Validated Pain Assessment Tools Research Articles

Reliability, validity, and responsiveness of multidimensional pain assessment tools used in postoperative adult patients: a systematic review of measurement properties.

The objective of this systematic review was to synthesize the best available evidence relating to the measurement properties of the multidimensional pain assessment tools used to assess postoperative pain in adults. Pain is a common and poorly managed occurrence in patients during the postoperative period. Currently, postoperative pain is usually evaluated with assessment tools that measure one dimension of pain, namely pain intensity, resulting in inadequate management of postoperative pain. It is important to understand the complex nature of pain by considering all dimensions for optimal postoperative pain management. Systematic, robust evidence is lacking regarding the most psychometrically reliable and valid multidimensional pain assessment tool for adult postoperative patients. This systematic review considered all study types for inclusion. Studies were considered if they assessed the measurement properties of a multidimensional pain assessment tool in adult postoperative patients within two weeks post-surgery. The outcomes included measurement of at least one of the psychometric properties, including reliability, validity, and responsiveness. A three-step search strategy was undertaken, including a search of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases performed in October 2019. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar, and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies was assessed independently by three reviewers using the COSMIN checklist. Seventeen studies involving five multidimensional postoperative pain assessment tools were included in the review: American Pain Society Pain Outcomes Questionnaire-Revised; Brief Pain Inventory; Houston Pain Outcome Instrument; McGill Pain Questionnaire; and the Quality Improvement in Postoperative Pain Management Postoperative Pain Questionnaire. The two most commonly used tools were the Brief Pain Inventory and the American Pain Society Pain Outcomes Questionnaire-Revised, which were assessed in six studies each. The included studies mainly reported internal consistency reliability, with four of the five identified tools demonstrating high Cronbach's alpha values ranging from 0.72 to 0.92. However, the Houston Pain Outcome Instrument demonstrated mixed findings, with eight of the nine subscales having moderate to high reliability while the expectations about pain subscale had poor reliability (α=0.003). This review provides much needed information about the current tools used in many clinical, educational, and research settings. Of the five tools included in this review, the Brief Pain Inventory demonstrated strong evidence of psychometric validity and is recommended for use in assessing postoperative pain. Further psychometric validation of multidimensional postoperative pain assessment tools with emphasis on responsiveness and measurement error is required in order to accurately assess the minimal clinically important difference in postoperative pain outcomes.

Trajectories of post-surgical pain in infants admitted to neonatal intensive care.

The aim of this study was (a) to statistically identify distinct trajectories of pain following surgery in infants less than 6months of age, and (b) to compare these trajectories to descriptions of chronic pain in infants in the neonatal intensive care unit (NICU). This was a retrospective medical record review of infants admitted to a NICU between 2008 and 2018 following surgery. All infants who underwent one major procedure to the abdomen or thorax and returned to the NICU following surgery were included. Pain was assessed regularly using a validated Pain Assessment Tool. Group-based trajectory analysis was used to determine the trajectory of recovery from pain following surgery. A total of 726 infants were included in the study. A two-group trajectory model, defined as typical and atypical pain trajectories, was selected. The typical group (n=467) consisted of infants who had significantly fewer days (1.5±2.3 vs 5.3±5.5, p<.001) and recorded instances of pain (2.0±3.4 vs 9.7±10.5, p<.001) compared to infants in the atypical group (n=259). The incidence of iatrogenic neonatal abstinence syndrome was greater in the atypical than the typical group (11% vs 5%, p=.001). This study has revealed two distinct pain trajectories in infants after surgery. While recovery from pain occurs within days in the typical group, the atypical group demonstrates pain for a significantly longer period, often weeks and months following surgery. This latter group adheres closely to current descriptions of chronic pain in infants.

