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Gouverneur P, Badura A, Li F, Bieńkowska M, Luebke L, Adamczyk WM, Szikszay TM, Myśliwiec A, Luedtke K, Grzegorzek M, Piętka E. An Experimental and Clinical Physiological Signal Dataset for Automated Pain Recognition. Sci Data 2024; 11:1051. [PMID: 39333541 PMCID: PMC11436824 DOI: 10.1038/s41597-024-03878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 09/11/2024] [Indexed: 09/29/2024] Open
Abstract
Access to large amounts of data is essential for successful machine learning research. However, there is insufficient data for many applications, as data collection is often challenging and time-consuming. The same applies to automated pain recognition, where algorithms aim to learn associations between a level of pain and behavioural or physiological responses. Although machine learning models have shown promise in improving the current gold standard of pain monitoring (self-reports) only a handful of datasets are freely accessible to researchers. This paper presents the PainMonit Dataset for automated pain detection using physiological data. The dataset consists of two parts, as pain can be perceived differently depending on its underlying cause. (1) Pain was triggered by heat stimuli in an experimental study during which nine physiological sensor modalities (BVP, 2×EDA, skin temperature, ECG, EMG, IBI, HR, respiration) were recorded from 55 healthy subjects. (2) Eight modalities (2×BVP, 2×EDA, EMG, skin temperature, respiration, grip) were recorded from 49 participants to assess their pain during a physiotherapy session.
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Affiliation(s)
- Philip Gouverneur
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Aleksandra Badura
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800, Zabrze, Poland
| | - Frédéric Li
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Maria Bieńkowska
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800, Zabrze, Poland
| | - Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Wacław M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Mikołowska 72a, 40-065, Katowice, Poland
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Andrzej Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Mikołowska 72a, 40-065, Katowice, Poland
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- German Research Center for Artificial Intelligence (DFKI), Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Ewa Piętka
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800, Zabrze, Poland
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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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Boring BL, Walsh KT, Ng BW, Schlegel RJ, Mathur VA. Experiencing Pain Invalidation is Associated with Under-Reporting of Pain: A Social Psychological Perspective on Acute Pain Communication. THE JOURNAL OF PAIN 2024; 25:104428. [PMID: 37984509 DOI: 10.1016/j.jpain.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Pain invalidation involves the dismissal or lack of understanding of another's pain, undermining their subjective experience. Frequent exposure to invalidation negatively impacts mental and physical health as well as pain-related behaviors, potentially leading people to conceal their pain from others in the future and/or withdraw from potential sources of support. It is therefore possible that experiencing pain invalidation may also impact pain-reporting behavior in clinical settings. Across 2 separate samples of emerging adults, we examined whether exposure to invalidation of one's pain was associated with cognizant modulation of one's subjective acute pain ratings within routine medical and dental settings. Drawing upon social psychological theories of impression management and self-presentation, we hypothesized that exposure to pain invalidation would be associated with the under-rating of one's pain. In Study 1, previous experiences of invalidation were associated with under-rating of one's pain when visiting the doctor and the dentist. Study 2 found that invalidation from family and medical professionals-but not from friends-was associated with under-rating pain in both settings. Findings provide further evidence for the harmful effects of pain invalidation, particularly for emerging adults, as the dismissal of one's subjective experience may sow self-doubt while reinforcing cultural stigmas against pain, leading to alterations in pain communication that ultimately creates barriers to efficacious clinical treatment and care and increase pain-related suffering. PERSPECTIVE: Pain invalidation imparts harm to those who already suffer from pain, be it mentally, physically, and/or behaviorally. We show that people who have encountered invalidation are more likely to under-rate their pain when seeking care, impeding assessment and treatment, and further highlighting the importance of clinical validation of pain experiences.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Brandon W Ng
- Department of Psychology, University of Richmond, Richmond, Virginia
| | - Rebecca J Schlegel
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, College Station, Texas
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Borten JBL, Barros MCM, Silva ES, Carlini LP, Balda RCX, Orsi RN, Heiderich TM, Sanudo A, Thomaz CE, Guinsburg R. Looking through Providers' Eyes: Pain in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e3242-e3248. [PMID: 37973154 DOI: 10.1055/a-2212-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Evaluate the pain of critically ill newborns is a challenge because of the devices for cardiorespiratory support. This study aim to verify the adults' gaze when assessing the critically ill neonates' pain at bedside. STUDY DESIGN Cross-sectional study in which pediatricians, nursing technicians, and parents evaluated critically ill neonates' pain at bedside, for 20 seconds with eye-tracking glasses. At the end, they answered whether the neonate was in pain or not. Visual tracking outcomes: number and time of visual fixations in four areas of interest (AOI) (face, trunk, and upper [UL] and lower [LL] limbs) were compared between groups and according to pain perception (present/absent). RESULTS A total of 62 adults (21 pediatricians, 23 nursing technicians, 18 parents) evaluated 27 neonates (gestational age: 31.8 ± 4.4 weeks; birth weight: 1,645 ± 1,234 g). More adults fixed their gaze on the face (96.8%) and trunk (96.8%), followed by UL (74.2%) and LL (66.1%). Parents performed a greater number of fixations on the trunk than nursing technicians (11.0 vs. 5.5 vs. 6.0; p = 0.023). Controlled for visual tracking variables, each second of eye fixation in AOI (1.21; 95% confidence interval [CI]: 1.03-1.42; p = 0.018) and UL (1.07; 95% CI: 1.03-1.10; p < 0.001) increased the chance of perceiving the presence of pain. CONCLUSION Adults, when assessing at bedside critically ill newborns' pain, fixed their eyes mainly on the face and trunk. The time spent looking at the UL was associated with the perception of pain presence. KEY POINTS · Pain assessment in critically ill newborns is a challenge.. · To assess critically ill neonates' pain, adults mainly look at the face and trunk.. · Looking at the upper limbs also helps in assessing critically ill neonates' pain..
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Affiliation(s)
- Julia B L Borten
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marina C M Barros
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erica S Silva
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas P Carlini
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Rita C X Balda
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rafael N Orsi
- Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tatiany M Heiderich
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Adriana Sanudo
- Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carlos E Thomaz
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Emam OS, Eldaly AS, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Anne Brown S, Haider CR, Forte AJ. Machine Learning Algorithms Predict Long-Term Postoperative Opioid Misuse: A Systematic Review. Am Surg 2024; 90:140-151. [PMID: 37732536 DOI: 10.1177/00031348231198112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION A steadily rising opioid pandemic has left the US suffering significant social, economic, and health crises. Machine learning (ML) domains have been utilized to predict prolonged postoperative opioid (PPO) use. This systematic review aims to compile all up-to-date studies addressing such algorithms' use in clinical practice. METHODS We searched PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science using the keywords "machine learning," "opioid," and "prediction." The results were limited to human studies with full-text availability in English. We included all peer-reviewed journal articles that addressed an ML model to predict PPO use by adult patients. RESULTS Fifteen studies were included with a sample size ranging from 381 to 112898, primarily orthopedic-surgery-related. Most authors define a prolonged misuse of opioids if it extends beyond 90 days postoperatively. Input variables ranged from 9 to 23 and were primarily preoperative. Most studies developed and tested at least two algorithms and then enhanced the best-performing model for use retrospectively on electronic medical records. The best-performing models were decision-tree-based boosting algorithms in 5 studies with AUC ranging from .81 to .66 and Brier scores ranging from .073 to .13, followed second by logistic regression classifiers in 5 studies. The topmost contributing variable was preoperative opioid use, followed by depression and antidepressant use, age, and use of instrumentation. CONCLUSIONS ML algorithms have demonstrated promising potential as a decision-supportive tool in predicting prolonged opioid use in post-surgical patients. Further validation studies would allow for their confident incorporation into daily clinical practice.
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Affiliation(s)
- Omar S Emam
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Abdullah S Eldaly
- Department of General Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Sally Anne Brown
- Department of Administration, Mayo Clinic, Jacksonville, FL, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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da Silva GV, Pivato GM, Peres BG, Luna SPL, Pairis-Garcia MD, Trindade PHE. Simplified assessment of castration-induced pain in pigs using lower complexity algorithms. Sci Rep 2023; 13:21237. [PMID: 38040949 PMCID: PMC10692155 DOI: 10.1038/s41598-023-48551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023] Open
Abstract
Pigs are raised on a global scale for commercial or research purposes and often experience pain as a by product of management practices and procedures performed. Therefore, ensuring pain can be effectively identified and monitored in these settings is critical to ensure appropriate pig welfare. The Unesp-Botucatu Pig Composite Acute Pain Scale (UPAPS) was validated to diagnose pain in pre-weaned and weaned pigs using a combination of six behavioral items. To date, statistical weighting of supervised and unsupervised algorithms was not compared in ranking pain-altered behaviors in swine has not been performed. Therefore, the aim of this study was to verify if supervised and unsupervised algorithms with different levels of complexity can improve UPAPS pain diagnosis in pigs undergoing castration. The predictive capacity of the algorithms was evaluated by the area under the curve (AUC). Lower complexity algorithms containing fewer pain-altered behaviors had similar AUC (90.1-90.6) than algorithms containing five (89.18-91.24) and UPAPS (90.58). In conclusion, utilizing a short version of the UPAPS did not influence the predictive capacity of the scale, and therefore it may be easier to apply and be implemented consistently to monitor pain in commercial and experimental settings.
