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Tegenborg S, Fransson P, Martinsson L. The Abbey Pain Scale: not sufficiently valid or reliable for assessing pain in patients with advanced cancer. Acta Oncol 2023; 62:953-960. [PMID: 37382384 DOI: 10.1080/0284186x.2023.2228992] [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: 04/26/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Patients with advanced cancer can be unable to verbalize their pain. The Abbey Pain Scale (APS), an observational tool, is used to assess pain in this setting, but has never been psychometrically tested for people with cancer. The aim of this study was to assess the validity, reliability, and the responsiveness of the APS to opioids for patients with advanced cancer in a palliative oncology care setting. MATERIAL AND METHODS Patients with advanced cancer and poor performance status, drowsiness, unconsciousness, or delirium, were assessed for pain using a Swedish translation of the APS (APS-SE) and, if possible, the Numeric Rating Scale (NRS). The assessments using APS were conducted simultaneously, but independently, by the same raters on two separate occasions, approximately one hour apart. Criterion validity was assessed by comparing the APS and NRS values using Cohen's kappa (κ). Inter-rater reliability was determined using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and responsiveness to opioids using the Wilcoxon signed-rank test. RESULTS Seventy-two patients were included, of whom n = 45 could rate their pain using the NRS. The APS did not detect any of the n = 22 cases of moderate or severe pain self-reported using the NRS. The APS at first assessment had a κ of 0.08 (CI: -0.06 to 0.22) for criterion validity, an ICC of 0.64 (CI: 0.43-0.78) for inter-rater reliability, and a Cronbach's α of 0.01 for internal consistency. The responsiveness to opioids was z = -2.53 (p = 0.01). CONCLUSION The APS was responsive to opioids but displayed insufficient validity and reliability and did not detect moderate or severe pain as indicated by the NRS. The study showed a very limited clinical use of the APS in patients with advanced cancer.
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Affiliation(s)
- Sussi Tegenborg
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Tegenborg S, Fransson P, Martinsson L. Physicians' and nurses' experience of using the Abbey Pain Scale (APS) in people with advanced cancer: a qualitative content analysis. BMC Nurs 2023; 22:95. [PMID: 37016389 PMCID: PMC10071650 DOI: 10.1186/s12912-023-01227-7] [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: 10/31/2022] [Accepted: 03/02/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The Abbey Pain Scale (APS), an observational scale used to assess pain in people with end-stage dementia, is also widely used in Sweden to assess pain in patients with advanced cancer. It is unclear whether the APS is appropriate in this context. This study aims to explore physicians' and nurses' experiences of using a Swedish translation of the APS (the APS-SE) in people with advanced cancer. METHODS Conventional qualitative content analysis was used to analyse interviews with physicians (n = 6) and nurses (n = 6) working in oncology and specialised palliative care about their experiences of using the APS-SE. RESULTS Three categories were created: fills a need, not always on target, and does not fully suit the clinical situation. Participants reported that although the APS-SE provides support in a challenging situation, it sometimes misses the mark: it does not distinguish well between pain and other types of suffering and its pain score tends not to reflect professionals' intuitive perceptions of patients' suffering. Some parts of the APS-SE were not considered useful, and others were perceived as ethically questionable. CONCLUSION Health professionals greatly need an observational pain assessment tool for people with advanced cancer. The APS-SE is helpful in this context, but participants did not perceive it as ideal. Its problems seem inherent to the original APS rather than related to its translation from English to Swedish. Further research is needed to provide a more suitable pain assessment tool for patients with advanced cancer.
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Affiliation(s)
- Sussi Tegenborg
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Tegenborg S, Fransson P, Martinsson L. Translation, cultural adaptation and recommendations for clinical implementation of the Abbey Pain Scale to a Swedish dementia care context. Nurs Open 2022; 10:1367-1374. [PMID: 36217250 PMCID: PMC9912384 DOI: 10.1002/nop2.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/03/2022] [Accepted: 09/14/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To translate and culturally adapt the APS for people with end-stage dementia in various care settings in Sweden and to investigate factors important for clinical implementation. DESIGN Qualitative study design with interviews with care staff. METHODS After an initial discussion of concepts, the Abbey Pain Scale was translated into Swedish and back into English to check for accuracy. The resulting Swedish version was then revised and culturally adapted through a series of interviews with nursing assistants, nurses and physicians (n = 11) to develop the final Swedish version. RESULTS A Swedish version of the Abbey Pain Scale was developed. The instrument was considered straightforward and easy to use, but needed adjustments to make it more comprehensible to staff with less education in health care or with other first languages than Swedish. It was found important to carefully introduce new staff members to the instrument, to ensure they understand all the words and items.
