Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment

Midwives and women's experiences of Sterile Water Injections for back pain during labour: An integrative review

BACKGROUND

/ OBJECTIVE: This integrative review summarises original research that explores the experiences and perceptions of midwives and women using sterile water injections (SWI's) during labour.

DESIGN

Integrative review.

METHODS

A robust search strategy was conducted using the following databases: Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Ovid Medline and PubMed. All articles were assessed for quality using the Joanna Briggs Institute Critical Appraisal Tools (2017) scoring. Whittemore and Knafl's (2005) five stage approach was used to analyse the primary literature related to midwives and women's experiences of sterile water injections (SWI's) for back pain during labour.

FINDINGS

A total of 291 articles were retrieved and 13 papers were included in this review (four qualitative including one case report and nine quantitative) that fulfilled the inclusion criteria. Three overarching themes were identified: 'Assessment, perception and communication of pain', 'Techniques of administration of SWI's' and 'Barriers and resistance to using SWI's'. The 'Assessment, perception and communication of pain' theme included four subthemes: 'balancing the expectation of the injection pain against pain relief'; 'using appropriate language to prepare women'; 'rapid onset and increased pain relief with SWI's in comparison to saline'; and 'midwives high considerations for using SWI's as a form of pain relief'. The 'Techniques of administration of SWI's' theme included two subthemes: 'intradermal is better than subcutaneous injections'; and, 'four injections is better than one'. The 'Barriers and facilitators to using SWI's' theme included four subthemes: 'guidelines and evidence'; 'level of experience'; 'midwifery philosophy challenges'; and 'resistance from colleagues'. For example, 'midwifery philosophy challenges' included midwives being conflicted about providing an invasive, painful procedure as counter-intuitive to supporting women through the pain of labour. Midwives need opportunities to learn and develop skills for using SWI's. Women described feeling more empowered during their labour and appreciated the use of SWI's including the rapid onset of pain relief and the absence of side effects. The ability for women to exert some control over their pain whilst still being able to experience the physical sensations of labour and birth was important.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The review supports the evidence for the use of SWI's however, there is limited evidence available and more information needs to be provided about the benefits of this non-pharmacological technique for back pain during labour. Generalised guidelines are needed to ensure consistent practice in the provision of care for women experiencing back pain during labour.

Response scale selection in adult pain measures: results from a literature review

Background

The purpose of this literature review was to examine the existing patient-reported outcome measurement literature to understand the empirical evidence supporting response scale selection in pain measurement for the adult population.

Methods

The search strategy involved a comprehensive, structured, literature review with multiple search objectives and search terms.

Results

The searched yielded 6918 abstracts which were reviewed against study criteria for eligibility across the adult pain objective. The review included 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles providing insights into optimal response scale selection for pain assessment in the adult population. Based on the extensive and varied literature on pain assessments, the adult pain studies typically use simple response scales with single-item measures of pain—a numeric rating scale, visual analog scale, or verbal rating scale. Across 42 review articles, consensus guidelines, expert opinion pieces, and primary research articles, the NRS response scale was most often recommended in these guidance documents. When reviewing the empirical basis for these recommendations, we found that the NRS had slightly superior measurement properties (e.g., reliability, validity, responsiveness) across a wide variety of contexts of use as compared to other response scales.

Conclusions

Both empirical studies and review articles provide evidence that the 11-point NRS is likely the optimal response scale to evaluate pain among adult patients without cognitive impairment.

Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards

BACKGROUND

A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented.

METHODS

This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden.

RESULTS AND CONCLUSION

The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way.

Midwifery students' conceptions of worst imaginable pain

BACKGROUND

The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'.

METHODS

A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis.

RESULTS

Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering.

CONCLUSIONS

The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse.

Association between anxiety and pain in the latent phase of labour upon admission to the maternity hospital: a prospective, descriptive study

This study investigated the association between anxiety experienced by the mother, a request for analgesia, and the level of pain at maternity hospital admission in early labour. Anxiety levels were measured by the State-Trait Anxiety Inventory and pain was assessed using a Visual Analogue Scale. Anxiety and Visual Analogue Scale scores were compared using a linear regression model and indicated a statistically significant association between the anxiety state and degree of pain (p < 0.016; Y = 0.895 x score + 32.656). There was no significant association between anxiety and a request for epidural analgesia. During labour, an evaluation of anxiety should be associated with an assessment of the perceived degree of pain.

The current use of acupuncture during pregnancy and childbirth

PURPOSE OF REVIEW

Acupuncture has a growing clientele during pregnancy, delivery and the puerperium for an ever increasing list of indications. Objective evidence for its benefit is necessary to establish its roles in current practice.

RECENT FINDINGS

For many of the current uses, randomized studies when conducted using at least one control group have not established any clear advantages from treatment. Those areas which rely upon subjective assessment of symptoms are particularly difficult to investigate without rigorous blinding strategies, separating those who provide the acupuncture from those assessing outcome. Studies investigating the possible therapeutic benefit of acupuncture for managing intrapartum care require outcomes for nulliparae and multiparae to be analysed separately.

SUMMARY

Acupuncture therapy may offer some advantage over conventional treatment in the management of hyperemesis gravidarum and postcaesarean section pain and these areas warrant further study. Rigorous randomized studies, particularly those using objective measures, have failed to identify any obvious benefits from acupuncture for many of the other conditions studied.

Quality of life in dermatomyositis

BACKGROUND

Quality of life (QoL) for patients with inflammatory skin disease can be significant, but has been evaluated in just one study in dermatomyositis (DM).

OBJECTIVE

We sought to examine the relationship between the Cutaneous Dermatomyositis Area (CDASI) and Severity Index, a DM-specific cutaneous severity instrument, and various QoL study instruments and to determine the impact of DM on QoL.

METHODS

Skin-specific QoL instruments, the Skindex and the Dermatology Life Quality Index, and global medical QoL instruments, the Short Form 36 and the Health Assessment Questionnaire-Disability Index, were used. Pruritus was evaluated by a visual analog scale and a 0-to-10 scale in DM and cutaneous lupus erythematosus (CLE) populations, respectively.

RESULTS

There was a significant correlation between the CDASI and all skin-specific QoL scores (lowest P = .0377). Using the Short Form 36, DM population was found to have significantly worse QoL scores than the general population with the exception of bodily pain (all subscore P values < .01). Furthermore, DM had a significantly lower vitality score, representing energy level, compared with CLE, hypertension, diabetes, and recent myocardial infarction scores (lowest P = .003). There was a significantly lower mental health score, representing overall mood, to all compared diseases except CLE and clinical depression (P values < .01 when significant). We found that DM produces more pruritus than CLE (P < .0001).

LIMITATIONS

A larger patient population needs to be studied to further assess QoL in patients with DM.

CONCLUSION

We conclude that DM has a large impact on QoL, even when compared with other diseases, and that DM skin disease activity correlates with a poorer QoL.