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Affiliation(s)
- Gustavo Venâncio da Silva
- Laboratory of Applied Artificial Intelligence in Health (LAAIH), Department of Anesthesiology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Giovana Mancilla Pivato
- Laboratory of Applied Artificial Intelligence in Health (LAAIH), Department of Anesthesiology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Beatriz Granetti Peres
- Laboratory of Applied Artificial Intelligence in Health (LAAIH), Department of Anesthesiology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Stelio Pacca Loureiro Luna
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Monique Danielle Pairis-Garcia
- Global Production Animal Welfare Laboratory, Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA
| | - Pedro Henrique Esteves Trindade
- Laboratory of Applied Artificial Intelligence in Health (LAAIH), Department of Anesthesiology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.
- Global Production Animal Welfare Laboratory, Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA.
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Dreismickenbecker E, Zinn S, Romero-Richter M, Kohlhaas M, Fricker LR, Petzel-Witt S, Walter C, Kreuzer M, Toennes SW, Anders M. Electroencephalography-Based Effects of Acute Alcohol Intake on the Pain Matrix. Brain Sci 2023; 13:1659. [PMID: 38137107 PMCID: PMC10741681 DOI: 10.3390/brainsci13121659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The effects of acute and chronic intakes of high doses of alcohol on pain perception are well known, ranging from short-term analgesic effects to long-term sensitization and polyneuropathies. The short-term analgesic effects of ethanol consumption on subjective pain perception have been well studied in the literature. Recent advances in neuroimaging allow for an insight into pain-related structures in the brain, fostering the mechanistic understanding of the processing of nociceptive input and pain. We aimed to utilize EEG, combined with standardized noxious mechanical/thermal stimulation and subjective pain testing, to research the effects of acute alcohol intake on nociceptive processing and pain perception. We recruited 12 healthy subjects in an unblinded cross-over study design and aimed at achieving a blood alcohol level of 0.1%. Our data revealed a significant reduction in subjective pain ratings to noxious thermal and mechanical stimuli after alcohol ingestion. Our EEG data revealed suppressing effects on the cortical structures responsible for processing pain, the "pain matrix". We conclude that in addition to its analgesic effects, as expressed by the reduction in subjective pain, alcohol has a further impact on the "pain matrix" and directly affects the salience to a nociceptive stimulus.
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Affiliation(s)
- Elias Dreismickenbecker
- Center for Pediatric and Adolescent Medicine, Department of Pediatric Hematology/Oncology, University Medical Center Mainz, 55131 Mainz, Germany
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Sebastian Zinn
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Mara Romero-Richter
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Madeline Kohlhaas
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Lukas R. Fricker
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Silvana Petzel-Witt
- Institute of Legal Medicine, University Hospital, Goethe University, 60590 Frankfurt, Germany
| | - Carmen Walter
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | - Stefan W. Toennes
- Institute of Legal Medicine, University Hospital, Goethe University, 60590 Frankfurt, Germany
| | - Malte Anders
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596 Frankfurt, Germany
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Qureshi I, Harris T, Pathan SA, Qureshi RS, Al-Bakri F, Thomas SH, Azad AM. What adult patients prefer for reporting their pain levels, and frequency of reassessment when in the emergency department. Am J Emerg Med 2023; 73:11-16. [PMID: 37573661 DOI: 10.1016/j.ajem.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES This study interviewed adult patients presenting to the emergency department (ED) for various pain conditions enquiring about their preferred tool for reporting pain severity and preferred time interval between initial assessment and subsequent pain reassessments. METHODS A prospective observational (cross-sectional) study was conducted in adult patients with acute pain in a tertiary care hospital ED setting. Patients' initial pain score was recorded using NRS (numerical rating scale) pain scale, and appropriate analgesia offered. Once the patient had been evaluated by an attending physician, a research team member interviewed the patient regarding the pain reassessment time and preferred pain assessment tool. The pain assessment tools evaluated in this study were NRS, PS (picture scale or face pain scale), VRS (verbal rating scale), and VAS (visual analogue scale). The patients were presented with the four pain assessment tools (in their primary language) through an audio-visual on an electronic tablet display. RESULTS 200 (138 male, mean age 36.5 ± 11.17) patients participated in the study. With increasing age, pain reassessment interval increased by 0.19 min (95% CI 0.03-0.36 min). Males requested pain reassessment 6.7 min (95% CI 2.2-10.8) faster than females. In this study, the preferred interval for pain reassessment was reported as a mean of 22.8 (SD + -13.6) minutes. There was no relationship reported between time reassessment and pain severity (P = 0.22). Out of 200 subjects, irrespective of the initial pain scores, 100 preferred NRS. NRS was preferred by patients with mild to moderated pain due to the perception of being faster. However, patients with severe pain choose a non-NRS scale to prioritize accuracy. CONCLUSION There was no influence found between the initial pain severity scores and the desired frequency of pain reassessment. However, associations were identified between the time for pain reassessment interval and age, sex, and geographical region. Patients with severe pain preferred PS or VRS while patients with mild/moderate pain preferred the NRS.
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Affiliation(s)
- Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tim Harris
- Blizard Institute, Queen Mary University London, UK
| | - Sameer A Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute, Queen Mary University London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raheel S Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Faten Al-Bakri
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Blizard Institute, Queen Mary University London, UK; Beth Israel Deaconess Medical Center and Harvard Medical School, United States of America
| | - Aftab M Azad
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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9
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Lücke AJ, Wrzus C, Gerstorf D, Kunzmann U, Katzorreck M, Hoppmann C, Schilling OK. Bidirectional Links of Daily Sleep Quality and Duration With Pain and Self-rated Health in Older Adults' Daily Lives. J Gerontol A Biol Sci Med Sci 2023; 78:1887-1896. [PMID: 36124664 DOI: 10.1093/gerona/glac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sleep and health perceptions, such as self-ratings of pain and health are closely linked. However, the temporal ordering of such associations is not well understood, and it remains unclear whether sleep quality and sleep duration show similar or differential associations with health perceptions. METHODS We used ecological momentary assessment data from 123 young-old (66-69 years, 47% women) and 47 old-old adults (84-90 years, 60% women). Across 7 consecutive days, participants reported their sleep quality and sleep duration each morning and rated their momentary pain and health 6 times per day. We applied dynamic structural equation models to examine bidirectional links of morning reports of sleep quality and duration with daily levels of self-rated pain and health. RESULTS In line with the hypotheses, results showed that when participants reported better sleep quality than what is typical for them, they reported less pain and better self-rated health on the day that followed. Longer sleep duration was not linked with subsequent pain or self-rated health. On days when people rated their health as better than usual, they reported better sleep quality but not longer sleep duration the following night. These associations were not moderated by age, gender, or chronic pain. CONCLUSION Findings suggest that in old age, sleep quality is more relevant for health perceptions than sleep duration. Associations between sleep quality and self-rated health seem to be bidirectional; daily pain was linked to prior but not subsequent sleep quality.
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Affiliation(s)
- Anna J Lücke
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Cornelia Wrzus
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Ute Kunzmann
- Institute of Psychology, University of Leipzig, Leipzig, Germany
| | | | - Christiane Hoppmann
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver K Schilling
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
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10
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Djordjevic CM. Finding a meaning for pain: Definitions, sense-making, and philosophical health. J Eval Clin Pract 2023; 29:1196-1202. [PMID: 37309094 DOI: 10.1111/jep.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Pain has proven to be a refractory problem in US healthcare. This paper argues that starting to address this requires viewing pain-assessment as a form of sense-making that occurs between patients and providers. Section I argues that two standard definitions of 'pain' that are thought to subtend pain assessment are not viable. Section II proffers a very different way to think about the meaning of 'pain'. Section III develops this novel account by pairing Rorty's account of hermeneutics with recent developments in the pain-assessment literature. Finally, section four moves beyond Rorty by linking sense-making to philosophical health. Should this prove persuasive, I will have shown an area in biomedicine where philosophy is not an 'optional add on', but a vitally important part of what should be clinical practice.