Using a clinical judgement model to understand the impact of validated pain assessment tools for burn clinicians and adult patients in the ICU: A multi-methods study

BackgroundIntensive care (ICU) patients’ burn pain is difficult to assess, communicate and address, risking chronic pain syndromes and psychological morbidity. AimsTo understand how the introduction of validated pain tools (Critical Care Pain Observation Tool [CPOT], Numerical Rating Scale [NRS], Pain Assessment in Advanced Dementia [PAINAD]) affected clinical judgement processes, analgesia/sedation administration and the experience of burn-injured patients. MethodsConsecutive chart review compared type and amount of analgesia/sedation administered, ventilation time and length of ICU/hospital stay between consecutive burn patients pre- and 6-months post-intervention (n=70). Analysis of 36 qualitative interviews with ICU clinicians (n=12) and burn-injured adults (n=12) pre- and post-intervention was guided by Tanner's (2006) Clinical Judgement Model. ResultsOverall, there was a significant increase in morphine (P=0.04) and propofol (P=0.04) use and a trend towards increased paracetamol (P=0.06) use post-intervention. There was a trend towards greater Midazolam use for TBSA<20% (P=0.06), and significantly increased propofol use for TBSA≥20% (P=0.03). Ventilation time and ICU/hospital length of stay were unchanged.Qualitative analysis revealed complex clinical judgement dependent on the context of the patient's situation, unit culture, background beliefs of clinicians and in knowing the patient. Whilst the CPOT and NRS enhanced analytic reasoning and pain advocacy, the PAINAD appeared redundant. ConclusionsEffective pain assessment, management and advocacy are assisted by evidence-based assessment practices.

SO090EVALUATING PAIN IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims Chronic pain is prevalent in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and is associated with a substantial quality of life burden. Literature describing ADPKD-related chronic pain (ACP) is limited, and generic pain management strategies are suboptimal with patients often reporting inadequate relief. Furthermore, the absence of a validated and widely accepted pain assessment tool (PAT) in ADPKD has posed a significant barrier to better pain management and research. We established an ADPKD PAT (APAT) and confirmed its feasibility and validity through administration to ADPKD patients participating in a randomised high water intake trial (NCT02933268). Method A collaboration of key stakeholders (patients, ADPKD experts, trialists and pain specialists) constructed an ADPKD pain conceptual framework consisting of eight prioritized pain assessment domains. We constructed an APAT from components of previously validated pain assessment tools covering each of the prioritized pain domains. The finalized APAT was administered to participants in a feasibility trial which randomised adult ADPKD patients with an eGFR≥20mls/min/1.73m2 to prescribed high water intake (HW) or ad libitum water intake (AW group) over eight weeks. Participants were asked to complete the APAT at least twice (baseline and week 8), although more frequent submissions were permitted. Results 93% (39/42) of trial participants with CKD stages 1-4 completed a total of 129 questionnaires. Each participant completed a median of 3 (range 1-10) questionnaires. In terms of baseline characteristics; mean age of respondents was 47±13 years, 90% (35) were White British ethnicity, and 59% (23) were female. Median disease duration was 14.2 (IQR 7.0-25.9) years, 69% had enlarged kidneys, 64% had hypertension and hepatic cysts were present in 59%. Pain (52%) and associated analgesic use (29%) were prevalent. Participants with pain were more likey to report interference with mobility (25% vs 0%), self-care (20% vs 0%) and usual activities (31% vs 1%) compared to those with no pain (p&amp;lt;0.001. Pain was also associated with a higher risk of anxiety and depression (RR 2.97, CI 1.70-5.20, p=0.000). Pain severity was predicted by traditional risk factors of disease progression including increasing age (OR 1.07, p=0.009), eGFR&amp;lt;60mls/min/1.73m2 (OR 5.45, p=0.021), and hypertension (OR 12.11, p=0.007), but not kidney size, consistent with findings of previous studies. Neuropathic descriptors were not commonly used, while continuous and intermittent descriptors were more frequently selected by patients to describe their pain quality (figure). The APAT achieved good internal consistency (Cronbach’s alpha coefficient =0.91) and test-retest reliability was demonstrated with domain intra-class correlation coefficients ranging from 0.62-0.90. Conclusion A bespoke APAT including components of previously validated pain assessment tools was reliable in evaluating pain in patients with ADPKD, and was acceptable to participants. Pain was prevalent among participants and associated with a substantial emotional and physical burden. The APAT represents a viable instrument for standardised evaluation of ADPKD pain in observational and interventional research.

