Wong-Baker Faces Pain Scale Research Articles

Comparative clinical evaluation of chemomechanical caries removal agent Papacarie® with conventional method among rural population in India: in vivo study

The use of minimally invasive procedures and attention to patient comfort are of great importance, especially for dental treatment in young children. This has led to the development of chemomechanical methods for caries removal. Aim: To evaluate and compare the antimicrobial efficacy, efficacy in terms of time consumption and pain perception of chemomechanical caries removal agent Papacarie® and conventional method of caries removal. Methods: Subjects for this study were chosen from children admitted to dental clinic for restorative procedures. Forty children (age 4-8 years) with early childhood caries were included in this study. Two primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with either Papacarie® or rotary instruments. The time taken for caries removal was measured using stopwatch. Pain response during caries removal was evaluated using the Wong Baker Face Pain Scale. Dentin samples of both groups were taken prior to, and after caries removal for microbiological analysis. Results The time taken for caries removal in chemomechanical caries removal method was three times longer than the conventional method. Pain score during chemomechanical method of caries removal was 1.525 as compared with 6.65 when conventional method was used. The antimicrobial efficacy of chemomechanical caries removal was significantly similar to conventional method. Conclusions: Papacarie® can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars.

Comment

This paper's authors have undertaken to establish, and have largely succeeded in establishing, the potential utility of a new visual prostate symptom score. Building on a prior analog scale assessing the force of urinary stream as well as incorporating a quality-of-life assessment similar to the Wong Baker Faces Pain scale, a scale often cited in the literature, serves to lend further credence to the concept. Overall, with a sample population considered small by many standards, the authors demonstrate that the Visual Prostate Symptom Score (VPSS) does in fact correlate with the IPSS as well as objective measure of urinary flow rate. This is a potentially very important endpoint, given how laborious proper urinary flow rates can be to obtain from patients and how spurious the results can be. The novelty of the VPSS concept and its use to better assess and quantify urinary symptoms in men is worthy of further investigation and possibly development before adoption for wider distribution and use among practitioners in our speciality worldwide. Prospective Comparison of a New Visual Prostate Symptom Score Versus the International Prostate Symptom Score in Men With Lower Urinary Tract SymptomsUrologyVol. 78Issue 1PreviewTo evaluate the correlation between the International Prostate Symptom Score (IPSS) and a new Visual Prostate Symptom Score (VPSS) using pictures rather than words to assess lower urinary tract symptoms (LUTS). Full-Text PDF ReplyUrologyVol. 78Issue 1PreviewThe positive comments by Dr. Mark Plante are greatly appreciated. As instruments designed to translate subjective symptoms (qualitative data) into objective numbers (quantitative data) suitable for statistical analysis, the AUA-SS or IPSS remains an indispensable component of clinical trials evaluating the efficacy of treatment for men with lower urinary tract symptoms (LUTS). In daily practice, these scores are extremely useful for evaluating the symptomatic response to various forms of therapy. Full-Text PDF

Reply

The positive comments by Dr. Mark Plante are greatly appreciated. As instruments designed to translate subjective symptoms (qualitative data) into objective numbers (quantitative data) suitable for statistical analysis, the AUA-SS or IPSS remains an indispensable component of clinical trials evaluating the efficacy of treatment for men with lower urinary tract symptoms (LUTS). In daily practice, these scores are extremely useful for evaluating the symptomatic response to various forms of therapy. However, their reliability is dependent on the educational level and intelligence of the patient, and on validated translations for those who are not proficient in English. CommentUrologyVol. 78Issue 1PreviewThis paper's authors have undertaken to establish, and have largely succeeded in establishing, the potential utility of a new visual prostate symptom score. Building on a prior analog scale assessing the force of urinary stream as well as incorporating a quality-of-life assessment similar to the Wong Baker Faces Pain scale, a scale often cited in the literature, serves to lend further credence to the concept. Overall, with a sample population considered small by many standards, the authors demonstrate that the Visual Prostate Symptom Score (VPSS) does in fact correlate with the IPSS as well as objective measure of urinary flow rate. Full-Text PDF

Quality of postoperative course in children: endoscopic endonasal surgery versus sublabial microsurgery

