlation (0.76-0.78) between the numerical rating scale and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The UCAPS and CPS were responsive; all items and total scores increased after surgery. Both scales were specific (81-85%) and sensitive (82-87%). The cut-off point for rescue analgesia was >4 for UCAPS and >3 for CPS. The UCAPS and CPS are valid and reliable to assess postoperative pain in Bos taurus and Bos indicus bulls.

Memojis Pain Scale: A novel pain assessment tool.

Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity. To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children. Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded. Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r= .966; p< .001) and MPS with FPS-R (r= .969; p< .001), and 81.6% of the children preferred MPS. The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

Clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection.

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

Low Dose Bupivacaine (0.25%) with Fentanyl vs Ropivacaine (0.25%) with Fentanyl for Caudal Analgesia in Paediatric Patients: A Randomised Clinical Study

Introduction: Caudal epidural block is one of the most common regional techniques in paediatric anaesthesia for infraumbilical surgeries. Though bupivacaine is widely used because of its long duration, ropivacaine is a newly emerging drug having differential neuraxial blockade with less motor block and reduced cardiovascular and Central Nervous System (CNS) toxicity. To further increase the duration and quality various adjuvants have been added. Aim: To compare low dose bupivacaine-fentanyl with ropivacaine-fentanyl in terms of hemodynamic stability, duration of analgesia, postoperative pain, level of sedation, and side-effects profile among patients undergoing infraumbilical surgery. Materials and Methods: A double-blind, randomised study was conducted on 60 children undergoing elective infraumbilical surgery. Patients were randomly divided into two groups of 30 each into Bupivacaine-Fentanyl (BF) group and RopivacaineFentanyl (RF) group, using a simple envelope method. After securing airway, caudal block was given. Group BF received 0.25% bupivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg and Group RF received 0.25% ropivacaine 0.5 mL/kg with fentanyl 0.5 mcg/kg. Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale, for 12 hours. The hemodynamics, duration of analgesia, rescue analgesia requirement and side effects (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) were noted and analysed statistically. Results: The mean duration of analgesia in the BF group was 270±46.60 minutes and in the RF group was 430±68.83 minutes (p-value &lt;0.001). Patients requiring rescue analgesia were 12 in Group BF and 5 in Group RF. Mean FLACC reached ≥4 at 4.5 hours in group BF and at 7 hours in group RF. There was no significant difference in hemodynamics and side-effects profile (bradycardia, hypotension, respiratory depression, retching, urinary retention, vomiting) between the two groups. Conclusion: Low dose caudal ropivacaine-fentanyl combination is superior to that of caudal bupivacaine-fentanyl with respect to duration and intensity of intraoperative and postoperative analgesia.