Visual Analogue Scale Levels Research Articles

Nurse's role in evaluating early treatment of acute pain during triage in ER

The purpose of this study is to define the nurse's role in the evaluation and early treatment of acute pain during triage. The assumption is that the treatment of acute pain in A&E by the triage nurse, in certain well selected cases, improves the level of care provided. The study's subject population is represented by all the users accessing A&E between 13th June 2005 and 13th July 2005, and presenting acute pain. The isolated sample is represented by users whose pain can be attributed to the following clinical conditions: musculoskeletal pain, contusions and sprains, fractures, headaches, earache, toothache and renal or biliary colic. The investigation was performed with the use of a grid by the triage nurse and the VAS (Visual Analogue Scale) to measure the intensity of the pain, whereas a dedicated protocol was followed for drug administration. In the period considered, the overall number of users (population) reporting to A& E was 2443. Of these 439 users (sample) (19%) complained of acute pain attributable to the above clinical conditions. The role of the triage nurse in pain management is undoubtedly important in the phase of evaluation using dedicated scales. The nurse's role in drug administration remains to be defined, given that this research demonstrated how even in the presence of medium-high or high VAS levels, the acceptance of pharmacological treatment at triage is somewhat limited. This aspect will provide an interesting basis for future research aimed at understanding to what extent cultural or individual elements are responsible for this attitude.

Ultrasonographic study of mechanosensory properties in human esophagus during mechanical distension

To study the esophageal geometry and mechanosensation using endoscopic ultrasonography during volume-controlled ramp distensions in the distal esophagus. Twelve healthy volunteers underwent distension of a bag. During distension up to moderate pain the sensory intensity was assessed on a visual analogue scale (VAS). The esophageal deformation in terms of multidimensional stretch ratios and strains was calculated at different volumes and VAS levels. Distensions were done before and during administration of the anti-cholinergic drug butylscopolamine. The stimulus-response (volume-VAS) curve did not differ without or with the administration of butylscopolamine. Analysis of stretch ratios demonstrated tensile stretch in circumferential direction, compression in radial direction and a small tensile stretch in longitudinal direction. A strain gradient existed throughout the esophageal wall with the largest circumferential deformation at the mucosal surface. The sensation intensity increased exponentially as function of the strains. The method provides information of esophageal deformation gradients that correlate to the sensation intensity. Hence, it can be used to study mechanosensation in the human esophagus. Further studies are needed to determine the exact deformation stimulus for the esophageal mechanoreceptors.

The effect of intravenously administered mexiletine on tinnitus-a pilot study

The effect of intravenously administered mexiletine on subjective tinnitus and hearing was studied in six patients, who initially responded positively to lidocaine. Distinct mexiletine-induced decreases in tinnitus loudness were demonstrated in three subjects, as reflected by maximum VAS (visual analogue scale) level reduction of 34%, 95%, and 100%, respectively. One subject reported change in tinnitus pitch, another one showed a slight (18% on VAS) tinnitus reduction, and one subject disclosed no effect. Side effects were seen only during one of seven infusions. Mexiletine induced shifts in pure-tone threshold, transient evoked otoacoustic emission, and acoustic reflex threshold, probably reflecting a reversible interference in the function of organ of Corti. The concentration effect relationship remained unclear and no general ‘therapeutic’ level could be identified. This study confirms the effect of mexiletine on the auditory function and its potential as a possible therapeutic agent or a model for further development in tinnitus pharmacotherapy.

Effectiveness of pre-emptive metoclopramide infusion in alleviating pain, discomfort and nausea associated with nasogastric tube insertion: a randomised, double-blind, placebo-controlled trial

Aim of this study was to demonstrate that intravenous metoclopramide can reduce pain, nausea and discomfort during nasogastric tube (NGT) insertion in ED. This prospective, randomised, double-blind, placebo-controlled trial was conducted in the university-based ED. One-hundred patients were enrolled. Before NGT insertion, each eligible patient was randomised to one of the two treatment arms: one group received 2 cc of 10 mg IV metoclopramide, whereas others received 2 cc of normal saline. Before and after the procedure, pain, nausea and discomfort were evaluated using 100-mm visual analogue scale (VAS). This study was analysed using the paired sample test, the independent sample test and the chi(2) test. Forty-nine patients received metoclopramide, and 51 received normal saline. Although initial VAS levels elicited for pain, nausea and discomfort were similar, consequent VAS levels of those in the metoclopramide group were significantly lower as compared with those in the normal saline group. The mean differences of VAS levels were statistically significant for three symptoms (p < 0.001). Mean VAS levels of nausea, discomfort and pain during NGT insertion were significantly lower following administration of IV metoclopramide as compared with normal saline.

Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial

The aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. A total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). The children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/cartoon versus control) was calculated to be 90%, based on pilot study data. The computer preparation package facilitated coping behavior in children undergoing DGA induction.

Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool

The objective was to validate the use of the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria for fatigue (P-ICD10) through comparison with the Functional Assessment of Cancer Therapy Fatigue (FACT-F) subscale and three visual analogue scale (VAS) qualities in cancer patients thought to be fatigued. Fatigue was assessed in 834 cancer patients at three clinical centres in Belgium, using P-ICD10, FACT-F, and VAS to assess: level of energy (VAS1), quality of life (VAS2), and ability to perform daily activities (VAS3). Of the 834 interviewed cancer patients, 54% were classified as fatigued by the P-ICD10 criteria. Internal consistency of P-ICD10 was very good (alpha coefficient 0.82). The principal component analysis corroborated good internal consistency with all variables included in the first component; a second component was used to identify psychological fatigue (concentration and short-term memory disabilities). An abridged set of screening tools based on the first three general symptoms of the P-ICD10 is proposed with 100% specificity and 86% specificity, respectively. There was a marked decrease in FACT-F and VAS1 scores in patients diagnosed as fatigued by the P-ICD10 (mean+/-SD, FACT-F 20+/-9 vs 39+/-8, VAS1 34+/-21 vs 61+/-21). A logistic regression model between P-ICD10 criteria diagnosis and FACT-F (VAS1) identified a score of 34 (61) on the FACT-F scale as a proposed cut-off point for the diagnosis of fatigue. The ICD-10 criteria can be recommended as a diagnostic tool, whereas the FACT-F scale and the level of energy 100-mm VAS assess the intensity of fatigue, and are more suitable for follow-up of cancer-related fatigue.

SLEEP QUALITY AND IMMUNE FUNCTIONS IN RHEUMATOID ARTHRITIS PATIENTS WITH AND WITHOUT MAJOR DEPRESSION

The purpose of this study was to determine the discriminative factors between rheumatoid arthritis (RA) patients with and without major depression (MD). We assessed subjective sleep quality, pain, and cell-mediated immune functions in RA patients with (n = 20) and without (n = 20) MD by using Pittsburgh Sleep Quality Index (PSQI), visual analogue scale (VAS), and fluorescein isothiocyanat (FITC) labeled CD3, CD4, CD8, CDI9, CD45, CD56, and HLADR T monoclonal antibodies by flow cytometry. We found that the RA patients with MD had significantly higher pain level, poorer sleep equality, higher HDRS points, and higher HLADR T cell level than those without MD; and that these variables are discriminant factors between patient groups. These findings suggest that the RA patients with MD may be differentiated from those without MD by using VAS, PSQI, and HLADR levels; that these variables correctly classify the depressed and non-depressed groups up to an accuracy level of 96.8%

The Lower Pole of the Earlobe is an Alternative Site for Painless Blood Sampling in the Self-assessment of Blood Glucose Concentrations

