Validated Pain Assessment Tools Research Articles

Pain Experiences of Children and Adolescents With Osteogenesis Imperfecta: An Integrative Review.

Pain is a commonly experienced symptom for children and adolescents diagnosed with osteogenesis imperfecta (OI). The purpose of this integrative review was to describe the pain experience of children and adolescents with OI as well as critically appraise the content and methods of studies assessing OI pain. Five electronic bibliographic databases were searched. Published quantitative, qualitative, and/or mixed-method studies assessing pain in children and adolescents with OI were included and appraised. Constant comparison of the extracted data was used to synthesize themes. A total of 783 titles were identified, and 19 studies that met the inclusion criteria were included in this review. Study appraisal scores ranged from 25.0% to 83.3% using the Quality Assessment Tool. The majority of studies included assessed pain as a secondary outcome (63%) and less than half used moderately established or well-established tools (42%). Two themes were uncovered: "Pain is Present and Problematic" and "Issues with Pain Assessment." Key findings under each theme include: (1) the negative impacts of pain and the substandard use of pain management strategies; and (2) the lack of multidimensional and consistent pain assessments, as well as difficulties in assessing pain in younger children. Research on OI has focused very little on pain experience in children and adolescents, and there is no standard method of assessing pain. To better describe the pain experience of these patients, future research should focus on better characterizing OI pain with the use of age-appropriate valid, reliable, and multidimensional pain assessment tools.

Skin-to-skin contact for procedural pain in neonates: acceptability of novel systematic review synthesis methods and GRADEing of the evidence.

The aim of this study was to assess the acceptability of methods that increase trial inclusion in meta-analyses, and the level of evidence for skin-to-skin contact for procedural pain in infants. The current Cochrane review of skin-to-skin contact for pain in newborns found it to be an effective intervention, but identified several methodological limitations. Meta-re-analysis METHODS: Trial designs included randomized trials reporting a validated pain assessment tool as a primary outcome including term and pre-term infants undergoing a tissue-breaking painful procedure. The search in the original review was conducted to January 2013. Scores of validated tools were scaled to the premature infant pain profile in a fixed-effect meta-re-analysis. The GRADE was used to assess quality of meta-analysed evidence. New analysis vs. original found a mean difference: -3·11 in favour of skin-to-skin contact vs. -3·21 at 30seconds; and -2·71 vs. -1·85 at 60seconds for heel lance. Based on cut-off scores for the Neonatal Infant Pain Scale, infants receiving skin-to-skin contact during IM injection were more likely to display low pain after injection; and during recovery. Scaling scores to a single outcome can provide additional information in meta-analyses, simplifies interpretability of pooled scores, and can improve GRADE outcomes. Sensitivity analyses of scaled scores improve confidence in their validity. Risk of bias subgroups simplified the GRADE process, and confidence intervals for heterogeneity statistics assisted in interpretation of sensitivity analyses.

Can improvised somatic dance reduce acute pain for young people in hospital?

Aim This study explores the effects of improvised somatic dance (ISD) on children and young people experiencing acute pain following orthopaedic or cardiac surgery, or post-acquired brain injury. Methods The study involved 25 children and young people and adopted a mixed methods approach. This included a descriptive qualitative approach to help the participants and witnesses verbalise their experience of ISD, and pain scores were assessed before and after ISD using validated pain assessment tools. Data were analysed using descriptive statistical analysis. Findings A total of 92% of participants experienced a reduction in pain, with 80% experiencing a >50% reduction. There was an improved sense of well-being for all. Conclusion Although not a replacement for pharmacological treatments, a multidimensional, child-centred and inclusive approach with ISD can be a useful complementary, non-pharmacological method of pain management in children and young people.

Validation of the Critical Care Pain Observation Tool in Critically Ill Patients With Delirium: A Prospective Cohort Study.