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Affiliation(s)
- Charles M Djordjevic
- Lorain County Community College, Elyria, Ohio, USA
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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11
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Lee SR. Efficacy of Laparoscopic Iliopubic Tract Repair Plus Transabdominal Preperitoneal Hernioplasty for Treating Inguinal Hernia After Robot-assisted Radical Prostatectomy. Surg Laparosc Endosc Percutan Tech 2023; 33:276-281. [PMID: 37058476 PMCID: PMC10234324 DOI: 10.1097/sle.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) is a risk factor for inguinal hernia (IH). Furthermore, in patients who have undergone RARP, the fibrotic scar tissue in the RARP area limits preperitoneal dissection. This study aimed to evaluate the efficacy of performing laparoscopic iliopubic tract repair (IPTR) in addition to transabdominal preperitoneal hernioplasty (TAPPH) to treat IH after RARP. PATIENTS AND METHODS A total of 80 patients with an IH after RARP were treated with TAPPH from January 2013 to October 2020 and were included in this retrospective study. Patients who underwent conventional TAPPH were categorized as the TAPPH group (25 patients with 29 hernias), whereas those who underwent TAPPH with IPTR were categorized as the TAPPH + IPTR group (55 patients with 63 hernias). The IPTR comprised suture fixation of the transversus abdominis aponeurotic arch to the iliopubic tract. RESULTS All patients had indirect IH. The incidence of intraoperative complications was significantly higher in the TAPPH group than in the TAPPH + IPTR group [13.8% (4/29) vs 0.0% (0/63), P = 0.011]. The average operative time was also significantly shorter in the TAPPH + IPTR group than in the TAPPH group ( P < 0.001). There were no differences between the two groups in the duration of hospitalization, recurrence rate, and pain severity. CONCLUSIONS The addition of laparoscopic IPTR to TAPPH for treating IH after RARP is safe and is associated with a minimal risk of intraoperative complications and a short operative time.
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Engskov AS, Ydrefors A, El-Jaleb K, Åkeson J. Prospective paired crossover evaluation of potential impact of investigator gender on perceived pain intensity early after acute or scheduled surgery. Biol Sex Differ 2023; 14:23. [PMID: 37095547 PMCID: PMC10127324 DOI: 10.1186/s13293-023-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Postoperative pain is common but often difficult to assess, and there are many potential confounders. Over the last decades, the gender of investigator as well as participant has been found to influence pain perception in both preclinical and clinical studies. However, to our knowledge this has not been studied in various postoperative patients. Objectives of this study were to test the hypotheses that pain intensity levels early after acute or scheduled in- or out-hospital surgery are lower when evaluated by a female investigator, and higher when reported by a female patient. METHODS In this prospective observational paired crossover study, two investigators of opposite genders independently obtained individually reported pain intensity levels with a visual analogue scale in a mixed cohort of adult postoperative study patients at Skåne University Hospital in Malmö, Sweden. RESULTS In total, 245 (129 female) study patients were included and then one female excluded. The study patients rated their intensity of postoperative pain lower when evaluated by a female than by a male investigator (P = 0.006), where the male patients constituted the significant difference (P < 0.001). Pain intensity levels did not differ between female and male study patients (P = 0.210). CONCLUSIONS Main findings of lower pain intensity reported by males to a female than to a male investigator early after surgery in this paired crossover study in mixed postoperative patients, indicate that potential impact of investigator gender on pain perception should be considered and further evaluated in clinical bedside practice. Trial registration Retrospectively registered in the ClinicalTrials.gov research database on 24th June 2019 with TRN number NCT03968497.
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Affiliation(s)
- Anna Sellgren Engskov
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden.
- Skåne University Hospital, Carl Bertil Laurells Gata 9, 3rd floor, SE-20502, Malmö, Sweden.
| | - Andreas Ydrefors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
| | - Karolin El-Jaleb
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
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Alotaibi M, Aljahany M, Alhamdan Z, Alsaffar M, Almojally A, Alassaf W. Differences in acute pain perception between patients and physicians in the emergency department. Heliyon 2022; 8:e11462. [PMID: 36406726 PMCID: PMC9667246 DOI: 10.1016/j.heliyon.2022.e11462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Pain is a subjective complaint that comprises a vast majority of emergency department (ED)1 visits. Owing to its subjectivity, pain reporting is prone to variations that could impact patient care. We aimed to determine the extent of differences in pain rating-scores between patients and their physicians in the ED and impact on patient satisfaction. Methods A prospective cross-sectional sample of eligible patients was recruited from two centers in Saudi Arabia. Pain scorings were performed using validated online questionnaires during patients' ED stay. Results Pain rating scores by physicians was lower than that by patients (6.3 ± 2.0 versus 7.0 ± 3.1, p = 0.004). Additionally, severe pain rating (8–10 rating) was given less frequently by physicians compared with that by patients (26.0% versus 48.1%, p = 0.004). Comparing the ratings by physicians with those by patients, underestimation was observed in 70.1%, overestimation in 16.9%, and matching rating in 13.0% cases. The most frequent analgesic medication administered was paracetamol (79.2%), followed by diclofenac (26.0%), morphine (10.4%), and ketorolac (9.1%). The medications were administered mainly intravenously (87.0%) and, to a lesser extent, intramuscularly (31.2%). Majority of patients (62.5%) reported not to have sufficient pain relief after treatment. Conclusion Most physicians tend to underestimate the level of pain perceived by their patients, which often leads to under-treatment and lower patient satisfaction. The present study revealed a significant difference in pain ratings between patients and physicians. There was a significant difference between patient and physician pain ratings Pain ratings by physicians were lower than those of patients Comparing the physicians' with patients' ratings, underestimation was 70.1% Comparing the physicians' with patients' ratings, overestimation was 16.9%, Comparing the physicians' with patients' ratings, matching rating was 13.0%.
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Affiliation(s)
- Malak Alotaibi
- Department of Emergency, Prince Mohammad bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Muna Aljahany
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Corresponding author.
| | - Zaid Alhamdan
- Department of Emergency, King Abdullah bin Abdulaziz Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mashael Alsaffar
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Wajdan Alassaf
- Department of Emergency, King Abdullah bin Abdulaziz Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Hsu HP, Cheng MT, Lu TC, Chen YC, Liao ECW, Sung CW, Liew CQ, Ling DA, Ko CH, Ku NW, Fu LC, Huang CH, Tsai CL. Pain Assessment in the Emergency Department: A Prospective Videotaped Study. West J Emerg Med 2022; 23:716-723. [PMID: 36205678 PMCID: PMC9541978 DOI: 10.5811/westjem.2022.6.55553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Research suggests that pain assessment involves a complex interaction between patients and clinicians. We sought to assess the agreement between pain scores reported by the patients themselves and the clinician’s perception of a patient’s pain in the emergency department (ED). In addition, we attempted to identify patient and physician factors that lead to greater discrepancies in pain assessment.
Methods: We conducted a prospective observational study in the ED of a tertiary academic medical center. Using a standard protocol, trained research personnel prospectively enrolled adult patients who presented to the ED. The entire triage process was recorded, and triage data were collected. Pain scores were obtained from patients on a numeric rating scale of 0 to 10. Five physician raters provided their perception of pain ratings after reviewing videos.
Results: A total of 279 patients were enrolled. The mean age was 53 years. There were 141 (50.5%) female patients. The median self-reported pain score was 4 (interquartile range 0-6). There was a moderately positive correlation between self-reported pain scores and physician ratings of pain (correlation coefficient, 0.46; P <0.001), with a weighted kappa coefficient of 0.39. Some discrepancies were noted: 102 (37%) patients were rated at a much lower pain score, whereas 52 (19%) patients were given a much higher pain score from physician review. The distributions of chief complaints were different between the two groups. Physician raters tended to provide lower pain scores to younger (P = 0.02) and less ill patients (P = 0.008). Additionally, attending-level physician raters were more likely to provide a higher pain score than resident-level raters (P <0.001).
Conclusion: Patients’ self-reported pain scores correlate positively with the pain score provided by physicians, with only a moderate agreement between the two. Under- and over-estimations of pain in ED patients occur in different clinical scenarios. Pain assessment in the ED should consider both patient and physician factors.
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Affiliation(s)
- Hao-Ping Hsu
- National Taiwan University, College of Medicine, Department of Medicine, Taipei, Taiwan
| | - Ming-Tai Cheng
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Tsung-Chien Lu
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Yun Chang Chen
- National Taiwan University Hospital Yun-Lin Branch, Department of Emergency Medicine, Hsinchu, Taiwan
| | - Edward Che-Wei Liao
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Chih-Wei Sung
- National Taiwan University Hospital Hsin-Chu Branch, Department of Emergency Medicine, Hsinchu, Taiwan
| | - Chiat Qiao Liew
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Dean-An Ling
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Chia-Hsin Ko
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Nai-Wen Ku
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Li-Chen Fu
- National Taiwan University, Department of Computer Science and Information Engineering, Taipei, Taiwan
| | - Chien-Hua Huang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Chu-Lin Tsai
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
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Vitou V, Gély-Nargeot MC, Jeandel C, Bayard S. The influence of Alzheimer's disease stigma on pain assessment in older persons. DEMENTIA 2022; 21:2418-2441. [PMID: 35976758 DOI: 10.1177/14713012221117907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored. RESEARCH QUESTION The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes. METHODS Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage). RESULTS Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions. CONCLUSION These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.