Māori pain experiences and culturally valid pain assessment tools for Māori: A systematic narrative review

Physiotherapists in Aotearoa New Zealand use various models and tools for assessing pain, many of which have been developed and validated in other ethnic populations outside Aotearoa New Zealand. In particular, assessing pain within the Māori population should be culturally appropriate and capture Māori realities associated with pain experience. The purpose of this systematic review was three-fold: to explore evidence of pain experiences among Māori, to identify any pain assessment questionnaires that capture Māori experiences of pain, and to propose a framework to evaluate the adherence to kaupapa Māori research guidelines. Due to the gap in the literature, only two studies were eligible. Based on these two studies, whānau, Māori holistic views of health, whakapapa, and spirituality were identified as key themes associated with Māori pain experiences. The quality of included studies was “medium-high” and “high”. The overall evaluation based on the Confidence in the Evidence from Reviews of Qualitative research demonstrated “high-moderate” confidence in the findings. Evaluation of adherence to a kaupapa Māori theory framework of the included studies found these to be limited. This review could not identify culturally valid tools to capture Māori experiences of pain, and established the need to develop tools encompassing themes associated with Māori experiences of pain.

Validation of the Greek Version of Comfort-B, FLACC, and BPS Scales in Critically Ill Children and Their Association with Clinical Severity

BackgroundA variety of valid pediatric pain assessment tools are used in clinical practice globally; however, none have been validated for use in the Pediatric Intensive Care Unit (PICU) in Greece. Furthermore, the association between pain behavioral responses and clinical status is unclear. AimsTo assess the reliability and validity of the Greek version of FLACC, Comfort B, and BPS pain scales in critically ill children and to explore their association with clinical severity (Denver MOF, PMODS) and levels of sedation and analgesia. MethodsA methodological and descriptive correlational study was performed in a 6-bed PICU. A total of 60 observations in a sample of 30 children (mean age 4.1 years; 63.3% male) were obtained by 2 independent nurses during rest and painful procedures. At the same time, the bedside nurse assessed the child's pain intensity using the VASobs. ResultsHigh internal consistency and strong interrater reliability were detected (Cronbach's alpha ≥ .85; ICC > .95, p < .001). The agreement between observers was satisfactory (0.71 ≤ Kappa ≤ 0.96, p < .001). Strong correlations were found among the scales (0.65 ≤ rho ≤0 .98, p < .05). Increased pain scores (≥moderate pain) were observed during painful procedures regardless the administration of analgesia. Statistically significant correlations were found between clinical severity and the FLACC and Comfort B scores (−0.577 ≤ rho ≤ −0.384, p < .05). ConclusionsThese pain tools were found to be suitable for this sample of children in Greece. Wider application of these tools in Greek PICUs and further research regarding their association with the clinical severity and the pain responses is required for the improvement of pain management in critically ill children.

Nurses' underuse of non-pharmacological pain relief interventions in preterm infants.

The aim of this literature review was to explore nurses' underuse of non-pharmacological pain relief interventions for minor procedures in preterm infants on neonatal intensive care units (NICUs). A search of the literature using keywords was undertaken using multiple databases. After inclusion and exclusion criteria were applied, three main themes emerged from 11 studies: preterm infant factors; nurse factors; and organisational factors. The literature review found that nurses consistently underused non-pharmacological pain relief interventions for minor procedures in preterm infants. Several contributory factors were identified, including the absence of pain guidelines, the quality of nurses' training and education, patient acuity, the lower gestational age of patients, and the intensity level of NICUs. Recommendations for future practice include the implementation of pain guidelines and validated pain assessment tools via neonatal clinical networks and local pain champions. Effective dissemination of education and training for nurses in pain affecting preterm infants is also required to overcome barriers such as staff shortages and excessive workloads.

Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. The German CPOT version can be recommended for ICUs in German-speaking countries.

Using Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients

Pain management and sedation strategies have become more complex in recent years, with accompanying documented increases in morbidity and mortality. Consequently, various government agencies and professional associations have issued requirements or recommendations designed to ensure optimal and safe pain management in different populations. The pediatric nurse must understand the rationale behind these guidelines, which pain and sedation assessment tools are valid and reliable, how and when to use these tools, and the purpose and limitations of each tool. This article summarizes the recent recommendations, identifies valid and reliable pediatric pain and sedation assessment tools, and describes the appropriate use of these tools to provide safe and high-quality patient care.

Pain assessment tools for chronic lower limb wounds: A scoping review

Background Pain in chronic lower limb wounds has been identified as one of the most painful wounds and negatively impacts health-related quality of life and wound healing. In order to optimise pain management, it is necessary to accurately assess wound pain, however there is no identified reliable and valid assessment specifically for wound-related pain in the lower extremities. Objective The objective of this review was to identify how wound-related pain is assessed in people with chronic lower limb wounds. Design A scoping review of the literature was conducted. Methods A search of MEDLINE, EMBASE, CINAHL and PsycINFO was undertaken of eligible studies that reported on assessment tools for pain in chronic lower limb wounds from inception 1946 to current June 2018. Systematic reviews, meta-analyses, randomised controlled trials, observational and qualitative studies were included. Discussion This study investigated the current assessment tools being utilised for pain in chronic lower limb wounds. Conclusion There is no validated pain assessment tool for patients with chronic lower limb wounds.

Assessment of pain in chronic wounds: A survey of Australian health care practitioners.

Pain associated with chronic wounds can delay wound healing, affects quality of life, and has a major impact on physical, emotional, and cognitive function. However, wound-related pain is often under-assessed and may therefore be suboptimally managed. The aim of this study was to describe the assessment practices used to assess chronic wound pain by health practitioners in Australia. A structured self-administered questionnaire was posted to members of an Australian national wound care organisation, whose membership represents various health practitioners involved in wound management. A total of 1190 (53%) members completed the survey. Overall, wound pain assessment was most commonly conducted at every consultation or wound dressing change (n = 718/1173, 61%). Nurses were more likely to assess wound-related pain before, during, and after the wound dressing procedures compared with other health care practitioners. In contrast, podiatrists assessed wound pain only when the patient complained about the pain. The most common assessment method was simply talking to the patient (n = 1005/1180, 85%). Two-thirds of practitioners used a validated pain assessment tool. The most commonly used tool was the numerical analogue scale (n = 524/1175, 46%). In summary, these findings suggest that there is no consistent method for the assessment of wound-related pain, and there are substantial variations in how and when wound-related pain is assessed between different professions.

MP42: Validation of the Stoplight Pain Scale tool in the Canadian emergency setting