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Coelho A, Rocha A, Cardoso D, Rodrigues R, Costeira C, Gomes S, Parola V. Monitoring and Management of the Palliative Care Patient Symptoms: A Best Practice Implementation Project. NURSING REPORTS 2022; 12:365-370. [PMID: 35645361 PMCID: PMC9149824 DOI: 10.3390/nursrep12020035] [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: 03/31/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background: In palliative care, symptoms are multiple and combined, evolving and changing, with a multidimensional character and multifactorial causes, and a high prevalence, negatively influencing the patient’s and family’s quality of life. Nurses who provide palliative care need to recognize and respond effectively to their patients’ symptoms. Methods: A project will be applied to implement the best practice in monitoring and managing palliative care patients’ symptoms. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool will be used. The JBI PACES and GRiP framework for promoting evidence-based healthcare involves three phases of activity. First, a baseline audit. In a second phase, feedback will be given to the project team after the conclusion of the baseline audit report. Then, a third phase will be conducted as a follow-up audit. Conclusions: This project will improve the practice of the nursing team in monitoring and managing the symptoms of palliative care patients, positively influencing the quality of life of the patient and his family. The implementation and dissemination of this project could boost its replication in other centres.
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Affiliation(s)
- Adriana Coelho
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004 Coimbra, Portugal; (D.C.); (R.R.); (C.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, 3000 Coimbra, Portugal
- Correspondence:
| | - Ana Rocha
- Portuguese Oncologic Institute of Coimbra, Palliative Care Unit, 3004 Coimbra, Portugal; (A.R.); (S.G.)
| | - Daniela Cardoso
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004 Coimbra, Portugal; (D.C.); (R.R.); (C.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, 3000 Coimbra, Portugal
| | - Rogério Rodrigues
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004 Coimbra, Portugal; (D.C.); (R.R.); (C.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, 3000 Coimbra, Portugal
| | - Cristina Costeira
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004 Coimbra, Portugal; (D.C.); (R.R.); (C.C.); (V.P.)
- ciTechCare, School of Health Sciences, Polytechnic of Leiria, 2411 Leiria, Portugal
| | - Sara Gomes
- Portuguese Oncologic Institute of Coimbra, Palliative Care Unit, 3004 Coimbra, Portugal; (A.R.); (S.G.)
| | - Vitor Parola
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004 Coimbra, Portugal; (D.C.); (R.R.); (C.C.); (V.P.)
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, 3000 Coimbra, Portugal
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The conscious state of the dying patient: An integrative review. Palliat Support Care 2021; 20:731-743. [PMID: 34615571 DOI: 10.1017/s1478951521001541] [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: 11/06/2022]
Abstract
OBJECTIVES The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. METHODS An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. RESULTS Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. SIGNIFICANCE OF RESULTS In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.
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Cook H, Kaiser KS, Walker KA, McPherson ML. Interprofessional Healthcare Students' Attitudes, Skills, and Knowledge After Comprehensive Pain Assessment Training in Verbal and Nonverbal Patients. J Hosp Palliat Nurs 2021; 23:386-395. [PMID: 33990515 DOI: 10.1097/njh.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A comprehensive pain assessment is the first step in safe, effective pain management. Few studies have explored variations of strategies and measures for multidimensional pain assessment education in both verbal and nonverbal patients. In this retrospective cohort study, interprofessional health care students enrolled in a palliative care curriculum completed a pain assessment training, which taught the PQRSTA ("palliating factors, precipitating factors, previous treatments, quality, region, radiation, severity, temporal factors and associated symptoms") mnemonic as a strategy for assessing pain in verbal patients and the Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures for nonverbal patients. The purpose of this study was to compare the change in attitudes, self-perceived skills, and knowledge regarding pain assessment before and after the training. Attitudes and self-perceived skills were assessed in the pretraining and posttraining survey, which was analyzed using χ2 test or Fisher exact test. Students' knowledge responses were analyzed using Wilcoxon signed rank test to assess accuracy of responses compared with the expert defined score. One hundred eighty-two students were included. Results showed a statistically significant improvement in attitudes related to applicability of pain measures and self-perceived skills. Overall, data did not support an increase in knowledge using the PQRSTA mnemonic, or Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures. Future pain trainings should consider training on only 1 nonverbal pain measure, incorporating bedside assessments, and integrating real-time feedback.