The practice of endoscopic endonasal surgery is still limited in children because of the relative rarity of sellar lesions in the paediatric population. However, such an approach is increasingly reported in the literature as an alternative option to standard sublabial microsurgery, and its surgical results are being analysed. No information on the trend of the postoperative course is currently available. The goal of this paper is to assess the impact of these two different transsphenoidal approaches on the postoperative course. Thirty-one consecutive paediatric patients were treated for sellar region lesions by transsphenoidal surgery. Fourteen children (group A) underwent surgery with a microsurgical sublabial transsphenoidal approach between 2000 and 2005; the remaining 17 children (group B) underwent surgery with an endoscopic endonasal transsphenoidal approach between 2005 and 2009. The two groups were compared as to rate of admission to the PICU, relief from preoperative symptoms, early surgical complications, postoperative pain (Wong-Baker FACES Pain Scale) and length of postoperative hospital stay. Children in group B showed decreased rates of admission to the PICU (35% versus 100%) and peroperative blood transfusions (23% versus 71%), and a shorter mean postoperative hospital stay (4 days versus 5.7 days). The pain perception was significantly lower in group B than in group A, as demonstrated by the scores registered during both the early (2.05 ± 0.74 versus 2.92 ± 0.91) and late postoperative period (0.82 ± 0.95 versus 1.64 ± 0.84). No remarkable differences in terms of operative time, symptom improvement and early complications were detected. Endoscopic endonasal surgery can improve the quality of the postoperative course in children regardless of the type of lesions treated and the surgical complications.

Validating English- and Spanish-language patient-reported outcome measures in underserved patients with rheumatic disease

IntroductionRheumatic diseases are among the most common and debilitating health problems in the United States. These diseases are chronic, can result in severe decrements of physical and psychosocial functioning and affect patients' overall quality of life. A consensus regarding the best patient outcomes to be measured in randomized, controlled trials and prospective natural history studies is essential to provide best estimates of efficacy and safety of interventions across diverse patient populations.MethodsFace-to-face English- and Spanish-language cognitive interviews were conducted among urban Hispanic and African American patients with rheumatic disease to develop a questionnaire booklet. Six measures validating patient-reported outcomes were included: the Arthritis Self-Efficacy Scale, the Stanford Health Assessment Questionnaire Disability Index, the Wong-Baker Faces Pain Scale, the Short Acculturation Scale, the Center for Epidemiologic Studies Depression Scale and the Inventory of Complementary and Alternative Medicine Practices. A sample of patients (n = 15) attending the National Institute of Arthritis and Musculoskeletal and Skin Diseases Community Health Center participated in the initial interviews. Revised measures were further tested for reliability in a separate sample of patients (n = 109) upon enrollment at the health center.ResultsCognitive interviews provided feedback for questionnaire modifications and methods to enhance content validity and data quality, including discarding redundant questions, providing visual aids and concrete examples when appropriate and increasing the use of racially and ethnically concordant interviewers. The cognitive interviews further elucidated that some contextual assumptions and language usage in the original questionnaires may not have taken each respondent's environmental and sociocultural context into consideration. Internal reliability for previously tested measures remained high (Cronbach's α = 0.87-0.94).ConclusionsCognitive interviewing techniques are useful in a diverse sample of racial and ethnic minority patients with rheumatic disease as a method to assess the content validity of the specific outcome measures selected. The data collection approaches and methods described here ultimately enhance data quality. Vigilance is required in the selection of outcome measures in studies or in practice, particularly with each new language translation and/or culturally unique or diverse sample.

Prospective Evaluation of a Single Incision Sling for Stress Urinary Incontinence

We report 12-month outcomes of the MiniArc single incision sling for stress urinary incontinence in women. We performed a multicenter, prospective, single arm institutional review board/ethics committee approved study evaluating the effectiveness of the MiniArc sling after implantation via qualitative (Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form) and quantitative (1-hour pad weight test and cough stress test) measurements. Secondary outcome measures included procedural variables (procedure time and estimated blood loss), length of stay, perioperative complications, Wong-Baker Faces Pain Scale and adverse events. A total of 188 women with a mean age of 51.1 +/- 10.6 years (median 50.4, range 25.9 to 79.6) were enrolled in the study. At 1 year 157 patients were available for analysis. Mean procedure time, estimated blood loss and length of hospital stay were 11.0 +/- 6.7 minutes (median 10, range 2 to 55), 41.7 +/- 47.0 ml (median 25, range 0 to 250) and 9.5 +/- 14.1 hours (median 3.2, range 0.5 to 77.2), respectively. At discharge from hospital the mean Wong-Baker pain score was 1.3 +/- 2.0 (range 0.0 to 10.0). Of the patients 90.6% had a negative cough stress test and 84.5% had a 1-hour pad weight test less than 1 gm at 12 months. Median Urogenital Distress Inventory-Short Form and Incontinence Impact Questionnaire-Short Form scores showed a statistically significant decrease (p <0.001). Adverse events included urinary tract infection (4.3%), constipation (3.7%), temporary urinary retention (3.2%), dyspareunia (2.1%) and vaginal extrusion (1.6%). The MiniArc single incision sling is a safe and effective first line surgical procedure for the treatment of female stress urinary incontinence. It demonstrated excellent patient tolerability with minimal pain, early return to normal activity and low morbidity. In addition to sustained efficacy outcomes at 12 months patients treated with the MiniArc experienced a significant improvement in quality of life.

