Prevalence and correlates of pain and pain treatment in a western Kenya referral hospital

Practice of Nonpharmacological Pain Control Strategies Among Nurses Working in Public Hospitals of West Arsi Zone, Ethiopia

Background

Nonpharmacological pain control strategies combine numerous strategies that contain nondrug measures for pain remedies for sufferers.

Objective

To assess the practice of nonpharmacological pain control strategies among nurses working in public hospitals of West Arsi zone, Ethiopia, 2022.

Methods

An institutional-based cross-sectional study design was employed from April 15 to May 30, 2022. The total sample size was 422 and a simple random sampling technique was used. Data were entered using Epi-information 4.6 version and analyzed using SPSS version 25. Multicollinearity was checked by considering the variance inflation factor and tolerance. The goodness of fit test was done using the Hosmer-Lemeshow goodness of fit check. Binary logistic regression analysis was done and variables with a p-value of < 0.25 within the bivariable analysis were taken into the multivariable analysis. Statistical significance was declared at a p-value of < 0.05 with an adjusted odds ratio (AOR) and 95% confidence interval (CI).

Result

The practice of nonpharmacological pain control strategies was 53.8% (95% CI: 48.9-58.7). Age of 30-39 years old (AOR: 2.28, 95% CI: 1.34-3.86), educational status bachelor's degree (AOR: 2.25, 95% CI: 1.47-4.45), marital status married (AOR: 0.46, 95% CI: 0.28-0.73), and having training (AOR: 1.98, 95% CI: 1.23-3.17) were found to be significantly associated with practice of nonpharmacological pain control strategies.

Conclusion

About five in 10 nurses working in West Arsi zone public hospitals had good practice of nonpharmacological pain control strategies. Age, educational status, marital status, and training were found to be significantly associated with practice. Therefore, improving the educational status of nurses through various opportunities such as continued professional development and regular updating, and training nurses about methods may increase the nurses' practice toward nonpharmacological pain control strategies.

"It is difficult for us to treat their pain". Health professionals' perceptions of Somali pastoralists in the context of pain management: a conceptual model

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals' perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals' perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. 'Patient-professional relationship' was the core category we identified within the conceptual model. This category was closely linked with issues of '(mis)trust' and 'communication (barriers)'. 'Patient-related conditions' (eg, (under)-reporting of pain, care preferences and beliefs) and 'health professional-related' conditions' (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.

Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study

INTRODUCTION

Pain is unpleasant sensory and emotional experiences associated with actual and/or potential tissue damage. It is the most common and prevalent reason for emergency departments (ED) visits with prevalence over 70% in the world.

AIM OF THE STUDY

The study aimed to assess the adequacy and appropriateness of pain management at Aabet Hospital, Addis Ababa, Ethiopia.

METHODS

A hospital-based prospective cross-sectional study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult trauma patients having pain (at least score 1 on Numeric Rating Scale) with Glasgow Coma Scale score > 13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission (o minute) and then at 60, 120, 180, and 240 minutes. The time of the first analgesics was registered. The adequacy and the appropriateness of the pain management were calculated through pain management index (PMI).

RESULTS

Two hundred thirty-two (232) participants were included in this study of which 126 (54.3%) were admitted due to road traffic accident followed by fall 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment at all within 240 minutes. The mean pain intensity score at admission was 5.55 ± 2.32 and reduced to 4.09 ± 2.69. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score). There was a weak and negative correlation between PMI and time to analgesia (r = - .159, p = 0.0001). The type of analgesia used, the time to analgesia, and the degree of pain may predict 65% of the variance in PMI score (R2 = 0.65, P = .001).

CONCLUSION

From the results of this study, it can be concluded that acute pain in trauma patients was under and inappropriately treated.

Increasing pain prevalence and intensity among middle-aged and older adults: Evidence from the German Ageing Survey

OBJECTIVE

Pain is a very common chronic condition in late life that is associated with poorer quality of life and greater functional restrictions. Little is known regarding temporal trends in pain prevalence and pain intensity. Therefore, we estimated trends in pain prevalence and intensity over time among German middle-aged and older adults.

METHODS

We used two independent samples drawn in different years from the German Ageing Survey, which is a nationwide population-representative study with a cohort-sequential design. Specifically, a sample of individuals aged 40-85 years who were assessed in 2008 (n = 5961) was compared with a sample of individuals with the same age range who were assessed in 2014 (n = 5809). Individuals were asked if and to what extent they had experienced constant or recurrent pain within the past four weeks. χ² tests and regression analyses were computed.