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McAnee G, Norwood K, Rosato M, Leavey G. Assessment of pain in people living with dementia at the end of life: a systematic review. Int J Palliat Nurs 2021; 27:72-85. [PMID: 33886358 DOI: 10.12968/ijpn.2021.27.2.72] [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: 11/11/2022]
Abstract
BACKGROUND People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL). AIMS To understand the best way to examine pain in people with dementia. METHODS A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched. FINDINGS A total of 15 articles were identified, which were qualitatively synthesised. CONCLUSION There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.
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Affiliation(s)
- Grainne McAnee
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Kelly Norwood
- School of Psychology, Ulster University, Northern Ireland, United Kingdom
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
| | - Gerry Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, United Kingdom
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Tetteh L, Aziato L, Mensah GP, Vehviläinen-Julkunen K, Kwegyir-Afful E. Burns pain management: The role of nurse-patient communication. Burns 2020; 47:1416-1423. [PMID: 33277090 DOI: 10.1016/j.burns.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/12/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nursing is an embodiment of knowledge, clinical work, and interpersonal communication. Effective nursing care has a distinct influence on the overall satisfaction and experience of the patient. Communication is said to be indispensable in the delivery of quality healthcare. Effective communication between nurses and patients has proven to yield better results with pain control and improved psychological status of patients. OBJECTIVES The aim of the study is to explore nurses' perceptions on the role of communication in the management of burns pain. METHODS A qualitative design with purposive sampling was carried out to recruit 11 registered nurses from a Reconstructive Plastic Surgery and Burns Center in Ghana. To identify the participants' perception on the role of nurse-patient communication in the management of burns pain, a face to face semi-structured interviews were conducted using an interview guide to collect data. RESULTS Thematic analysis was done with various themes emerging. Helping patients manage pain, early detection of patient's distress, improved patient participation in their care were some of the positive effects of nurse-patient communication whiles reduced level of cooperation during caregiving, and endurance of pain by the patient were the results of poor nurse-patient communication. Language and time factor were the barriers that were identified to hinder effective communication between nurses and patients. CONCLUSIONS Due to the subjective nature of pain, the current study highlights the need for increased communication for an effective assessment and management of pain among patients with burns. It is, therefore, imperative that nurses be well trained in communication with an emphasis on patient-centered communication.
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Affiliation(s)
- Linda Tetteh
- University of Ghana College of Health Sciences, School of Nursing and Midwifery, P.O. Box LG 43, Legon, Accra, Ghana
| | - Lydia Aziato
- University of Ghana College of Health Sciences, School of Nursing and Midwifery, P.O. Box LG 43, Legon, Accra, Ghana
| | - Gwendolyn Patience Mensah
- University of Ghana College of Health Sciences, School of Nursing and Midwifery, P.O. Box LG 43, Legon, Accra, Ghana
| | - Katri Vehviläinen-Julkunen
- University of Eastern Finland, Faculty of Health Sciences, Department of Nursing Science, FI-70211, Kuopio, Finland; Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Emma Kwegyir-Afful
- University of Salford, School of Health and Society, Manchester, Frederick Road, M6 6PU, United Kingdom.
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Ludvigsson C, Isaksson U, Hajdarevic S. Experiencing improved assessment and control of pain in end-of-life care when using the Abbey Pain Scale systematically. Nurs Open 2020; 7:1798-1806. [PMID: 33072364 PMCID: PMC7544863 DOI: 10.1002/nop2.566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Aim To describe staff's reflections on aspects influencing pain assessment at end-of-life (EoL) care in nursing homes before and after the implementation of the Abbey Pain Scale (APS). Background People with cognitive impairment in the EoL care often suffer from underdiagnosed and undertreated pain due to the lack of knowledge and guidelines for systematic pain assessment. Methods Semi-structured focus group interviews were conducted and analysed using qualitative content analysis. Results The staff described their experiences before the implementation of APS as striving to achieve control of pain by trusting in themselves and the team, while the experiences after the implementation of APS were described as improving symptom control with remaining weak confidence in the team. Conclusions Implementation of APS was experienced as improving systematic pain assessment. Efforts to establish clear routines and improve confidence in the care team would be prioritized to optimize pain assessment and pain relief in EoL care.