Yoga for Pain and Anxiety in Pediatric Hematology- Oncology Patients: Case Series and Review of the Literature

In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, and the mean reduction in anxiety T-score was 9.62 (SD ± 6.74), p = .0001. Patient quotes suggest that yoga was benefi cial, especially for relaxation. Literature review offers preliminary support for the use of yoga for anxiety in children. Our data suggest that further research on yoga as an effective intervention for pediatric hematology-oncology patients for pain and anxiety is needed.

The Effect of Programmed Distraction on the Pain Caused by Venipuncture among Adolescents on Hemodialysis

Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. The purpose of this quasi-experimental study was to test the effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. All of the pediatric hemodialysis centers in Tehran (three centers) were assigned to case group (one center with 21 patients) and control groups (two centers with a total of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three first sessions were held without intervention (pretest) and the next nine sessions were held with distraction intervention (posttest). To cause distraction, the adolescents were asked to look at two similar pictures and tell the number of differences between them during venipuncture. Results showed that case and control groups matched in demographic variables and pain intensity. After distraction, pain intensity during venipuncture significantly decreased ( p = .003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.

Does a Pain Scale Improve Pain Assessment in the Pediatric Emergency Department?

Pain management in children requires rapid and sensitive assessment. The Wong-Baker FACES pain scale (WBFPS) is a widely accepted, validated tool to assess pain in children. Our objective was to determine whether incorporation of the WBFPS into the emergency medical record (EMR) improves pain documentation in the pediatric emergency department. We also examined whether this intervention improves the management of children who present with pain. The WBFPS was incorporated into the EMR in an urban tertiary care pediatric emergency department. We performed a review of EMRs for patients aged 3 to 20 years at 30 days before and 30 days after the intervention. All physicians were trained to use the WBFPS. We excluded patients younger than 3 years or who were unable to perform the assessment. We compare rates of pain score documentation for the preintervention (PRE) and postintervention (POST) groups and times from triage to analgesia administration using Fisher exact test. A total of 462 and 372 EMRs were included in the PRE and POST groups, respectively. The groups were similar with respect to age (P = 0.46); there were more males in the POST group (47.2% vs 56.5%, P = 0.008). The rate of pain score documentation was 7.4% (n = 34) in the PRE group and 38.2% (n = 142) in the POST group (P < 0.001). In patients with pain score of 6 or greater, there was no statistical difference in analgesia administration (PRE, 41.7% [10/24] vs POST, 41.8% [28/67]) or time to administer analgesia in minutes (PRE, 80.4%; median, 42 and POST, 100.5%; median, 52.5; P = 0.71). Incorporating the WBFPS into the EMR significantly improves pain assessment in children. Despite this, there was neither improvement in analgesia administration nor reduction in time to administer analgesia in children with pain.

CT 검사에서 소아 환자의 정맥 카데터 삽입 통증에 대한 측정 도구 비교

Needle phobia of medical devices is a significant problem in children patients. We conducted study in 130 pediatric patients aged (mean age 10.5) who had venipuncture performed in a computed tomography. This review aims to explore the research available relating to three commonly used pain rating scales of children, the visual analogue scale(VAS), numeric pain rating scale(NPRS) and Wong-Baker faces pain scale(WBFPS) with scores. Its validity is supported by a strong positive correlation with the three-pain rating scales(correlations ranging from 0.70 to 0.92) measure in children. There were no significant differences between the means on the VAS and either of the pain rating scales. It has the advantage of being suitable for use with the most widely used metric for scoring(), and conforms closely to a linear interval scale. These scales presented moderate to good correlation and moderate agreement, sufficient for valid use in children. All three pain-rating scales are valid, reliable and appropriate for use in intravenous catheter placement.