RESULTS

In 2008, about 44% of all individuals reported suffering from at least very mild pain. In 2014, this proportion was higher by about 7%. Controlling for chronological age, gender, education, region of residence (West vs. East Germany), depressive symptoms, chronic diseases, BMI, and physical activity, the difference in pain prevalence and pain intensity between the samples remained statistically significant.

CONCLUSION

Our data suggest an increase in the prevalence and intensity of pain among middle-aged and older German adults between 2008 and 2014, which remained statistically significant when controlling for socio-demographic and health-related indicators. Further research is needed to identify the factors underlying this increasing pain prevalence and pain intensity in order to counteract this negative temporal trend.

Practice of Postoperative Pain Management in Under-Five Children in A Tertiary Hospital: A Prospective Crossectional Study

Background

Despite advancements in pain management, children have remained undertreated for postoperative pain. Data regarding the practice of post-operative pain management in paediatric patients remains less available in the developing world. This study was aimed at evaluating practice of postoperative pain management in under five children.

Methods

A prospective cross sectional one-year study was conducted on all paediatric patients who underwent major paediatric surgical procedures from February 1, 2020 to January31, 2021, at a tertiary hospital in Addis Ababa, Ethiopia.

Result

A single type of analgesic medication was used in 67.1% patients. Analgesic medications were administered on standing base only in 64.4% of patients. Patients' charts had no documentation of pain assessment both in the neonatal intensive care units and wards.32.89 % of assessed patients had moderate to severe pain record.

Conclusion

Significant number of patients suffer from postoperative pain because of absence of proper pain assessment and inadequate administration of analgesic medication.

Palliative and End-of-Life Care Self-perceived Educational Needs of Physicians and Nurses in Rwanda

Palliative care access is an urgent and ethical imperative to effectively manage the increasing burden of serious health-related suffering worldwide. Understanding the palliative care educational needs of health care professionals is critical to support evidence-based clinical practice in Rwanda and other low- and middle-income countries. A cross-sectional study was conducted at 5 hospitals in Kigali, Rwanda, to assess the palliative/end-of-life educational needs of nurses and physicians. The End-of-Life Professional Caregiver Survey and a demographic form were used to collect data. Descriptive analyses and independent t tests were conducted. A total of 420 health care professionals participated in the study (response rate, 72%). Participants perceived their knowledge and skills in providing palliative/end-of-life care as low. Those who received palliative/end-of-life care training in the past 5 years, third- and fourth-year residents, and health care providers with 5 years of experience or more had significantly higher (P ≤ .05) mean scores on the End-of-Life Professional Caregiver Survey. Nurses scored higher than physicians in the patient- and family-centered communication (P = .049) and cultural and ethical values (P = .037) subscales. Pain management was identified as an educational need by 77% of participants. Our survey suggests the need for increased governmental investments in palliative/end-of-life care education among nurses and physicians in Rwanda.

Use of Virtual Reality Distraction to Reduce Child Pain and Fear during Painful Medical Procedures in Children with Physical Disabilities in Uganda: A feasibility study

OBJECTIVE

This study explored the acceptability and feasibility of the use of low-cost virtual reality (VR) glasses, and the Wong-Baker Faces Pain Scale and Children's Fear Scale scales, for pain and fear reduction in children admitted at the septic ward of CoRSU Rehabilitation Hospital in Uganda.

METHODS

In total 79 children aged 4 to 17 years of age were offered to watch cartoons using VR glasses while undergoing painful dressing procedures. Before and after the procedure children were asked to index current pain; children and their caregivers were asked to rate anticipated fear. Focus group discussions with 13 children, 10 caregivers and 9 nurses explored acceptability and feasibility. Quantitative data were analysed using STATA15, NVIVO12 was used for qualitative data analysis.

RESULTS

The VR glasses were accepted by 76 (96%) of the children. Children, caregivers, and nurses mentioned the glasses were helpful in distracting children from the medical procedure, and felt the use of the glasses helped reduce child fear and pain. Nurses felt it made their work easier. The Wong-Baker Faces Pain Scale was an acceptable and feasible method to measure pain, whilst the Children's Fear Scale was more difficult to interpret for our study population as they felt the faces on the scale were hard to read and identify with.