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Affiliation(s)
- Valérie Vitou
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France.,Fondation Partage et Vie, Montrouge, France
| | | | - Claude Jeandel
- Fondation Partage et Vie, Montrouge, France.,Département de Gériatrie, Université De Montpellier, 26905CHU de Montpellier, Montpellier, France
| | - Sophie Bayard
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France
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16
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Jurth C, Zimmermann V, Schaaf L, Lezius F, Bublitz VK, Lichtner G, von Dincklage F. Investigation of behavioral pain scale, critical care pain observation tool, nociceptive flexion reflex and pupillary dilatation reflex as predictors of behavioral reactions to nociceptive procedures in critically ill patients unable to self-report pain. Eur J Pain 2022; 26:2074-2082. [PMID: 35959740 DOI: 10.1002/ejp.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/20/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Procedural pain is a common burden in critical care treatment and the prediction of nociceptive reactions remains challenging. Thus, we investigated the behavioral pain scale (BPS), the critical pain observational Tool (CPOT), the nociceptive flexion reflex (NFR), the pupillary dilation reflex (PDR), the Richmond agitation-sedation scale (RASS) as predictors of behavioral reactions to nociceptive procedures. METHODS In this monocentric, prospective, observational study we analyzed data of 128 critically ill adults unable to self-report pain to investigate the predictability of behavioral reactions to two procedures: endotracheal suctioning and turning. Next to routine clinical data, CPOT, BPS, PDR, NFR, RASS, propofol and sufentanil doses were recorded before the procedures. RESULTS For endotracheal suctioning, NFR, BPS, CPOT, RASS showed predictive performances significantly better than chance, but none of them performed significantly better than the sufentanil dose rate. For turning, BPS, CPOT, RASS showed predictive performances significantly better than chance, but only the RASS performed significantly better than the propofol dose rate. CONCLUSIONS Behavioral reactions to both investigated clinical procedures can be predicted by observational scales or nociceptive reflexes. For endotracheal suctioning, none of the predictors performed superior to using the sufentanil dose rate as a predictor. As using sufentanil as a predictor requires no extra effort in contrast to the other predictors, none of the here investigated tools seem advisable for predicting behavioral reactions to endotracheal suctioning. For patient turning, the RASS predicts reactions better than any other tool.
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Affiliation(s)
- C Jurth
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - V Zimmermann
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - L Schaaf
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - F Lezius
- HELIOS Klinikum Berlin-Buch, Klinik für Anästhesie, perioperative Medizin und Schmerztherapie, Berlin, Germany
| | - V K Bublitz
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - G Lichtner
- Universitätsmedizin Greifswald, Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Greifswald, Germany
| | - F von Dincklage
- Universitätsmedizin Greifswald, Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Greifswald, Germany
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17
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Rababa M, Al-Sabbah S. Nurses’ Pain Assessment Practices for Cognitively Intact and Impaired Older Adults in Intensive Care Units. Dement Geriatr Cogn Dis Extra 2022; 12:115-121. [PMID: 35950149 PMCID: PMC9294931 DOI: 10.1159/000525477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Pain is still under-recognized and undertreated among intensive care unit (ICU) patients, such as those being intubated or with dementia, cognitive impairments, or communication deficits due to inability to self-report. This study aimed to describe nurses' pain assessment practices for cognitively intact and impaired older adult ICU patients. Methods A descriptive correlational study of a convenience sample of 200 registered nurses was conducted in private, public, and university-affiliated hospitals in Irbid, Jordan. Descriptive statistics, such as mean, standard deviation, and frequency, were used to analyze the study data. Results Statistically significant differences were found in the proportion of nurses who assessed and documented pain every 1–4 h in cognitively intact patients than those with cognitive impairment (n = 67, 63.21% vs. n = 39, 36.79%), p = 0.002, compared to the proportion of nurses who never assessed and document pain in cognitively impaired patients than those without cognitive impairment (n = 38, 76.0% vs. n = 12, 24%), p < 0.001. Discussion/Conclusion Our study results showed that the majority of participant nurses felt that the use of pain assessment tools for cognitively intact and impaired older adult ICU patients to self-report is somewhat not at all important. This study also reported that nurses perceived themselves as the individuals who accurately rate the pain in cognitively intact patients, followed by the patients themselves.
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A Comprehensive Assessment of The Eight Vital Signs. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.
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Kelly MA, Slatyer S, Myers H, Gower S, Mason J, Lasater K. Using Audio-Visual Simulation to Elicit Nursing Students’ Noticing and Interpreting Skills to Assess Pain in Culturally Diverse Patients. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. FRONTIERS IN PAIN RESEARCH 2022; 3:896276. [PMID: 35721658 PMCID: PMC9201034 DOI: 10.3389/fpain.2022.896276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.
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Affiliation(s)
- Sara E. Berger
- Responsible and Inclusive Technologies Research, Exploratory Sciences Division, IBM Thomas J. Watson Research Center, Yorktown Heights, NY, United States
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21
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Nurses' use of the clinically aligned pain assessment tool: A mixed methods study. Pain Manag Nurs 2022; 23:377-384. [PMID: 35659467 DOI: 10.1016/j.pmn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 04/13/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Assessment of pain in the hospital has often relied on intensity rating alone. To address the gap in meeting patients' pain management expectations, a Midwestern medical center implemented the CAPA (Clinical Aligned Pain Assessment) tool for more comprehensive nursing pain assessments. AIMS This research described nurses' experience using CAPA on an adult general medicine unit and their documentation of the tool in the electronic health record (EHR) more than 5 years after CAPA implementation. DESIGN Mixed methods exploratory sequential design. METHODS A convenience sample of nurses (N = 8) participated in 2 focus groups to describe how they used CAPA, how well it assessed pain, how it determined pain interventions, and the challenges and advantages of using CAPA. Patient EHR data (N = 373) for a 6-month period from the same unit were analyzed to evaluate CAPA documentation. RESULTS Qualitative themes included: benefits of using CAPA, CAPA leads to a more comprehensive picture, variation in how CAPA is used, and challenges. Quantitative findings demonstrated most frequent documentation in the comfort domain and earlier, though still delayed, reassessment when a higher level of pain was noted. Mixed methods analysis revealed variation in knowledge and practice regarding which domains to document each shift and during reassessment. CONCLUSIONS As patient advocates, nurses are integral to thorough assessment and treatment of pain. Findings identified the need for methodological research of CAPA. As with any assessment tool, when using CAPA, ongoing monitoring is needed to address how it is administered, coded, and used for decision-making about pain management.
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22
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Lee SR. Laparoscopic Hydrocelectomy of Encysted Hydrocele of the Canal of Nuck with High Ligation in Children or Iliopubic Tract Repair in Adults. J Laparoendosc Adv Surg Tech A 2022; 32:684-689. [PMID: 35446148 DOI: 10.1089/lap.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Encysted hydrocele of the canal of Nuck (EHCN) is homologous to spermatic cord hydrocele in males. EHCN causes swelling in the inguinal region and should be considered in the differential diagnosis of inguinal hernias and masses in females. Complete excision and internal inguinal ring closure are the recommended treatments for symptomatic EHCN. In this study, we aimed at evaluating the safety and feasibility of laparoscopic hydrocelectomy, as well as age-appropriate procedures for EHCN. Materials and Methods: The medical records of 161 female adults and children, who underwent laparoscopic transabdominal hydrocelectomy from January 2014 to December 2020 at a single institution, were reviewed retrospectively and symptoms, location of EHCN, type of fluid in EHCN, postoperative complications, recurrence, and operating time were analyzed. Laparoscopic hydrocelectomy was performed and the internal inguinal ring was closed with high ligation in children and iliopubic tract repair (IPTR) in adults. Results: Fifty-two pediatric (age 2-11 years) and 109 adult (age 21-51 years) female patients were included. More adult patients had inguinal pain (34.9%, 38/109) compared with children (3.8% 2/52) (P < .001). More EHCNs were located in the inguinal canal than protruding into the abdominal cavity in both groups. Regarding the fluid characteristics, hemorrhagic and inflammatory hydroceles were more common in adults than in children (P < .001). There were no serious complications, neither recurrence nor chronic pain was observed in either group except for a surgical-site hematoma in 1 adult patient. Conclusion: Laparoscopic hydrocelectomy together with additional age-appropriate procedures, including high ligation in children and IPTR in adults, is a safe and feasible method for treating EHCN.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
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23
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Hagstrom S, O'Conner-Von S, Tracy MF. Survey of Nurses' Use of the Clinically Aligned Pain Assessment (CAPA) Tool. Pain Manag Nurs 2022; 23:568-575. [PMID: 35551846 DOI: 10.1016/j.pmn.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/01/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Limited research is available on tools for assessing pain and its effect on function in the acute care setting. AIM This research's purpose is to describe nurses' use of the Clinically Aligned Pain Assessment (CAPA) tool and their beliefs about its utility for assessing pain compared to the numeric rating scale (NRS) in a hospital where CAPA had been used for 6 years. DESIGN A cross-sectional self-report survey. METHODS Nurses (N = 110) from 13 adult inpatient units in an academic center participated in this survey describing frequency of CAPA and NRS use, CAPA domains documented, and how nurses asked about pain and distinguished between categories when coding for documentation. Beliefs about the tools' effectiveness were also reported. RESULTS Most nurses used CAPA routinely for assessments; almost half used the NRS at times. They believed both tools were effective for assessment, but CAPA was more effective to determine what intervention was needed. They also believed patient report using CAPA was more likely to match the nurse's assessment; a majority reported incorporating their observations into CAPA documentation. Most asked the patient about pain without using CAPA words, although many used the specific words. Practice varied in how nurses determined which category to select in the comfort domain and which domains were assessed routinely. CONCLUSIONS Although many nurses believed CAPA was effective, variation existed in how it was used to assess and document pain, increasing potential for inconsistent assessments and interpretations of pain and pain management.