Intracapsular vs. Extracapsular Tonsillectomy: A Comparison of Pain

To measure differences in postoperative pain in children undergoing intracapsular tonsillectomy vs. extracapsular tonsillectomy. Prospective clinical trial carried out at a tertiary children's hospital over 1 year. The study included 43 patients age 5 to 19 years with adenotonsillar hypertrophy, 27 undergoing extracapsular tonsillectomy and 16 undergoing intracapsular tonsillectomy. Tonsillectomy was performed in either an intracapsular or extracapsular fashion using bipolar electrosurgical scissors and monopolar suction cautery for hemostasis. Residents under faculty supervision performed all operations. Postoperative pain was assessed using the Wong-Baker Faces Pain Scale through postoperative day 10. The patients recorded in a standardized diary pain scores and analgesic use. The main outcome measure was postoperative pain as measured by the Wong-Baker Faces Pain Scale. The quantity of postoperative pain medicine consumed was a secondary outcome measure. Average postoperative pain for extracapsular tonsillectomy was 5.21 on a 10-point scale versus 2.75 for intracapsular tonsillectomy (P < .0001). Intracapsular tonsillectomy with bipolar scissors results in less postoperative pain than extracapsular tonsillectomy with bipolar scissors in children age 5 to 19 years.

Parental assessment and management of children's postoperative pain: a randomized clinical trial

As day case surgery increases, one needs to improve the management of pain in children at home. This study wished to determine whether the use of a self-report pain scale would result in children receiving more analgesia. Eighty-eight children aged four to 12 years undergoing tonsillectomy, whose parents agreed they could participate, were randomly assigned into two groups. Group A received the routine postoperative advice and a three-day prescription of paracetamol, ibuprofen and codeine. In addition, group B used the Wong-Baker Faces Pain Scale. Seventy-two children completed the study. There was no difference in the total number of analgesics administered to children in the two groups (p = 0.26, Mann- Whitney U-test). It appears that a self-report pain scale does not improve the postoperative management of pain in children at home.

Cold Dissection Versus Coblation‐Assisted Adenotonsillectomy in Children

To compare intraoperative efficiency and postoperative recovery between cold dissection adenotonsillectomy (CDA) and coblation-assisted adenotonsillectomy (CAA). A prospective, randomized, single-blind trial of pediatric patients aged 2 to 16 years undergoing adenotonsillectomy was conducted. Patients were randomized to undergo either CDA or CAA. Measured intraoperative parameters included surgical duration and intraoperative blood loss. Measured postoperative parameters included a 14 day caregiver questionnaire that recorded a daily pain rating using the Wong-Baker FACES pain scale, pain medication use, days to return to a normal diet, and days to return to a normal caregiver routine. Postoperative complications were also recorded. Intraoperative and postoperative measures were statistically compared between groups. Forty-six children with a mean age of 6.7 years (23 CDA and 23 CAA) were randomized and completed the study. Mean age and sex distributions were similar between groups (P > .05). Surgical times were significantly shorter for the CAA group versus the CDA group (11.2 min vs. 17.0 min, P < .001). Intraoperative blood loss was statistically lower for both the adenoidectomy and tonsillectomy portions of the procedure for the CAA group versus the CDA group (P < .001 and P < .001, respectively). There was no statistically significant difference in reported daily pain scores between groups (P = .296, analysis of variance). Both groups returned to normal diet (P = .982), and caregivers returned to their normal routine on similar postoperative days (P = .631). CAA offers better operative speed and intraoperative hemostasis as compared with CDA. However, CAA does not result in poorer postoperative pain scores or recoveries despite these intraoperative advantages.

Intramuscular and nerve root stimulation vs lidocaine injection to trigger points in myofascial pain syndrome

To compare the efficacies of an intramuscular stimulation technique and 0.5% lidocaine injection to trigger points in myofascial pain syndrome. Forty-three people with myofascial pain syndrome of the upper trapezius muscle. Twenty-two subjects were treated with intramuscular stimulation and another 21 with 0.5% lidocaine injection at all the trigger points on days 0, 7 and 14. Intramuscular stimulation resulted in a significant reduction in Wong-Baker FACES pain scale scores at all visits and was more effective than trigger point injection. Intramuscular stimulation also resulted in significant improvement on the Geriatric Depression Scale - Short Form. Local twitch responses occurred in 97.7% (42/43) of patients. All the passive cervical ranges of motion were significantly increased. Post-treatment soreness was noted in 54.6% of patients in the intramuscular stimulation group and 38.1% in the trigger point injection group, respectively, and gross subcutaneous haemorrhage (> 4 cm2) was seen in only one patient in the trigger point injection group. In managing myofascial pain syndrome, after one month intramuscular stimulation resulted in more significant improvements in pain intensity, cervical range of motion and depression scales than did 0.5% lidocaine injection of trigger points. Intramuscular stimulation is therefore recommended for myofascial pain syndrome.