CONCLUSIONS

The use of VR glasses may offer an acceptable and effective pain and fear reduction method in resource-constrained settings and should be further explored in a randomized controlled trial.

Knowledge and Attitude Towards Non-Pharmacological Pain Management and Associated Factors Among Nurses Working in Benishangul Gumuz Regional State Hospitals in Western Ethiopia, 2018

BACKGROUND

Millions of people worldwide are suffering from pain. Non-pharmacological therapy has an important role in the treatment of pain and is recognized as a valuable, simple help to lower the dosage of analgesic drugs needed, decreasing the side effects, reducing drug dependency and reducing health care costs; however, knowledge and attitude of nurses greatly affect the use of non-pharmacological pain management methods.

OBJECTIVE

The study aimed to assess knowledge and attitude towards non-pharmacological pain management and associated factors among nurses working in Benishangul Gumuz Regional State Hospitals, western Ethiopia, 2018.

METHODS

Institution-based cross-sectional study was conducted from April 1st to May 1st, 2017. Two hundred sixteen nurses were selected by using simple random sampling. Data were collected by using a pretested self-administered structured questionnaire. Collected data were checked, coded and entered to Epi-Info version 7 and exported to SPSS version 20 for further analysis. Bivariable and multivariable logistic regression was used.

RESULTS

A total of 209 professional nurses participated in the study, a 96.7% response rate. This study shows that 51.2% (95% CI: 51.1-51.3) of nurses had adequate knowledge and 47% (95% CI: 46.9-47.06) of nurses had a favorable attitude towards non-pharmacological pain management. The findings reveal that level of qualification (AOR=12.2 (3.05, 48.4)), taking educational courses (AOR=7.5 (2.7, 21.24)), nurse to patient ratio (AOR=4.9 (1.64, 14.55)) and work experience were factors significantly associated with knowledge. Findings also show that nurse to patient ratio (AOR=10.36 (2.8, 38.4)), training (AOR=4.6 (1.4, 15.4)) and knowledge of non-pharmacological pain management (AOR=4.3 (1.74, 10.56)) were significantly associated with nurses' attitude to non-pharmacological pain management.

CONCLUSION AND RECOMMENDATIONS

Nurses in Benishangul Gumuz regional state hospitals have unfavorable attitude, but they have relatively adequate knowledge about non-pharmacological pain management. Work experience, level of education, nurse to patient ratio and taking educational courses were associated with nurses' knowledge, and nurse to patient ratio, training, and knowledge of non-pharmacological pain management were associated with nurses' attitude. Therefore, efforts should focus on innovative educational strategies for nurses, training and achieving a 1:6 nurse to patient ratio.

Quality of life assessments in a cohort of Mozambican children with sickle cell disease

Introduction

sickle cell disease (SCD) has significant pediatric morbidity and mortality in sub-Saharan Africa, where access to therapies such as hydroxyurea and opioids is often limited. Poor disease control and Pain management adversely affects the well-being and mental health of affected children. Questionnaires have been utilized in other regions to report the quality of life (QOL) in children with SCD, but assessments from Africa are lacking.

Methods

children age 2-14 years with SCD presenting for routine outpatient consultations at Hospital Central de Maputo from June-August 2017 were offered participation. After informed consent, the Pediatric QOL Inventory (PedsQL) SCD Module was administered to all caregivers and children > 5 years. Responses were scored from 0-100, with higher scores representing better QOL.

Results

a total of 14 children were included, with six (43%), four (29%), two (14%), and two (14%) from the age groups of 2-4, 5-7, 8-12, and 13-14 years, respectively. Mean overall patient QOL was 65.3 and 56.0 in child and caregiver respondents. In patients > 5 years, the difference in mean overall QOL for those on/not on hydroxyurea was 0.6 (66.5-64.9) in child respondents and 15.8 (68.4-52.6) in caregiver respondents. Domains related to worry/emotions and communication scored lower in QOL than Pain-related domains for both patient and caregiver respondents.

Conclusion

SCD has a negative impact on QOL as reported by this cohort of Mozambican pediatric patients and caregivers, with Pain being less of a concern than emotional and interpersonal issues. A comprehensive, child-focused care approach with robust psychosocial support is needed.