Introduction: Introduction: A variety of pain assessment tools exist for children, however none of the current scales were created specifically for family use. Further, none provide direct guidance with regards to pain treatment threshold. This study aimed to validate a novel, three faced, coloured coded (red, yellow, green), family-friendly pain tool, the Stoplight Pain Scale, by comparing it to the widely accepted and validated Faces Pain Scale-Revised (FPS-R). This novel tool has the capability to guide families with regards to treatment, as well as measure pain. Methods: Methods: A prospective observational cohort study was conducted at the Stollery Childrens Hospital emergency department (ED) (Edmonton, Alberta) from November, 2014 to February, 2017. Demographic information was collected, and patients (3-12 years) and their caregivers were asked to rate their pain using the novel Stoplight Pain Scale as well as the FPS-R. Pain was measured at presentation to the ED, immediately following painful procedures, and thirty minutes after analgesia administration. Patients and their caregivers also indicated their preferred scale for assessing pain. Results: Results: A purposeful random sample of 227 patients were included for analyses; 61/227 (26.9%) of patients were 3-5 years old and 166/227 (73.1%)were 6-12 years old. 53/227 (23.3%) of patients had been previously hospitalized. Correlation between the two pain scales was consistently fair to moderate; using Kappa Statistics, a baseline correlation for Stoplight and FPS-R was fair for both caregivers (0.38, 95% CI 0.28 0.48) and patients (0.36 95% CI 0.27-0.45). The Stoplight Pain Scale had fair to moderate correlation between caregiver and patient scores, (0.37, 95% CI 0.27-0.47), compared to FPS-R which showed poor to fair agreement between caregiver and child scores (0.20, 95% CI 0.12-0.29). Regardless of age or hospitalization status, 64% of patients (139/218) and 54% caregivers (118/220) preferred the Stoplight Pain scale (p=0.001). Conclusion: Conclusions: The Stoplight Pain Scale correlates moderately well with FPS-R, a validated pain assessment tool for children and shows good correlation between patients and caregivers assessment of reported pain. The Stoplight Pain Scale is a simple, easy to administer tool that may have a role in empowering family involvement in ED pain management. Future research should focus on at-home study of the tool.

MP84-19 THE ROLE OF ROBOTIC ASSISTED ABDOMINAL DENERVATION FOR THE TREATMENT OF CHRONIC GROIN PAIN

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-19 THE ROLE OF ROBOTIC ASSISTED ABDOMINAL DENERVATION FOR THE TREATMENT OF CHRONIC GROIN PAIN Mohamed Etafy, JAMIN BRAHMBHATT, and Sijo PAREKATTIL Mohamed EtafyMohamed Etafy More articles by this author , JAMIN BRAHMBHATTJAMIN BRAHMBHATT More articles by this author , and Sijo PAREKATTILSijo PAREKATTIL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2787AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic groin pain that is unresponsive to conservative treatments. However there are limited options for patients who failed MDSC or patients who have refractory pain after an orchiectomy for pain. One option for these difficult cases is Targeted Robotic assisted abdominal Denervation (TRAAD) of the genitofemoral and inferior hypogastric nerves above the internal ring. METHODS Retrospective review of 53 patients who underwent RAAs from October 2010 to July 2016. Selection criteria were as follows: chronic groin pain (>3 months), failed standard pain management treatments (including MDSC), patients who have refractory pain after an orchiectomy and negative urologic workup. A robotic microsurgical platform was utilized (DaVinci Sïf¤ŤHD with magnification, Intuitive Surgical, Sunnyvale, CA). The primary outcome measure was pain relief. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median age was 45 years. Median operative duration (robot console time) was 19 minutes. One patient developed pain at assistant port site and one patient had port site bleeding both were treated conservatively. 79 % (42) patients had significant pain reduction among them 27 patient had complete relief in pain. The median Follow up was 39 months. CONCLUSIONS Targeted robotic assisted abdominal denervation of genitofemoral and inferior hypogastric nerves is a safe and viable treatment option for patients with chronic groin pain refractory to other lines of treatment. Further evaluation and studies are warranted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1132 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mohamed Etafy More articles by this author JAMIN BRAHMBHATT More articles by this author Sijo PAREKATTIL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Identifying Pain and Effects on Quality of Life from Chronic Wounds Secondary to Lower-Extremity Vascular Disease: An Integrative Review.

To provide information to enable better assessment and management of patients with lower extremity vascular disease (LEVD) chronic wound pain. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you will be able to: ABSTRACT: A lack of wound pain validation and provider understanding about the effect of pain on quality of life are the biggest barriers to pain management for patients with chronic wound pain. There is also a need for a holistic, validated pain assessment tool for these patients. This is an integrative review of the literature intended to identify gaps in pain identification and (re)assessment for patients with chronic wounds related to lower-extremity vascular disease.

Ghanaian nurses' knowledge of invasive procedural pain and its effect on children, parents and nurses.