Intravenous Patient-controlled Analgesia for Postoperative Pain Management in Patients with Cerebral Palsy

Purpose: The purpose of this study was to evaluate the safety and efficacy of intravenous patient-controlled analgesia (PCA) with fentanyl and ketorolac for postoperative pain management in patients with cerebral palsy. Materials and Methods: Sixty patients were categorized based on operation complexity into either a minor operation group or a major operation group, and then subdivided based on the analgesic methods used, i.e., intravenous PCA with fentanyl and ketorolac or intravenous pethidine injection. Pain intensity was assessed using the Wong-Baker's faces pain scale. Results: In the major operation group, patients that received PCA had significantly lower pain scores than those who received intravenous pethidine injection, while no significant differences in pain scores were observed in the minor operation group. Moreover, the side effects of these two analgesic methods did not differ significantly. Conclusion: Intravenous PCA with fentanyl and ketorolac is effective and safe for moderate to severe postoperative pain control in pediatric patients with cerebral palsy.

Managing acute postoperative pain: Is 3 hours too long?

This case study discusses a 64-year-old opioid-tolerant patient who underwent amputation below the left knee and received pain management in the PACU. The patient's self-reported pain level remained 9 on a 0 to 10 scale despite having received a total of 62 mg of morphine sulfate (MSO 4 ) and 60 mg of ketorolac in just less than 3 hours. The patient's facial expression corresponded to a score of 4 to 5 based on the Wong-Baker Faces Pain Scale. This case study illustrates that it is crucial to promptly involve the pain management service when an opioid-tolerant patient requires aggressive pain treatment. The initial patient-controlled analgesia (PCA) order and MSO 4 -loading doses must take into account the patient history of opioid tolerance, increasing the frequency and dosage-loading doses of MSO 4 for treating severe pain until the patient's pain is reduced by at least 50% on a numeric scale, or until the patient states satisfactory relief. The most important rule of pain management is that pain is what the patient says it is.

Oral Tramadol for the Treatment of Pain of 7–30 Days’ Duration in Children

Oral Tramadol for the Treatment of Pain of 7–30 Days’ Duration in Children

Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures

Objective: To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the...

Ameliorating adults' acute pain during phlebotomy with a distraction intervention

This study evaluated the effectiveness of a distraction intervention on subjects' perceptions of pain. During phlebotomy, 96 adults received either usual care or used a kaleidoscope as a distraction. After phlebotomy they rated their level of experienced pain with each of three instruments: Wong-Baker FACES Pain Scale, pain visual analogue scale, and Present Pain Intensity Scale. Statistical analyses revealed significantly lower perceptions of experienced pain among subjects using the kaleidoscope and concurrent validity for using the FACES Pain Scale with adults. Because the distraction intervention is effective, inexpensive, and easy to implement, its routine use during phlebotomy is recommended.

The effects of electro-acupuncture of distant segment point on the nociceptive responses of spinal neurons in the rat

Fibromyalgia (FMS) is a syndrome characterized by chronic widespread musculoskeletal pain, whose etiology is not completely understood. Different therapeutic approaches have been used with inconsistent results. This observation does not invalidate the continued search for alternative treatments aimed at improving quality of life (QoL) in FMS.This study compared three classical traditional Chinese medicine (TCM) therapies: acupuncture (AC), electroacupuncture (EAC) and moxibustion (MX) in the management of pain and promotion of QoL in FMS patients.A preliminary, group-assigned, comparative study enrolled 30 women, mean age (46.90±9.24) years (range 20–60 years), who met the 1990 American College of Rheumatology criteria for FMS diagnosis and a pain-pressure threshold (PPT) > 4 kg/cm2. The study was conducted in a teaching tertiary-care medical institution from May 2010 through April 2012. AC, EAC and MX were delivered for 30 min, once a week, for 8 weeks, bilaterally at Neiguan (PC6), Hegu (LI4), Yanglingquan (GB34), Sanyinjiao (SP6) and Taichong (LR3) acupoints.Each week, immediately before treatment and after treatment, subjects were tested for PPTs, Wong-Baker Faces Pain Scale (WBFPS; for pain intensity) and Medical Outcomes Study 36-item Short Form Health Survey (SF-36: for QoL).There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session. Significant improvement of QoL was perceived in vitality (after AC treatment) and in mental health (after EAC and MX treatments).TCM therapies (AC, EAC and MX) promoted an improvement in the QoL in two areas (vitality and mental health) in FMS women. Further large-scale clinical trials are required to confirm this effect.