Prevalence and factors associated with poor self-rated health among communitydwelling older adults in Lomé (Togo) in 2019

The number of older adults is increasing worldwide, including in sub-Saharan Africa (SSA). However, there is a paucity of data on the overall health status of older adults living in SSA. To assess the prevalence and factors associated with poor Self-Rated Health (SRH) among community-dwelling older adults in Lomé, Togo, we conducted a cross-sectional study from January to June 2019 in Lomé among community-dwelling older adults aged 50 years and older. A 30- minute questionnaire was used to collect socio-demographic characteristics, medical history, patterns of medication use and use of herbal products and dietary supplements during a face-to-face interview. SRH was assessed using a single item: Overall, you would say that your health is… (1) excellent, (2) very good, (3) good, (4) fair and (5) poor with response fair or poor defining poor SRH. A total of 344 respondents with median age 63 years, (IQR: 55-72) were enrolled in the study. Women represented 57.6% of the sample. Overall prevalence of poor SRH was 56.4% (95%CI: 51.0-61.9) and was the highest among females (62.6% vs 47.9%; P=0.007) and participants ³60 years (61.5% vs 51.1%; P=0.021). Female sex, aged ≥60 years, osteoarthritis, hospitalization within the 12 months preceding the survey, polypharmacy, and the use of herbal products were factors associated with poor SRH (P<0.05). More than half of community- dwelling older adults had poor SRH in Lomé. Further studies are needed to guide policymakers in their efforts to design and implement meaningful policies to improve older adults health conditions.

Long-term results of reconstructing the joints' articular surface in the knee and ankle with the surgical diamond instrumentation (SDI)

PURPOSE

The surgical diamond instrumentation (SDI), a precise wet-grinding technology, promised contact healing of press-fit inserted bone and even hyaline cartilage, lacks medium- and long-term results. This retrospective study was conducted to identify risk factors associated with the failure of the technique and the subjective patient outcome.

METHODS

All patients treated for cartilage defects of the knee or ankle joint using the SDI technology between 2000 and 2012 with a follow-up > 1 year were included. Patients with general joint diseases or joint-related procedures, except for corrective osteotomies, were excluded. A standardized questionnaire (EQ-5D) and a questionnaire-based patient-reported outcome survey were used. Descriptive statistics were applied. A multivariate analysis examining risk factors for joint failure was performed. A p value < 0.05 was considered to indicate significant differences.

RESULTS

87 patients with autologous osteochondral transplantation (68 knee, 19 ankle) were included. The median age was 53 years (IQR 37.5-63.0 years) for knee and 36 years (IQR 27.5-54.0 years) for ankle joints. 57.9% of knee and 55.6% of ankle patients were female. Nine patients (8 knee, 1 ankle) had received arthroplasty. 93.3% of knee and 83.3% of ankle patients had an excellent function or minor disabilities. 73.3% of knee and 64.7% of ankle patients did not require pain medication. The mean EQ-5D score was 0.84 for knee and 0.77 for ankle. Patients with higher age were more likely to receive arthroplasty (p = 0.022).

CONCLUSIONS

The SDI technique provides promising results with excellent joint survival rates and satisfying patient-reported outcomes. Failure of the technique might be associated with higher age.

An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital

INTRODUCTION

Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries.

OBJECTIVES

This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa.

METHOD

A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa.

RESULTS

Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores.

CONCLUSION

The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.

Nursing students and nurses' knowledge and attitudes regarding children's pain: A comparative cross-sectional study

INTRODUCTION

Nurses encounter children who report of pain of diverse and unknown causes in their professional work. The current study therefore assessed and compared nursing students and nurses' knowledge and attitudes pertaining to children's pain in the Ghanaian context. The goal of this was to have a baseline information to guide the development and implementation of the content for a sustainable educational programme (short-course) for nursing students and nurses in Ghana.

METHODS

Between October and December 2018, a cross-sectional study was carried out among 554 final year nursing students and 65 nurses in Ghana. The Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PNKAS) was used to collect data from participants who were affiliated to four educational institutions and eight hospitals. Data were descriptively and inferentially analyzed using chi-square test of independence, independent samples t-test and one-way analysis of variance (ANOVA).

RESULTS

Our findings revealed that nursing students and nurses generally had unsatisfactory knowledge and attitudes towards pain management in children. Nursing students however, had significantly higher scores than nurses in the total PNKAS score and in 10 out of the 13 identified item-areas. Greater scores were obtained by nursing students in areas which were related to pain physiology, pharmacokinetics, pharmacology of analgesics and pain perceptions (p < .05). All the participating nurses could not accurately determine: the onset of action of orally administered analgesics, equianalgesia of orally administered morphine, and the right dosage of prescribed morphine for a child who consistently reported of moderate to severe pain.