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Affiliation(s)
| | | | - Mary Fran Tracy
- M Health Fairview, Minneapolis, Minnesota; University of Minnesota School of Nursing, Minneapolis, Minnesota
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Lee SR. Laparoscopic hydrocelectomy with transabdominal preperitoneal hernioplasty or iliopubic tract repair for treatment of encysted spermatic cord hydrocele. Surg Endosc 2022; 36:5540-5545. [PMID: 35511343 DOI: 10.1007/s00464-022-09285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND An encysted spermatic cord hydrocele (ESCH) causes an inguinal swelling resembling an inguinal hernia (IH). An ESCH should be considered as a differential diagnosis of IH. Although laparoscopic operations have been performed to treat ESCHs in pediatric patients, such operations have not been reported in adults. This study was performed to evaluate the outcomes of laparoscopic hydrocelectomy for treatment of ESCHs in adults. METHODS The medical charts of 49 patients who underwent laparoscopic transabdominal hydrocelectomy for ESCHs from January 2015 to December 2020 at a single institution were retrospectively reviewed. The patients were divided into those with and without an IH. Laparoscopic hydrocelectomy was performed, and the internal inguinal ring was closed with iliopubic tract repair (IPTR) or transabdominal preperitoneal (TAPP) hernioplasty depending on the presence of an IH. The patients' age, ESCH location, postoperative complications, recurrence, and operating time were examined. RESULTS The patients' mean age was 46.7 (20-77) years. All patients underwent laparoscopic hydrocelectomy without open conversion. ESCHs were more common on the right side (35/49, 71.4%) than on the left (14/49, 28.6%). The presenting symptom in all patients was inguinal swelling. The ESCH was located inside the inguinal canal in 47 patients and protruded to the abdominal cavity from the inguinal canal in 2 patients. After laparoscopic hydrocelectomy, 32 patients without an IH underwent IPTR and 17 patients with an IH underwent TAPP hernioplasty. The mean operating time was shorter in the IPTR than TAPP hernioplasty group. The postoperative complications and hospital stay were not different between the two groups. There were no recurrences in either group. CONCLUSIONS Laparoscopic hydrocelectomy with IPTR or TAPP hernioplasty is safe and feasible for treatment of ESCHs in adults.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea.
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Slatyer S, Myers H, Kelly MA. Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review. Pain Manag Nurs 2022; 23:663-671. [DOI: 10.1016/j.pmn.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
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Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The Symptom Experience in Pediatric Cancer: Current Conceptualizations and Future Directions. Curr Oncol Rep 2022; 24:443-450. [PMID: 35150393 DOI: 10.1007/s11912-022-01222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aimed to review the recent research on the childhood cancer symptom experience pertaining to socioeconomic factors, biology and genetics, growth and development, family psychosocial dynamics, and social and treating environments to begin to formulate recommendations for a personalized approach to symptom management. RECENT FINDINGS Cancer symptoms are common and distressing in children and negatively impact child and family quality of life. Many interacting factors influence children's cancer symptoms experiences, including the assessment and management of such symptoms. This paper highlights several gaps in the research related to the cancer symptom experience including routine symptom assessment, the impact of socioeconomic, biological, and genetic factors on symptoms, and the establishment of effective symptom management partnerships with families. Based on our findings, we provide recommendations related to that research which is ready to be implemented into clinical practice and areas for needed future efforts.
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Affiliation(s)
- Lindsay A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, M5T 1P8, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.
| | | | | | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Canada
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Collins PJ, Renedo A, Marston CA. Communicating and understanding pain: Limitations of pain scales for patients with sickle cell disorder and other painful conditions. J Health Psychol 2022; 27:103-118. [PMID: 32744117 PMCID: PMC8739581 DOI: 10.1177/1359105320944987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Pain communication in healthcare is challenging. We examine use of pain scales to communicate pain severity via a case study of people with sickle cell disorder (SCD). We show how pain communication involves complex social interactions between patients, healthcare professionals and significant others - none of which are included in pain ratings. Failure to account for relational aspects of pain may cause problems for any patient. For SCD, mutual distrust shapes pain communication, further complicating clinical assessments. Moreover, SCD pain is particularly severe, making ratings hard to interpret compared with ratings from non-SCD patients, potentially exacerbating problems in managing pain relief.
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Affiliation(s)
- Peter J Collins
- University of Greenwich, UK
- Munich Center for Mathematical Philosophy, Ludwig-Maximilian-University, Munich, Germany
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Mazur LB, Richter L, Manz P, Bartels H. The importance of cultural psychological perspectives in pain research: Towards the palliation of Cartesian anxiety. THEORY & PSYCHOLOGY 2021. [DOI: 10.1177/09593543211059124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite widespread awareness of the psychological dimensions of pain, researchers often and easily slip into essentializing understandings that treat pain as a purely physiological experience that can be isolated within experimental research. This drive towards scientific objectivity, while at times of tremendous utility, can also limit our understanding of pain to reductionistic conceptualizations that in effect deny the subjective and even the psychological dimensions of pain. In other words, researchers often attempt to understand pain by means of empirical, scientific explanations, while being simultaneously aware that such an approach cannot grasp the phenomenon in its entirety. This yearning for deeper, ontological understanding in a world that admits of only empirical, scientific explanations has been called Cartesian anxiety. In the current study, it is argued that cultural psychology can help to alleviate this Cartesian anxiety by helping us to appreciate the psychological aspects of pain as dynamic processes of meaning making.
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Tan A, Wilson AN, Eghrari D, Clark H, Tse WC, Bohren MA, Homer C, Vogel JP. Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials. BJOG 2021; 129:845-854. [PMID: 34839565 DOI: 10.1111/1471-0528.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential. OBJECTIVE To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. DESIGN A review of systematic reviews and their included randomised controlled trials was undertaken. SEARCH STRATEGY Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language. SELECTION CRITERIA Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. DATA COLLECTION AND ANALYSIS All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported. MAIN RESULTS Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains. CONCLUSIONS Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice. TWEETABLE ABSTRACT Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.
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Affiliation(s)
- A Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - A N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - D Eghrari
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - H Clark
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - W C Tse
- School of Medicine, Faculty of Medicine, Nursing, and Health Science, Monash University, Clayton, Vic., Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - Cse Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - J P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
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Martínez-Burnes J, Muns R, Barrios-García H, Villanueva-García D, Domínguez-Oliva A, Mota-Rojas D. Parturition in Mammals: Animal Models, Pain and Distress. Animals (Basel) 2021; 11:2960. [PMID: 34679979 PMCID: PMC8532935 DOI: 10.3390/ani11102960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Parturition is a complex physiological process and involves many hormonal, morphological, physiological, and behavioural changes. Labour is a crucial moment for numerous species and is usually the most painful experience in females. Contrary to the extensive research in humans, there are limited pain studies associated with the birth process in domestic animals. Nonetheless, awareness of parturition has increased among the public, owners, and the scientific community during recent years. Dystocia is a significant factor that increases the level of parturition pain. It is considered less common in polytocous species because newborns' number and small size might lead to the belief that the parturition process is less painful than in monotocous animal species and humans. This review aims to provide elements of the current knowledge about human labour pain (monotocous species), the relevant contribution of the rat model to human labour pain, and the current clinical and experimental knowledge of parturition pain mechanisms in domestic animals that support the fact that domestic polytocous species also experience pain. Moreover, both for women and domestic animal species, parturition's pain represents a potential welfare concern, and information on pain indicators and the appropriate analgesic therapy are discussed.
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Affiliation(s)
- Julio Martínez-Burnes
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Ramon Muns
- Agri-Food and Biosciences Institute, Hillsborough, Co Down BT26 6DR, Northern Ireland, UK;
| | - Hugo Barrios-García
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Dina Villanueva-García
- Division of Neonatology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
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Woznowski-Vu A, Aternali A, Gervais A, Pavilanis ADS, Nijs J, Sullivan MJL, Wideman TH. The Prospective Prognostic Value of Biopsychosocial Indices of Sensitivity to Physical Activity Among People With Back Pain. Clin J Pain 2021; 37:719-729. [PMID: 34419972 DOI: 10.1097/ajp.0000000000000965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Many people living with musculoskeletal pain conditions experience a range of negative biopsychosocial responses to physical activity, referred to as increased sensitivity to physical activity (SPA), that may undermine successful rehabilitation. This exploratory study aims to provide the first prospective analysis of the potential prognostic value of 3 biopsychosocial indices of SPA in relation to rehabilitation outcomes. This study also aimed to shed light on the cross-sectional interrelationships between these 3 biopsychosocial indices of SPA. MATERIALS AND METHODS Adults with back pain were evaluated upon starting physical therapy and then again 3 months later. The initial testing session consisted of self-reported pain-related questionnaires and assessment of activity-related changes in pressure pain thresholds (SPA-Sensory), pain intensity ratings (SPA-Pain), and situational catastrophizing (SPA-Psych). The 3-month follow-up consisted of self-reported disability and pain questionnaires. Correlational and hierarchical linear regression analyses were conducted. RESULTS A total of 97 participants completed both the initial visit and 3-month follow-up. The SPA-Pain index and the SPA-Psych index were significantly intercorrelated, but neither were correlated with the SPA-Sensory index. The SPA-Sensory index was not correlated with outcomes. The SPA-Pain index was correlated only with cross-sectional disability and pain outcomes. The SPA-Psych index was the only SPA index significantly correlated with outcomes both cross-sectionally and at 3-month follow-up. After controlling for baseline pain/disability and pain catastrophizing, SPA-Psych was no longer a significant prognostic factor for pain, but remained a significant prognostic factor for disability at 3-month follow-up (β=0.272, t=2.674, P=0.008, R2 Δ=5.60%). DISCUSSION This study highlights the importance of conceptualizing and measuring SPA as a biopsychosocial (rather than unidimensional) construct and points toward the added prognostic value of this construct. Implications for future research and practice are discussed.