The 2013 clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the ICU suggest that pain be routinely assessed using a validated pain assessment tool. Currently available tools have only been evaluated in nondelirious critically ill patients, yet delirium can affect as many as 80% of ICU patients. The validated pain assessment tool adopted by our institution is the Critical Care Pain Observation Tool, and the objective of this study was to investigate the validity of this tool in patients with evidence of delirium. Prospective cohort study. Two ICUs within a Canadian tertiary healthcare center. Forty consecutive adult patients deemed delirious on the day of enrollment using the Confusion Assessment Method for ICU. Serial Critical Care Pain Observation Tool assessments were conducted simultaneously by study personnel and objective nurses at baseline and after nonpainful and painful stimuli. Subjective opinions about pain and objective physical variables (including mean arterial pressure, heart rate, respiratory rate, and oxygen saturation) were collected at the same time points. Discriminant validity was described using paired t tests, whereas internal consistency was described using the Cronbach α statistic. Responsiveness of the Critical Care Pain Observation Tool was measured by effect size, and reliability was described as the agreement between raters. Comparisons between the Critical Care Pain Observation Tool and the subjective assessments and objective measurements were based on positive and negative percent agreement. Critical Care Pain Observation Tool demonstrated excellent discriminant validity as evidenced by a highly statistically and clinically significant change in mean Critical Care Pain Observation Tool scores between baseline and painful procedures (mean difference, 3.13 ± 1.56; p < 0.001; Cohen D, 2.0). Interrater agreement was also excellent (κ > 0.6), and scores between raters were highly correlated (r = 0.957). The Critical Care Pain Observation Tool possessed a high level of internal consistency (overall Cronbach α, 0.778). Percent agreement was found to be greater between the Critical Care Pain Observation Tool and the nurse's subjective opinion of the presence or absence of pain when compared with that between the Critical Care Pain Observation Tool and physiologic variables (80.5% vs 67.5%, respectively). The Critical Care Pain Observation Tool is a valid pain assessment tool in noncomatose, delirious adult ICU patients who are unable to reliably self-report the presence or absence of pain.

Perioperative pain therapy in dogs and cats - an overview

Undermanaged pain leads to negative systemic effects that may greatly disturb our patients' welfare. Therefore, a pain assessment tool should be routinely implemented into clinical practice. Validated pain assessment tools are available for dogs and cats. Advanced analgesic therapy follows the principle of a multimodal approach. This means that different analgesic drugs, which act on different targets within the nociceptive pathway, are combined to achieve the desired analgesic effects. In addition to opioids, nonsteroidal anti-inflammatory drugs and local anaesthetics, α2-receptor-agonists, ketamine and gabapentin as well as different nonpharmacologic analgesic techniques are used within the framework of a multimodal analgesic plan.

Psychometric Validation of the Japanese Version of the Neuropathic Pain Symptom Inventory.

ObjectiveThis study aimed to evaluate the validity and reliability of the Japanese version of the Neuropathic Pain Symptom Inventory (NPSI-J).DesignCross-sectional study design.Subjects and MethodsThe original Neuropathic Pain Symptom Inventory (NPSI) was translated into Japanese according to published guidelines. Subsequently, an observational study of 60 Japanese patients suffering from neuropathic pain was performed to evaluate the validity and reliability of the NPSI-J.ResultsThe NPSI-J exhibited a statistically significant correlation with pain intensity (Numerical Rating Scale). The Cronbach alpha value for Likert items was 0.86. Using the test–retest analysis method, the intraclass correlation coefficient between the two scores was 0.81. Factor analysis revealed that the main component of NPSI-J comprised three determinative factors.ConclusionsThe NPSI-J is a reliable and valid pain assessment tool.

Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy

ObjectivesThe withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen. MethodsA 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0–10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups. ResultsMore than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups. ConclusionThis service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery.

Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score

Background and aimsAssessment of pain in children with cognitive impairment (CI) including cerebral palsy (CP) is difficult. Several pain assessment tools have been developed and validated for use in children with CI. The revised Face, Legs, Activity, Cry and Consolability score (r-FLACC) includes core behaviours of children with CI and adds an open-ended descriptor for individualisation (5 items assigned 0–2 points, total range 0–10). Other pain assessment tools including individual pain behaviours are the Individualised Numeric Rating Scale (INRS) and the Paediatric Pain Profile (PPP). Both the Noncommunicating Childrens's Pain Checklist – Postoperative version (NCCPC-PV) and the Echelle Douleur Enfant San Salvador (DESS) are developed from core pain behaviours for children with CI but have no possibility for individualisation. For successful clinical application a pain assessment tool should not only be reliable and valid, but also clinically feasible. The aim of this study was to select the most valid and feasible pain assessment tool for children with CI and translate that tool into Danish. MethodsA literature review on studies on pain, pain assessment tools, feasibility and CI was performed. Studies were evaluated with focus on children with CI not able to self-report pain and the r-FLACC was chosen for translation. A 10 step translation process guideline was used from the Translation and Cultural Adaptation Group, which describes preparation, forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalisation, proofreading, and final report. ResultsStudies show that the r-FLACC is superior regarding clinical feasibility. The r-FLACC is a useful tool for assessing pain in children with CI due to its ease to use in a clinical setting and its use of both core and individual pain behaviours. In the back translation review discrepancies of words between the original and the back-translated English versions were assessed and in three of nine discrepancies a word was changed. In the cognitive debriefing no issues were found regarding understandability, interpretation or cultural relevance of the translation. No other language translations of the r-FLACC score have been published; hence the harmonisation step with a comparison of the English back translations was not possible. ConclusionsThe r-FLACC is assessed to have the most preferable profile with use of core pain behaviours, flexibility regarding individualisation, good psychometric properties, and high clinical feasibility; hence suited for use in Danish children with CP. A Danish version of the r-FLACC score now exits and may be used in a clinical setting for the assessment of pain. ImplicationsIt is important for health-care professionals to be able to assess pain in hospitalized children with CP who are not able to self-report. The r-FLACC score is clinically feasible and has the potential for becoming the gold standard of pain assessments in children with CP. A standardised approach to pain assessment may lead to an increased focus on pain and help improve the treatment of pain in children with CP in Denmark.

Pain in Intellectually Disabled Children: Towards Evidence-Based Pharmacotherapy?

This critical opinion article deals with the challenges of finding the most effective pharmacotherapeutic options for the management of pain in intellectually disabled children and provides recommendations for clinical practice and research. Intellectual disability can be caused by a wide variety of underlying diseases and may be associated with congenital anomalies such as cardiac defects, small-bowel obstructions or limb abnormalities as well as with comorbidities such as scoliosis, gastro-esophageal reflux disease, spasticity, and epilepsy. These conditions themselves or any necessary surgical interventions are sources of pain. Epilepsy often requires chronic pharmacological treatment with antiepileptic drugs. These antiepileptic drugs can potentially cause drug–drug interactions with analgesic drugs. It is unfortunate that children with intellectual disabilities often cannot communicate pain to caregivers. Although these children are at high risk of experiencing pain, researchers nevertheless often have to exclude them from trials on pain management because of ethical considerations. We therefore make a plea for prescribers, researchers, patient organizations, pharmaceutical companies, and policy makers to study evidence-based, safe and effective pharmacotherapy in these children through properly designed studies. In the meantime, parents and clinicians must resort to validated pain assessment tools such as the revised FLACC scale.

PD45-09 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/Andrology: Medical and Non-Surgical Therapy II1 Apr 2015PD45-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt, and Sijo Parekattil Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal 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.2015.02.2581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. 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. 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 25 patients who underwent Scrotox (29 procedures: 4 bilateral, 10 right side, 11 left side) from July 2013 to July 2014. 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 43 years. Median duration of pain prior to the procedure was 10 years. Median operative duration was 15 minutes. Median follow up post procedure was 8 months. Subjective VAS patient pain outcomes: 70% significant reduction in pain (14% complete resolution, 56% reported a greater than 50% reduction in pain). Objective PIQ-6 outcomes: significant reduction in pain in 40% of patients at 6 months and 20% at 1 year post-op. There were no complications in our small 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. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e905 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bayo Tojuola More articles by this author Ibrahim Kartal 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 ...