To explore Ghanaian nurses' knowledge of invasive procedural pain in children who are in hospital and to identify the effect of unrelieved pain on children, parents and nurses. An exploratory, descriptive and qualitative design was adopted. A purposive sampling technique was used and individual face-to-face, semi-structured interviews were conducted with 16 registered nurses from four children's units at a hospital in the Eastern Region of Ghana. Thematic and content analyses were performed. Four themes emerged: types of invasive procedure; pain expression; pain assessment; and effects of unrelieved pain. Participants had adequate knowledge of painful invasive procedures, however, they were not aware of the range of available validated pain assessment tools, using observations and body language instead to assess pain. Ghanaian nurses require education on the use of validated rating scales to assess procedural pain in children. The inclusion of pain assessment and management in pre-registration curricula could improve knowledge.

A comprehensive pain assessment tool (COMPAT) for chronic pancreatitis: Development, face validation and pilot evaluation

Background/objectivesChronic pancreatitis (CP) pain is challenging to treat. Treatment selection is hampered by there being no validated pain assessment tool that accounts for the complexity of CP pain and its underlying mechanisms.This study aims to develop a comprehensive pain assessment tool (COMPAT) specific for CP, evaluate its face validity with experts and patients and test it with a pilot cohort of patients. MethodsCOMPAT was developed from existing pain assessment tools and a literature review. Face validity was conducted by pancreatologists and CP patients using an item-content validity index for importance, relevance and clarity. Subsequent revisions were made to COMPAT. A pilot cohort of CP patients tested COMPAT. ResultsCOMPAT was developed and covered all important aspects of CP pain. Experts and CP patients reported that 70% of questions were important and relevant to CP pain. Most experts were willing to use COMPAT in clinic, ward/hospital and research settings. The most common location of pain was the epigastrium and food was the most important trigger. Pain Pattern C (constant background pain with pain attacks), had significantly higher frequency of pain attacks, higher opioid use, and affective descriptors of pain than Pattern A (pain attacks with no background pain). ConclusionsCOMPAT has high face validity and met with high acceptance. CP patients successfully self-reported their pain with COMPAT. The results reveal many differences in the CP pain within the pilot cohort, which may reflect different mechanisms of pain. A larger prospective cohort study is planned to further validate COMPAT.

Cancer pain assessment and management in ambulatory patients at a tertiary hospital in Ghana

Background: Adequate cancer pain assessment using valid and reliable pain assessment tools is essential for effective cancer pain management. This study evaluated the common types, effectiveness as well as adherence to prescribed analgesics in oncology outpatients in a tertiary oncology centre in Ghana.Methods: This descriptive cross-sectional study involved 204 oncology outpatients with different confirmed cancer diagnosis attending clinic at the Oncology Directorate of a Tertiary Hospital in Ghana. The research instruments used were the medical folders of patients, a hospital-based electronic drug database system; hospital administration management systems (HAMS) and the Brief Pain Inventory Long-Form (BPI-LF).Results: More than half (63.7%) of the participants reported moderate pain, 37.8% received opioid analgesics: 31.4% strong opioids and 6.4% weak opioids. Less than one-fourth (21.6%) had complete pain relief and 18.1% felt they needed a stronger pain medication. A little more than one-fourth (28.4%) of participants took their pain medications 1-2 times per day. Almost half (45.6%) of participants did not experience side effects from taking pain medications and 27.9% needed more information about their pain medications.Conclusions: Enhancing effective cancer symptom management approaches in healthcare practitioners and incorporating existing knowledge and guidelines on cancer pain management into routine clinical practice should be done to enhance efficient pain relief.

MP89-20 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW.