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Affiliation(s)
| | - Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | | | | | - Jo Nijs
- Pain in Motion International Research Group
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
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Medical-Surgical Patients' and Registered Nurses' Satisfaction and Comprehensiveness of Patient Assessment Using the Clinically Aligned Pain Assessment Tool. Pain Manag Nurs 2021; 23:293-300. [PMID: 34493438 DOI: 10.1016/j.pmn.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/01/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The pain experience is complex, and nurses are challenged to objectively assess and document patients' subjective reports of pain. There is a clear need for an assessment tool that is easy to use and provides meaningful, actionable information for patients and nurses. AIMS This study explored nurses' and patients' satisfaction with the Clinically Aligned Pain Assessment (CAPA) as well as nurses' charting. SETTING AND PARTICIPANTS A convenience sample of adult patients and nurses on four medical-surgical units in one community hospital. METHODS A quantitative, two-group comparison design between patients and nurses using questionnaires to determine satisfaction and a retrospective chart review to determine comprehensiveness of nurse charting. RESULTS No significant differences existed between patients' and nurses' responses to seven of eight satisfaction questions The median score for seven of eight questions was 5 (using a 6-point Likert scale with 1 = strongly disagree and 6 = strongly agree), which demonstrated more than 80% agreement (somewhat agree, agree, strongly agree) among both groups that CAPA was superior to the NRS, based on individual responses. The one significant difference (p = 0.03) revealed patients were more likely to respond "agree or strongly agree" compared to nurses regarding the nurse thoroughly addressing patients' needs using CAPA. Inter-rater reliability using CAPA was determined to be 89.5%, and a panel of clinical experts determined CAPA had strong content validity of 88.33%. In addition, 70.41% of nurses charted comprehensively using CAPA. CONCLUSION As a result, CAPA was determined to be convenient, accurate, and valuable in guiding intervention decisions.
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Lourens A, Parker R, Hodkinson P. Emergency care providers' perspectives of acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A qualitative study. Int Emerg Nurs 2021; 58:101042. [PMID: 34333334 DOI: 10.1016/j.ienj.2021.101042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A growing body of evidence suggests that pain knowledge and management are poor, perhaps more so in the prehospital setting. The daily challenges that emergency care providers face in dealing with prehospital pain remain unclear. This study aimed to gain a deeper understanding of acute prehospital pain assessment and management in the Western Cape, South Africa. METHODS A series of focus group discussions, using a constructivist paradigm and qualitative content analysis were conducted. RESULTS The key themes emerging from six focus groups (total 25 emergency care providers) related to the difficulties of assessing pain in this setting, factors affecting clinical reasoning in this (hostile) setting, the realities of prehospital pain care for non-advanced life support practitioners, along with emergency departments' lack of understanding and appreciation of the prehospital environment, and participants' suggestions to improve pain practice. CONCLUSION Several barriers and enablers, some novel, to pain assessment and management in the South African prehospital setting were identified. Our findings provide valuable insight and understanding of the challenges related to pain care prehospital providers face, in other similar prehospital settings, but also to the global body of knowledge on prehospital barriers and enablers of pain assessment and management.
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Affiliation(s)
- Andrit Lourens
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town (UCT), Cape Town, Western Cape, South Africa.
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Gouverneur P, Li F, Adamczyk WM, Szikszay TM, Luedtke K, Grzegorzek M. Comparison of Feature Extraction Methods for Physiological Signals for Heat-Based Pain Recognition. SENSORS 2021; 21:s21144838. [PMID: 34300578 PMCID: PMC8309734 DOI: 10.3390/s21144838] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023]
Abstract
While even the most common definition of pain is under debate, pain assessment has remained the same for decades. But the paramount importance of precise pain management for successful healthcare has encouraged initiatives to improve the way pain is assessed. Recent approaches have proposed automatic pain evaluation systems using machine learning models trained with data coming from behavioural or physiological sensors. Although yielding promising results, machine learning studies for sensor-based pain recognition remain scattered and not necessarily easy to compare to each other. In particular, the important process of extracting features is usually optimised towards specific datasets. We thus introduce a comparison of feature extraction methods for pain recognition based on physiological sensors in this paper. In addition, the PainMonit Database (PMDB), a new dataset including both objective and subjective annotations for heat-induced pain in 52 subjects, is introduced. In total, five different approaches including techniques based on feature engineering and feature learning with deep learning are evaluated on the BioVid and PMDB datasets. Our studies highlight the following insights: (1) Simple feature engineering approaches can still compete with deep learning approaches in terms of performance. (2) More complex deep learning architectures do not yield better performance compared to simpler ones. (3) Subjective self-reports by subjects can be used instead of objective temperature-based annotations to build a robust pain recognition system.
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Affiliation(s)
- Philip Gouverneur
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (F.L.); (M.G.)
- Correspondence: ; Tel.: +49-451-3101-5613
| | - Frédéric Li
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (F.L.); (M.G.)
| | - Wacław M. Adamczyk
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Lübeck (P.E.R.L.), University of Lübeck, 23562 Lübeck, Germany; (W.M.A.); (T.M.S.); (K.L.)
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-959 Katowice, Poland
| | - Tibor M. Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Lübeck (P.E.R.L.), University of Lübeck, 23562 Lübeck, Germany; (W.M.A.); (T.M.S.); (K.L.)
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-959 Katowice, Poland
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Lübeck (P.E.R.L.), University of Lübeck, 23562 Lübeck, Germany; (W.M.A.); (T.M.S.); (K.L.)
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-959 Katowice, Poland
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (F.L.); (M.G.)
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Boring BL, Walsh KT, Nanavaty N, Ng BW, Mathur VA. How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others' Use of Numerical Pain Scales. Front Psychol 2021; 12:663890. [PMID: 34282355 PMCID: PMC8285731 DOI: 10.3389/fpsyg.2021.663890] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Brandon W Ng
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.,Texas A&M Institute for Neuroscience, College Station, TX, United States
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Kanbur BN, Mutlu B, Salihoğlu Ö. Validity and reliability of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS) in Turkish: prospective study. SAO PAULO MED J 2021; 139:305-311. [PMID: 34346962 PMCID: PMC9615587 DOI: 10.1590/1516-3180.2020.0721.r1.23122020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Using pain scales helps nurses in making early diagnoses and in assessing and managing pain symptoms and findings when developing a nursing care plan. OBJECTIVE To determine the validity and reliability of the Turkish form of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). DESIGN AND SETTING Prospective study conducted in Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. METHODS 145 newborns in the 26th to 42nd gestational weeks that were receiving treatment and care in the neonatal intensive care unit were included in this study. A total of 1740 pain assessments were made by two independent observers on these 145 newborns. The research data was collected using a newborn description form, NIAPAS and the Neonatal Infant Pain Scale (NIPS). RESULTS The scope validity index of NIAPAS was found to be between 0.90 and 1.00 and its Cronbach's alpha coefficient was 0.914. Correlations between characteristics and total scores (r = 0.20-0.82) were found to be sufficiently high. In an assessment on concurrency validity, there was a strong positive relationship between NIAPAS and NIPS scores (r = 0.73-0.82; P < 0.000). From kappa analysis (0.73-0.99) and intraclass correlation (r = 0.75-0.96), it was determined that there was concordance between the observers. CONCLUSION NIAPAS was found to be a valid and reliable scale for evaluating acute pain in newborns.
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Affiliation(s)
- Bahar Nur Kanbur
- RN, PhD. Assistant Professor, Department of Nursing, Istanbul Gelisim University, Istanbul, Turkey
| | - Birsen Mutlu
- RN, PhD. Associate Professor, Pediatric Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Özgül Salihoğlu
- MD, PhD. Professor, Neonatal Intensive Care Clinic, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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An Interactive Pain Application (MServ) Improves Postoperative Pain Management. Pain Res Manag 2021; 2021:8898170. [PMID: 33868524 PMCID: PMC8035036 DOI: 10.1155/2021/8898170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
Background Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.