Measurement of blood glucose is essential for better control of diabetes mellitus. The pain associated with repeated blood sampling is a significant problem, and a less painful technique would be advantageous. This study was conducted to establish a less painful method of blood sampling for monitoring of blood glucose concentrations. Fourteen healthy doctors and nurses at the age of 22 to 32 years were enrolled into this study. The earlobe was divided into 20 areas. Each area was punctured with a fine needle and the pain was assessed by the visual analog scale (VAS). Then, localized cooling or warming was applied before puncture and the pain was assessed by the VAS. The VAS tended to be lower toward the lower part of the earlobe. The VAS in the uppermost area was 53.1 +/- 19.1 mm and 28.9 +/- 16.8 mm in the lowest part of the earlobe. The VAS was higher in the uppermost area than in the lowest area in six of the seven volunteers (p=0.028). We did not find significant differences in the VAS and blood glucose levels between the control sampling and the warming, or cooling sampling. The localized warming shortens the time to obtain blood by 4.4 seconds (p=0.0426). The area of the ear, but not localized cooling or warming, significantly affects the pain in sampling blood from the earlobe. Blood sampling for glucose tests are recommended to be obtained at the lower pole of the earlobe.

Central pain associated with low thalamic blood flow treated by electroconvulsive therapy.

table central poststroke pain throughout his right hemibody, mostly in the upper and lower extremities, had lasted for almost 3 years. Three years after the event, he was referred to the pain clinic of the Department of Anesthesiology, Shiga University of Medical Science, in order to receive a course of ECT treatment for his persistent pain. Visual analogue scale (VAS) levels for pain were rated as 8–10 (0, no pain; 10, maximal pain). He was unable to resume walking because of the persistent pain. The patient was informed about the treatment protocol, which was approved by the Hospital Ethical Committee, and about the possible benefits and side-effects of ECT. Informed oral and written consent was obtained before ECT. Medication at that time consisted of 30mg·day 1 nortriptyline and 300mg·day 1 carbamazepin. The ECT was conducted by brief-pulse stimulus (frequency 60Hz, pulse width 1 ms, current 0.7 A, stimulus duration 2.8 s) once a week over 8 weeks unilaterally using a Thymatron DGX (Somatics) and seizure was assured by EEG monitoring and by viewing cuffed-limb seizures. The unilateral ECT application was to the nondominant hemisphere and ipsilateral to the cerebral vascular accident. Hypnosis was induced with a bolus injection of thiopental (2–3 mg·kg 1), and muscle relaxation was achieved by succinylcholine (1–1.5 mg·kg 1 IV). Ventilation was assisted using a facemask with 100% oxygen, and nicardipine (0.5–1.5mg IV) was injected to attenuate acute cardiovascular side-effects. A course of eight unilateral ECT treatments resulted in a reduction in pain. After ECT treatment, the patient still had some occasional pain, but was able to tolerate it. VAS levels for pain after ECT were rated 2–5. His mental state and daily activities improved, and he could enjoy walking. He suffered retrograde and anterograde memory impairments transiently, but recovered within 2 months. One and half years after the ECT treatment, the reduction in central poststroke pain has persisted.

Smoking habits and painful diabetic neuropathy

In order to assess the relationship between chronic painful diabetic neuropathy and current—or lifetime—smoking habits, the smoking history of 49 diabetic patients was investigated and compared with that of 23 diabetic patients without chronic pain (age 51.0 ± 1.9 years, mean ± SEM). Current level of nicotine intake was measured using urinary cotinine (a nicotine metabolite), and expressed as cotinine/creatinine ratio ( sol COT Cr ), and lifetime smoking load by pack years (20 cigarettes per day for 1 year equals 1 pack year). Current pain intensity was evaluated using a visual analogue scale (VAS). The presence of chronic painful diabetic neuropathy was based on clinical history and examination. Of those patients with painful neuropathy, 26% were current smokers (age 54.2 ± 3.2 years, mean ± SEM), 31% ex-smokers (age 57.0 ± 2.9 years), and 43% lifelong nonsmokers (age 58.0 ± 2.9 years). Pain duration and intensity were similar in all three groups. sol COT Cr levels were similar in current diabetic smokers with pain [5.0 (0.2–10.6) μg/mg] and the diabetic control group of smokers without pain [6.8 (1.8–13.3) μg/mg, NS]. There was no relationship between VAS and either sol COT Cr levels or pack years in current smokers, or between duration of pain and pack years in diabetic current or ex-smokers. In conclusion, we found no relationship between current or previous levels of smoking and severity or duration of chronic painful diabetic neuropathy.