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-20 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW. Nahomy Calixte, Bayo Tojuola, Ibrahim Kartal, Ahmet Gudeloglu, Jamin Brahmbhatt, and Sijo Parekattil Nahomy CalixteNahomy Calixte More articles by this author , Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Ahmet GudelogluAhmet Gudeloglu More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic scrotal content pain that is unresponsive to conservative treatments. A recent study has shown specific nerve fiber abnormalities (Wallerian degeneration) in the cord as a potential cause for this pain. Our goal was to assess outcomes of a more targeted technique in ablating only these abnormal nerves when performing MDSC: targeted robotic assisted microsurgical denervation of the spermatic cord (RMDSC). METHODS Retrospective review of 772 patients who underwent RMDSC by two fellowship trained microsurgeons from October 2008 to July 2016. Selection criteria were as follows: chronic testicular pain (>3 months), failed standard pain management treatments and negative urologic workup. Targeted ligation of tissues containing the trifecta location of nerves with Wallerian degeneration was performed: the cremasteric muscle fibers, the peri-vasal sheath and the posterior spermatic cord lipomatous tissues. The primary outcome measure was level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median age was 41 years. Median operative duration (robot console time) was 20 minutes (15-80). Median follow up was 24 months. Subjective VAS patient pain outcomes: 84% significant reduction in pain (50% complete resolution – 425 patients, 34% reported a greater than 50% reduction in pain – 291 patients). Objective PIQ-6 outcomes: significant reduction in pain in 67% of patients at 6 months and 68% at 1 year post-op. CONCLUSIONS Targeted robotic assisted microsurgical denervation of the spermatic cord is a safe and viable treatment option for patients with chronic scrotal content pain refractory to conservative measures. Further studies are warranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1209 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nahomy Calixte More articles by this author Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Ahmet Gudeloglu More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD69-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD.

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2017PD69-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD. Nahomy Calixte, Bayo Tojuola, Ibrahim Kartal, Ahmet Gudeloglu, Jamin Brahmbhatt, and Sijo Parekattil Nahomy CalixteNahomy Calixte More articles by this author , Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Ahmet GudelogluAhmet Gudeloglu More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3150AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC. METHODS Retrospective review of 44 patients who underwent Scrotox (60 procedures: 30 bilateral, 15 right side, 15 left side) from July 2013 to July 2016. All patients had failed prior MDSC. 100 units of Botox diluted in 10cc of saline was injected medial and lateral to the spermatic cord at the level of the external inguinal ring to ablate branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves. The primary outcome measure was the level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median age was 45 years. Median duration of pain prior to the procedure was 9 years. Median follow up post procedure was 7 months. Subjective VAS patient pain outcomes: 62.5% significant reduction in pain (7.5% complete resolution, 55% reported a greater than 50% reduction in pain) by 3 months post-op. Objective PIQ-6 outcomes: significant reduction in pain in 27% of patients at 6 months and 40% at 1 year post-op. There were no complications in our cohort. CONCLUSIONS Scrotox is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted to better understand the long-term durability of this treatment modality. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1347-e1348 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nahomy Calixte More articles by this author Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Ahmet Gudeloglu More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)

The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery. A prospective, observational cohort study. A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands. The study comprised 72 consecutive intubated and mechanically ventilated patients after cardiac surgery who were not able to self-report pain. Two nurses assessed the BPS and CPOT simultaneously and independently at the following 4 moments: rest, a nonpainful procedure (oral care), rest, and a painful procedure (turning). Both scores showed a significant increase of 2 points between rest and turning. The median BPS score of nurse 1 showed a significant increase of 1 point between rest and the nonpainful procedure (oral care), whereas both median CPOT scores did not change. The interrater reliability of the BPS and CPOT showed fair-to-good agreement of 0.74 overall. During the periods of rest 1 and rest 2, values ranged from 0.24 to 0.46. Cronbach's alpha values for the BPS were 0.62 (nurse 1) and 0.59 (nurse 2) compared with 0.65 and 0.58, respectively, for the CPOT. The BPS and CPOT are reliable and valid pain assessment tools in a daily clinical setting. However, the discriminant validation of both scores seems less satisfactory in sedated or agitated patients and this topic requires further investigation.