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Fritz RL, Wilson M, Dermody G, Schmitter-Edgecombe M, Cook DJ. Automated Smart Home Assessment to Support Pain Management: Multiple Methods Analysis. J Med Internet Res 2020; 22:e23943. [PMID: 33105099 PMCID: PMC7679205 DOI: 10.2196/23943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Poorly managed pain can lead to substance use disorders, depression, suicide, worsening health, and increased use of health services. Most pain assessments occur in clinical settings away from patients' natural environments. Advances in smart home technology may allow observation of pain in the home setting. Smart homes recognizing human behaviors may be useful for quantifying functional pain interference, thereby creating new ways of assessing pain and supporting people living with pain. OBJECTIVE This study aimed to determine if a smart home can detect pain-related behaviors to perform automated assessment and support intervention for persons with chronic pain. METHODS A multiple methods, secondary data analysis was conducted using historic ambient sensor data and weekly nursing assessment data from 11 independent older adults reporting pain across 1-2 years of smart home monitoring. A qualitative approach was used to interpret sensor-based data of 27 unique pain events to support clinician-guided training of a machine learning model. A periodogram was used to calculate circadian rhythm strength, and a random forest containing 100 trees was employed to train a machine learning model to recognize pain-related behaviors. The model extracted 550 behavioral markers for each sensor-based data segment. These were treated as both a binary classification problem (event, control) and a regression problem. RESULTS We found 13 clinically relevant behaviors, revealing 6 pain-related behavioral qualitative themes. Quantitative results were classified using a clinician-guided random forest technique that yielded a classification accuracy of 0.70, sensitivity of 0.72, specificity of 0.69, area under the receiver operating characteristic curve of 0.756, and area under the precision-recall curve of 0.777 in comparison to using standard anomaly detection techniques without clinician guidance (0.16 accuracy achieved; P<.001). The regression formulation achieved moderate correlation, with r=0.42. CONCLUSIONS Findings of this secondary data analysis reveal that a pain-assessing smart home may recognize pain-related behaviors. Utilizing clinicians' real-world knowledge when developing pain-assessing machine learning models improves the model's performance. A larger study focusing on pain-related behaviors is warranted to improve and test model performance.
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Affiliation(s)
- Roschelle L Fritz
- College of Nursing, Washington State University, Vancouver, WA, United States
| | - Marian Wilson
- College of Nursing, Washington State University, Vancouver, WA, United States
| | - Gordana Dermody
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Maureen Schmitter-Edgecombe
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
| | - Diane J Cook
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
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Jackson JB, O'Daly O, Makovac E, Medina S, Rubio ADL, McMahon SB, Williams SCR, Howard MA. Noxious pressure stimulation demonstrates robust, reliable estimates of brain activity and self-reported pain. Neuroimage 2020; 221:117178. [PMID: 32707236 PMCID: PMC7762811 DOI: 10.1016/j.neuroimage.2020.117178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Functional neuroimaging techniques have provided great insight in the field of pain. Utilising these techniques, we have characterised pain-induced responses in the brain and improved our understanding of key pain-related phenomena. Despite the utility of these methods, there remains a need to assess the test retest reliability of pain modulated blood-oxygen-level-dependant (BOLD) MR signal across repeated sessions. This is especially the case for more novel yet increasingly implemented stimulation modalities, such as noxious pressure, and it is acutely important for multi-session studies considering treatment efficacy. In the present investigation, BOLD signal responses were estimated for noxious-pressure stimulation in a group of healthy participants, across two separate sessions. Test retest reliability of functional magnetic resonance imaging (fMRI) data and self-reported visual analogue scale measures were determined by the intra-class correlation coefficient. High levels of reliability were observed in several key brain regions known to underpin the pain experience, including in the thalamus, insula, somatosensory cortices, and inferior frontal regions, alongside "excellent" reliability of self-reported pain measures. These data demonstrate that BOLD-fMRI derived signals are a valuable tool for quantifying noxious responses pertaining to pressure stimulation. We further recommend the implementation of pressure as a stimulation modality in experimental applications.
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Affiliation(s)
- Jade B Jackson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Owen O'Daly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Elena Makovac
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sonia Medina
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Stephen B McMahon
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Matthew A Howard
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
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Lapkin S, Ellwood L, Diwan A, Fernandez R. Reliability, validity, and responsiveness of multidimensional pain assessment tools used in postoperative adult patients: a systematic review of measurement properties. JBI Evid Synth 2020; 19:284-307. [PMID: 32833789 DOI: 10.11124/jbisrir-d-19-00407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this systematic review was to synthesize the best available evidence relating to the measurement properties of the multidimensional pain assessment tools used to assess postoperative pain in adults. INTRODUCTION Pain is a common and poorly managed occurrence in patients during the postoperative period. Currently, postoperative pain is usually evaluated with assessment tools that measure one dimension of pain, namely pain intensity, resulting in inadequate management of postoperative pain. It is important to understand the complex nature of pain by considering all dimensions for optimal postoperative pain management. Systematic, robust evidence is lacking regarding the most psychometrically reliable and valid multidimensional pain assessment tool for adult postoperative patients. INCLUSION CRITERIA This systematic review considered all study types for inclusion. Studies were considered if they assessed the measurement properties of a multidimensional pain assessment tool in adult postoperative patients within two weeks post-surgery. The outcomes included measurement of at least one of the psychometric properties, including reliability, validity, and responsiveness. METHODS A three-step search strategy was undertaken, including a search of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases performed in October 2019. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar, and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies was assessed independently by three reviewers using the COSMIN checklist. RESULTS Seventeen studies involving five multidimensional postoperative pain assessment tools were included in the review: American Pain Society Pain Outcomes Questionnaire-Revised; Brief Pain Inventory; Houston Pain Outcome Instrument; McGill Pain Questionnaire; and the Quality Improvement in Postoperative Pain Management Postoperative Pain Questionnaire. The two most commonly used tools were the Brief Pain Inventory and the American Pain Society Pain Outcomes Questionnaire-Revised, which were assessed in six studies each. The included studies mainly reported internal consistency reliability, with four of the five identified tools demonstrating high Cronbach's alpha values ranging from 0.72 to 0.92. However, the Houston Pain Outcome Instrument demonstrated mixed findings, with eight of the nine subscales having moderate to high reliability while the expectations about pain subscale had poor reliability (α=0.003). CONCLUSIONS This review provides much needed information about the current tools used in many clinical, educational, and research settings. Of the five tools included in this review, the Brief Pain Inventory demonstrated strong evidence of psychometric validity and is recommended for use in assessing postoperative pain. Further psychometric validation of multidimensional postoperative pain assessment tools with emphasis on responsiveness and measurement error is required in order to accurately assess the minimal clinically important difference in postoperative pain outcomes.
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Affiliation(s)
- Samuel Lapkin
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Spine Service, Department of Orthopaedic Surgery, St George Hospital Campus, Sydney, NSW, Australia
| | - Laura Ellwood
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - Ashish Diwan
- Spine Service, Department of Orthopaedic Surgery, St George Hospital Campus, Sydney, NSW, Australia.,SpineLabs, St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
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Vitullo M, Holloway D, Tellson A, Nguyen H, Estimon K, Linthicum J, Viejo H, Coffee A, Huddleston P. ∗Surgical patients' and registered nurses' satisfaction and Perception of Using the Clinically Aligned Pain Assessment (CAPA©) Tool for Pain Assessment. JOURNAL OF VASCULAR NURSING 2020; 38:118-131. [PMID: 32950112 DOI: 10.1016/j.jvn.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/17/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
Pain management is a significant issue in all health care systems. Pain is often mismanaged because of lack of a comprehensive pain assessment. This often leads to inappropriate medication administration, inadequate pain relief, negative patient outcomes, and delayed discharges. There is an opportunity for developing a more comprehensive pain assessment. The Clinically Aligned Pain Assessment (CAPA©) pain tool was developed by the University of Utah.. It assesses 5 dimensions of pain: comfort, change in pain, pain control, functioning, and sleep. The purpose of the study was to determine if the patients and nurses were more satisfied discussing pain with CAPA© or the numeric rating scale (NRS) and words to describe pain, intensity, location, duration, and aggravating and/or alleviating factors (WILDA) tool. This study had a 2-group comparison design with mixed methods approach. One group comprised patients and the other group comprised nurses. There were 63 nurses and 95 patients enrolled in the study at two perioperative hospitals. The results demonstrated that the patients and nurses were more satisfied with using the CAPA© tool than the NRS/WILDA. The CAPA© tool allows for a more comprehensive way to assess pain which has the potential to create more effective treatments for pain, improve discharge time, and positive patient outcomes.