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Affiliation(s)
| | - Ulf Isaksson
- Department of Nursing Umeå University Umeå Sweden.,Arctic Research Centre Umeå University Umeå Sweden
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Curseen KA, Taj J, Grant Q. Pain Management in Patients with Serious Illness. Med Clin North Am 2020; 104:415-438. [PMID: 32312407 DOI: 10.1016/j.mcna.2020.01.005] [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] [Indexed: 11/25/2022]
Abstract
Managing pain in patients with serious illness can be complex. However, pain is often a prominent symptom in patients with malignant and nonmalignant serious illness and providers have to be adept at balancing effective pain management and safety. Clinicians should start with a standard pain assessment that lays important groundwork for developing a tailored multimodal approach to pain management. It is important to identify physical causes of pain and also existential causes. Opioids are not always appropriate but are still an important tool for managing pain. Basic opioid management and safe practices are essential when managing this population.
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Affiliation(s)
- Kimberly Angelia Curseen
- Internal Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, Emory Palliative Care Center, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA.
| | - Jabeen Taj
- Hospice and Palliative Medicine, Cardiac Palliative Care, Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, Emory University Hospital, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA
| | - Quintesia Grant
- Palliative and Supportive Care, Grady Memorial Hospital, Harbor Grace Hospice, Atlanta, GA, USA; Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA
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Varndell W, Fry M, Elliott D. Pain assessment and interventions by nurses in the emergency department: A national survey. J Clin Nurs 2020; 29:2352-2362. [PMID: 32221999 DOI: 10.1111/jocn.15247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/12/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. BACKGROUND Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate-to-severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management. DESIGN This cross-sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses. METHODS Australian emergency nurses were invited to complete an online survey comprising 91 items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study. RESULTS Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses' intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients. CONCLUSIONS Emergency nurses recognise the importance of pain relief. The ability to nurse-initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor. RELEVANCE TO CLINICAL PRACTICE While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse-initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.
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Affiliation(s)
- Wayne Varndell
- Emergency Department, Prince of Wales Hospital, Randwick, NSW, Australia.,University of Technology Sydney, Ultimo, NSW, Australia
| | - Margaret Fry
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Doug Elliott
- University of Technology Sydney, Ultimo, NSW, Australia
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12
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Hack JB, Melikian GK, Jessey C, Baird J. A Novel Tool to Facilitate Communication of Pain Quality: "Pain Blocks". Clin Ther 2020; 42:286-294.e1. [PMID: 32029287 DOI: 10.1016/j.clinthera.2019.12.013] [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: 09/12/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Assessment of pain is difficult for many reasons, including the inability of patients to translate a subjective experience into words, and it is challenging for health care providers to create a shared understanding of what is being described. Physical representations exist to facilitate the objective scaling of "severity" or "intensity" of pain, but none exist to enable communication of pain quality. The objective of this proof-of-concept study was to develop, introduce, and evaluate consistency of participant interpretation of a novel kinesthetic tool set (Pain Blocks) that was designed to represent qualities of pain. METHODS A prospective convenience sampling of participants approached in nonmedical settings over 9 months was queried to assess 6 randomly ordered Pain Blocks during structured interviews. The subjects were directed to associate each Pain Block with a pain quality from a list of 12 suggestions or use a free-text area for "other" descriptors. During the study, Pain Blocks were removed and replaced based on consistency of response at interval assessments. In part 2, participants were asked if any of the Pain Blocks accurately characterized the quality of their last severe pain. FINDINGS A convenience sample of 220 participants was enrolled in the study and assessed 6 Pain Blocks. They interpreted and applied a pain quality to each of the blocks. Using interval assessments, a final selection of 6 Pain Blocks was derived that had consistent high association with specific pain qualities, either individually or with synonyms: Block 1 (stretching and tearing), 81.8%; Block 3 (crampy and throbbing), 90.4%; Block 4 (sharp and stabbing), 99.1%; Block 6 (crushing and dull), 94.1%; Block 7 (twisting), 95.8%; and Block 8b (burning), 100%. There were no differences in consistency of block interpretation between sexes or in terms of past experience of pain. IMPLICATIONS We were able to create a group of physical objects (Pain Blocks) that were consistently and persistently interpreted, with a high degree of reliability, to represent specific pain qualities across ages and sexes. Although this proof-of-concept article was limited by the inclusion of English-speaking patients only and voluntary participants not currently in pain, the results support further investigation into tools to create a shared understanding of pain sensations between provider and participant.
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Affiliation(s)
- Jason B Hack
- Alpert Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Brown University and Rhode Island Hospital, Providence, RI, USA.
| | - Gillian K Melikian
- Department of Emergency Medicine, Research, Rhode Island Hospital, Providence, RI, USA
| | - Clare Jessey
- Rhode Island School of Design, Providence, RI, USA
| | - Janette Baird
- Alpert Medical School, Department of Emergency Medicine, Research, Rhode Island Hospital, Providence, RI, USA
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