PD40-03 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 UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-03 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt, and Sijo Parekattil Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal 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.2015.02.2437AboutPDF 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 620 patients who underwent RMDSC by two fellowship trained microsurgeons from October 2008 to July 2014. Selection criteria was 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. A robotic microsurgical platform was utilized (DaVinci S, HD with magnification, Intuitive Surgical, Sunnyvale, CA). 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 operative duration (robot console time) was 20 minutes (15-80). Subjective VAS patient pain outcomes: 85% significant reduction in pain (63% complete resolution ¡V 385 patients, 22% reported a greater than 50% reduction in pain ¡V 135 patients). Objective PIQ-6 outcomes: significant reduction in pain in 71% of patients at 6 months and 72% at 1 year post-op. The 4th robotic arm allowed the surgeon to control one additional instrument leading to less reliance on the microsurgical assistant. 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. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFurr J and Bowen A (2018) Editorial CommentaryUrology Practice, VOL. 5, NO. 4, (277-277), Online publication date: 1-Jul-2018. Volume 193Issue 4SApril 2015Page: e836 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bayo Tojuola More articles by this author Ibrahim Kartal 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 ...

Analgésicos opioides en pacientes hospitalizados: Hospital de San Jpsé de Bogotá DC, Colombia

Los analgésicos opioides son esenciales para control del dolor moderado a severo, que es un parámetro de calidad en atención hospitalaria. Objetivo: describir el uso e indicación de analgésicos opioides en la población hospitalizada del Hospital de San José de Bogotá DC en febrero de 2014. Materiales y métodos: estudio retrospectivo de utilización de medicamentos (EUM) en 559 pacientes mayores de 16 años, midiendo dosis hospitalaria definida (DDD/DHD) y patrón de distribución opioide según especialidad, diagnóstico CIE10, utilización de herramientas validadas de valoración del dolor, concomitancia opioide e interconsulta a la unidad de dolor. Resultados: los principales motivos de hospitalización fueron la patología quirúrgica no oncológica y oncológica con 73,7%, y 8,4%. El opioide de mayor utilización fue tramadol con 15,4 DDD/100 camas/día. El consumo de morfina e hidromorfona parenteral es bajo con 2 y 1,3 DDD/100 camas/día. De los opioides fuertes, morfina es el más utilizado, siendo cirugía general, hematología y ortopedia los principales prescriptores con 27,4%, 20,4% y 20,4%. La distribución de morfina en los grupos poblacionales de cada especialidad es heterogénea, presentando mayor uso en pacientes hematológicos con 39,1%. Se utilizaron las escalas de valoración del dolor al ingreso y egreso hospitalario en el 48,6% y 5,1%. Conclusión: se deben fortalecer las guías de manejo de dolor institucionales. Hay poca adherencia al uso de escalas de dolor cómo parámetro de seguimiento de la terapia analgésica. Se crearán estrategias educativas para el adecuado manejo del dolor.

The effectiveness of surgery for adults with hallux valgus deformity: a systematic review protocol

Objective To establish the effectiveness of surgery compared to conservatory management for adults with hallux valgus. Inclusion criteria Types of participants This review will include adults (18 years or older) with hallux valgus deformity, excluding adults with neurological problems causing foot deformities e.g. cerebral palsy, neuropathy, stroke, Multiple Sclerosis. Types of intervention(s)/phenomena of interest The review will include any type of hallux valgus surgery compared to no surgery, conservative treatment (such as physical therapy, kinesio taping, orthosis, etc.) and comparison among different types of hallux valgus surgeries will also be included. Types of outcomes The primary outcome: - gait measures: assessed by any validated assessment tool (such as biomechanical movement analysis, etc.). The secondary outcomes: - quality of life: assessed by any validated assessment tool (such as SF-36, etc.), - patient satisfaction using any validated assessment tool, - pain using any validated pain assessment tool (such as the Visual Analogue Scale, Verbal Rating Scale, McGill Pain Questionnaire, etc.), - adverse events. All the above outcomes measured at the following time points: short-term: 1 year after surgery.

Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week

Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice. To describe the prevalence of pain, pain assessment and pain management practices at a tertiary pediatric hospital in Canada. The cross-sectional study design involved a combination of interviews with children and⁄or caregivers, and chart audits in five inpatient units. Information regarding pain intensity, painful procedures and pain management strategies was obtained from children and⁄or caregivers by interview. Patient charts were reviewed for information regarding pain assessment, pain scores, and pharmacological and nonpharmacological interventions. Sixty-two children (four days to 17 years of age) participated. Most children or their caregivers (n=51 [84%]) reported that pain was experienced during their hospitalization, with 40 (66%) reporting their worst pain as moderate or severe. Almost one-half reported analgesics were administered before or during their most recent painful procedure. Nineteen (32%) reported sucrose, topical anesthetics or nonpharmacological interventions were used; however, they were documented in only 17% of charts. Pain scores were documented in 34 (55%) charts in the previous 24 h. The majority of the children or their caregiver (n=44&nbsp;[71%]) were satisfied with pain management at the study hospital. Most infants and children had experienced moderate or severe pain during their hospitalization. Analgesics were frequently used, and although nonpharmacological strategies were reported to be used, they were rarely documented. Most parents and children were satisfied with their pain management.

Neonatal pain

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes

Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time.EPIQ units used significantly more validated pain assessment tools (P<0.001) and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4–6/10) and severe (7–10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26–0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes.

Pain Assessment in Nonverbal Patients

Patients who can’t self-report pain rely on caregivers to accurately assess pain and intervene appropriately. Nurses have several behavioral pain assessment tools available. However, few studies have actually investigated these tools’ usefulness for pain assessment and management at the bedside.Accurately assessing pain levels in all critically ill patients is the first step in evaluating patients for the presence of delirium. The Behavioral Pain Scale and the Critical-Care Pain Observation Tool are valid and reliable pain assessment tools that can be used for nonverbal patients with intact motor function. When combined with tools to evaluate sedation, such as the Richmond Agitation Sedation Scale or Sedation Agitation Scale, and tools to assess for the presence of delirium, such as the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist, patients will receive the appropriate intervention.

The Challenges of Assessing Osteoarthritis and Postoperative Pain in Dogs

The challenge of measuring pain in veterinary medicine is compounded by the lack of fully validated, reliable methods to measure and assess pain in nonverbal patients. In human medicine, there are numerous, validated pain assessment tools (PATs) for assessing various, specific types of pain. The advances in human medicine pain management and numerous validated pain scales should serve as incentives and templates to facilitate similar advances in the development of validated PATs for use in dogs (and other species). The limited number of canine PATs constrains our ability to adequately and reliably assess pain. Improving the ability to quantify osteoarthritis and postoperative pain in dogs would enhance the development of analgesics for animals, advance the management of animal pain, facilitate the use of animal pain models in preclinical trials for human analgesics, and provide insight into the quantification of pain responses in humans who lack the ability to adequately communicate. This review describes the need for practical, valid, and reliable PATs for use in veterinary patients and discusses some currently available PATs commonly used to evaluate acute and chronic pain in dogs.

Nurses need to respond promptly to older people's expressions of pain.

Nurses use simple questions to assess pain in older patients in hospital, including those who have difficulty communicating, despite the availability of validated pain assessment tools, a qualitative study has found.

Pain evaluation after a non-nociceptive stimulus in preterm infants during the first 28 days of life

BackgroundProtective mechanisms that modulate and lead to habituation to pain are immature in preterm newborn infants. AimsTo evaluate if a routine non-painful handling will be perceived as painful throughout the neonatal period in newborn infants with 28–32weeks of gestational age. Study designProspective cohort study. Subjects36 preterm infants without malformations evaluated for pain during a diaper change. Outcome measuresPatients were studied at three times (5min prior, during, and 3min after the diaper change) during five moments (72h, 7, 14, 21 and 28days of life) by evaluation of heart rate, oxygen saturation and 3 validated pain assessment tools: the Neonatal Infant Pain Scale (NIPS), the Behavioral Indicators of Infant Pain (BIIP) and Premature Infant Pain Profile (PIPP). Results were analyzed by repeated measures ANOVA adjusted for gender, gestational age at birth, number of painful procedures and use of opioids. ResultsPatients had, at birth, mean gestational age of 30.2±1.4weeks, birthweight of 1257±238g, with 50% males. Analysis of pain assessment tools did not show increase of pain presence or pain scores at the five sequential evaluation moments. The variation of oxygen saturation during the three study times was similar at the different post-natal ages, but heart rate variation increased significantly from 72h until the 28th day of life. ConclusionsIn preterm infants, the non-nociceptive handling does not trigger pain responses even after 28days of neonatal care, which includes the experience of repetitive procedural pain.