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Affiliation(s)
- Mary Vitullo
- Baylor Scott and White Research Institute, Dallas, TX.
| | | | | | - Hoa Nguyen
- Baylor Scott and White Research Institute, Dallas, TX
| | | | | | - Henry Viejo
- Baylor Scott and White Research Institute, Dallas, TX
| | - Amy Coffee
- Baylor Scott and White Research Institute, Dallas, TX
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Jibb LA, Khan JS, Seth P, Lalloo C, Mulrooney L, Nicholson K, Nowak DA, Kaur H, Chee-A-Tow A, Foster J, Stinson JN. Electronic Data Capture Versus Conventional Data Collection Methods in Clinical Pain Studies: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16480. [PMID: 32348259 PMCID: PMC7351264 DOI: 10.2196/16480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 03/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and feasibly collect pain-related data from patients in both clinical and research settings. OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis to compare electronic and conventional pain-related data collection methods with respect to pain score equivalence, data completeness, ease of use, efficiency, and acceptability between methods. METHODS We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception until November 2019. We included all peer-reviewed studies that compared electronic (any modality) and conventional (paper-, telephone-, or in-person-based) data capture methods for patient-reported pain data on one of the following outcomes: pain score equivalence, data completeness, ease of use, efficiency, and acceptability. We used random effects models to combine score equivalence data across studies that reported correlations or measures of agreement between electronic and conventional pain assessment methods. RESULTS A total of 53 unique studies were included in this systematic review, of which 21 were included in the meta-analysis. Overall, the pain scores reported electronically were congruent with those reported using conventional modalities, with the majority of studies (36/44, 82%) that reported on pain scores demonstrating this relationship. The weighted summary correlation coefficient of pain score equivalence from our meta-analysis was 0.92 (95% CI 0.88-0.95). Studies on data completeness, patient- or provider-reported ease of use, and efficiency generally indicated that electronic data capture methods were equivalent or superior to conventional methods. Most (19/23, 83%) studies that directly surveyed patients reported that the electronic format was the preferred data collection method. CONCLUSIONS Electronic pain-related data capture methods are comparable with conventional methods in terms of score equivalence, data completeness, ease, efficiency, and acceptability and, if the appropriate psychometric evaluations are in place, are a feasible means to collect pain data in clinical and research settings.
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Affiliation(s)
- Lindsay A Jibb
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - James S Khan
- Department of Anesthesia, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Puneet Seth
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauren Mulrooney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dominik A Nowak
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Harneel Kaur
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Joel Foster
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Craig KD. A child in pain: A psychologist’s perspective on changing priorities in scientific understanding and clinical care. PAEDIATRIC AND NEONATAL PAIN 2020; 2:40-49. [PMID: 35548593 PMCID: PMC8975203 DOI: 10.1002/pne2.12034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
My research and clinical career followed a trajectory of increasing appreciation for the importance of social factors as determinants of pain experience and expression. The social contexts of children’s lives determine whether infants and children are exposed to pain, how socialization in family and ethnocultural contexts lead to pain as a social experience, comprised of thoughts and feelings as well as sensory input, how others shape pain experience and expression, less so for automatic/reflexive features than purposeful representations, and how other's appraisals of children’s pain reflect the observer's unique background and capacities for intervening in the child’s interests. A greater understanding of the social dimensions of pain, as reflected in the social communication model of pain, would support innovation of psychological and social interventions.
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The Multimodal Assessment Model of Pain: A Novel Framework for Further Integrating the Subjective Pain Experience Within Research and Practice. Clin J Pain 2020; 35:212-221. [PMID: 30444733 PMCID: PMC6382036 DOI: 10.1097/ajp.0000000000000670] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges. METHODS This is a narrative review. RESULTS MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non-self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures. DISCUSSION MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain.
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Wright RC, Junghaenel DU, Rivas R, Hristidis V, Robbins ML. A new approach to capturing pain disclosure in daily life in-person and online. J Health Psychol 2020; 26:2577-2591. [PMID: 32419503 DOI: 10.1177/1359105320918322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This feasibility study employed a new approach to capturing pain disclosure in face-to-face and online interactions, using a newly developed tool. In Study 1, 13 rheumatoid arthritis and 52 breast cancer patients wore the Electronically Activated Recorder to acoustically sample participants' natural conversations. Study 2 obtained data from two publicly available online social networks: fibromyalgia (343,439 posts) and rheumatoid arthritis (12,430 posts). Pain disclosure, versus non-pain disclosure, posts had a greater number of replies, and greater engagement indexed by language style matching. These studies yielded novel, multimethod evidence of how pain disclosure unfolds in naturally occurring social contexts in everyday life.
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Jaaniste T, Noel M, Yee RD, Bang J, Tan AC, Champion GD. Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E132. [PMID: 31810283 PMCID: PMC6956370 DOI: 10.3390/children6120132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child's pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children's self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
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Affiliation(s)
- Tiina Jaaniste
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Hotchkiss Brain Institute, Calgary, AB T2N 1N4, Canada
| | - Renee D. Yee
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Joseph Bang
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | | | - G. David Champion
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
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Arnstein P, Gentile D, Wilson M. Validating the Functional Pain Scale for Hospitalized Adults. Pain Manag Nurs 2019; 20:418-424. [DOI: 10.1016/j.pmn.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/04/2019] [Accepted: 03/31/2019] [Indexed: 11/25/2022]
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Sampson FC, Goodacre SW, O’Cathain A. The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design. Ann Emerg Med 2019; 74:538-548. [DOI: 10.1016/j.annemergmed.2019.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 12/23/2022]
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Contreras-Aguilar MD, Escribano D, Martínez-Miró S, López-Arjona M, Rubio CP, Martínez-Subiela S, Cerón JJ, Tecles F. Application of a score for evaluation of pain, distress and discomfort in pigs with lameness and prolapses: correlation with saliva biomarkers and severity of the disease. Res Vet Sci 2019; 126:155-163. [PMID: 31494378 DOI: 10.1016/j.rvsc.2019.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 01/24/2023]
Abstract
A score system was used to evaluate pain, distress and discomfort in healthy pigs and pigs with two different diseases: lameness and rectal prolapse. In addition, correlations between the results of this score and a panel of salivary biomarkers and severity of disease were studied. This panel included biomarkers of stress (cortisol, salivary alpha-amylase (sAA), total esterase activity (TEA), butyrylcholinesterase (BChE) and lipase (Lip)), immunity (adenosine deaminase isozymes 1 (ADA1) and 2 (ADA2)) and oxidative status (uric acid (UA), Trolox equivalent antioxidant capacity (TEAC), cupric reducing antioxidant capacity (CUPRAC), ferric reducing ability of saliva (FRAS), advanced oxidation protein products (AOPP) and hydrogen peroxide (H2O2)). Based on their score, diseased animals were subdivided in those without and with evident pain. Lame pigs and prolapsed pigs with pain showed higher salivary levels of cortisol, sAA, TEA, BChE, ADA1 and ADA2 compared with the healthy pigs. In addition, the prolapsed pigs with pain showed higher levels of FRAS, AOPP and H2O2 compared with the healthy animals. Salivary cortisol, TEA, BChE, ADA isozymes 1 and 2, FRAS and AOPP correlated with the pain score. This five-point pain score system can be easily applied to lame and prolapsed pigs, and salivary biomarkers could be used as an additional tool for pain assessment in those pigs.
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Affiliation(s)
- María Dolores Contreras-Aguilar
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - Damián Escribano
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - Silvia Martínez-Miró
- Department of Animal Production, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
| | - Marina López-Arjona
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - Camila P Rubio
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - Silvia Martínez-Subiela
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - José J Cerón
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain
| | - Fernando Tecles
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Campus de Espinardo s/n, 30100, Espinardo, Murcia, Spain.
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Trandafir LM, Leon MM, Frasinariu O, Baciu G, Dodi G, Cojocaru E. Current Practices and Potential Nanotechnology Perspectives for Pain Related to Cystic Fibrosis. J Clin Med 2019; 8:jcm8071023. [PMID: 31336857 PMCID: PMC6678759 DOI: 10.3390/jcm8071023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Pain is a complex, multidimensional process that negatively affects physical and mental functioning, clinical outcomes, quality of life, and productivity for cystic fibrosis (CF) patients. CF is an inherited multi-system disease that requires a complete approach in order to evaluate, monitor and treat patients. The landscape in CF care has changed significantly, with currently more adult patients than children worldwide. Despite the great advances in supportive care and in our understanding regarding its pathophysiology, there are still numerous aspects of CF pain that are not fully explained. This review aims to provide a critical overview of CF pain research that focuses on pain assessment, prevalence, characteristics, clinical association and the impact of pain in children and adults, along with innovative nanotechnology perspectives for CF management. Specifically, the paper evaluates the pain symptoms associated with CF and examines the relationship between pain symptoms and disease severity. The particularities of gastrointestinal, abdominal, musculoskeletal, pulmonary and chest pain, as well as pain associated with medical procedures are investigated in patients with CF. Disease-related pain is common for patients with CF, suggesting that pain assessment should be a routine part of their clinical care. A summary of the use of nanotechnology in CF and CF-related pain is also given. Further research is clearly needed to better understand the sources of pain and how to improve patients’ quality of life.
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Affiliation(s)
- Laura M Trandafir
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Magdalena M Leon
- Medical I Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Otilia Frasinariu
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Ginel Baciu
- Pediatric Department, "Dunărea de Jos" University of Galati, 800008 Galati, Romania
| | - Gianina Dodi
- Advanced Centre for Research-Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania.
| | - Elena Cojocaru
- Morpho-Functional Sciences Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
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