CONCLUSION

Final year nursing students and nurses have unsatisfactory knowledge and attitudes regarding children's pain; which reiterates the need for urgent and effective educational efforts in this area. Regular in-service training should be offered to post-registration nurses to enhance their pediatric pain knowledge and attitudes for improved pain care in children.

Tramadol: a valuable treatment for pain in Ghana and Nigeria

OBJECTIVE

Pain management is unsatisfactory worldwide, particularly in developing countries where access to opioids is restricted and cost is an issue. It is a major concern in West Africa and we therefore undertook a survey of pain experts to obtain a better understanding of the problems in the region.

METHODS

Medical practitioners involved in pain management, identified via professional networks, were interviewed to share their experience in treating moderate-to-severe pain in West Africa. The questionnaire was based on an existing version modified to meet African conditions. Additionally, informal focus group meetings with palliative care physicians and pharmacists were conducted.

RESULTS

A total of 11 questionnaires were returned. All respondents were physicians who reported availability of opioids in their clinics, but access to morphine was challenging and not possible in some rural settings. Obligatory maintenance of detailed records was considered a burden. The main concern raised was the risk of misuse/addiction. Seven of 11 respondents reported that they would use tramadol as an alternative to strong opioids if required and, interestingly, 9 of 11 considered it to be an essential medicine. Based on personal experience, the respondents noted that some properties of tramadol make it a key pain treatment option in West Africa (strong/fast-acting, better tolerated than NSAIDs, less addictive than other opioids and relatively inexpensive).

CONCLUSIONS

Most stakeholders who completed the survey indicated that tramadol was essential to provide optimal pain management in the absence of access to strong opioids.

Acute Pain in the African Prehospital Setting: A Scoping Review

Background

Acute pain is a common reason for seeking prehospital emergency care. Regrettably, acute pain is often underestimated and poorly managed in this setting. The scoping review was conducted to gain insight into existing research on the topic and to make recommendations for future work.

Objectives

To identify all available evidence related to acute pain assessment and management in the African prehospital setting, describe the extent of the evidence, encapsulate findings, and identify research gaps.

Methods

The scoping review considered primary and secondary research related to acute pain assessment and management of both medical and traumatic origins in all age groups in the African prehospital setting. The search strategy aimed to identify published, unpublished, and ongoing research which met the inclusion criteria. Potentially eligible studies were identified by a comprehensive search of electronic databases, trial registers, dissertation/thesis databases, grey literature databases, and conference proceedings. Screening and data extraction were conducted independently and in duplicate.

Results

The comprehensive search identified 3823 potential studies, duplicate titles were removed, and 3358 titles/abstracts were screened. Full text of 66 potentially eligible titles was screened, 60 were excluded, and six publications met the inclusion criteria. Despite recommendations for pain assessment during general patient care, most studies reported no/limited pain assessment. In general, pain management was concluded to be insufficient and not conforming to best practice.

Conclusions

Only six publications addressing prehospital acute pain care in Africa could be identified, possibly indicative of a knowledge gap. Future research is indicated to enable a better understanding of the epidemiology of acute pain and barriers and enablers of acute pain care and to develop evidence-based clinical practice guidelines (CPGs) catering for all EMS systems in Africa. Additionally, educational initiatives should be implemented to improve the quality of acute pain care and to monitor quality through continuous quality improvement (CQI) programs.

Is symptom prevalence and burden associated with HIV treatment status and disease stage among adult HIV outpatients in Kenya? A cross-sectional self-report study

People with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio .45, 95% CI .23 to .88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth ^"90" in the UNAIDS 90-90-90 targets (that is good quality of life).

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.

Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda

Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.

Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale: "Revised" in Cameroon

The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.

Altered Associations between Pain Symptoms and Brain Morphometry in the Pain Matrix of HIV-Seropositive Individuals

Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p < 0.001), suggest adequate pain treatment would lead to better quality of life in all participants.

Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America

AIM

Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents.

MATERIALS & METHODS

A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies.

RESULTS

Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids.

CONCLUSION

This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.

Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya

PURPOSE

The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital.

METHODS

This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement.

RESULTS

This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services.

CONCLUSION

Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.