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Cascella M, Di Gennaro P, Crispo A, Vittori A, Petrucci E, Sciorio F, Marinangeli F, Ponsiglione AM, Romano M, Ovetta C, Ottaiano A, Sabbatino F, Perri F, Piazza O, Coluccia S. Advancing the integration of biosignal-based automated pain assessment methods into a comprehensive model for addressing cancer pain. BMC Palliat Care 2024; 23:198. [PMID: 39097739 PMCID: PMC11297625 DOI: 10.1186/s12904-024-01526-z] [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: 09/02/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Tailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address the potential correlations between subjective and APA-derived objectives variables in a cohort of cancer patients. METHODS A multidimensional statistical approach was employed. Demographic, clinical, and pain-related variables were examined. Objective measures included electrodermal activity (EDA) and electrocardiogram (ECG) signals. Sensitivity analysis, multiple factorial analysis (MFA), hierarchical clustering on principal components (HCPC), and multivariable regression were used for data analysis. RESULTS The study analyzed data from 64 cancer patients. MFA revealed correlations between pain intensity, type, Eastern Cooperative Oncology Group Performance status (ECOG), opioids, and metastases. Clustering identified three distinct patient groups based on pain characteristics, treatments, and ECOG. Multivariable regression analysis showed associations between pain intensity, ECOG, type of breakthrough cancer pain, and opioid dosages. The analyses failed to find a correlation between subjective and objective pain variables. CONCLUSIONS The reported pain perception is unrelated to the objective variables of APA. An in-depth investigation of APA is required to understand the variables to be studied, the operational modalities, and above all, strategies for appropriate integration with data obtained from self-reporting. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, number (NCT04726228), registered 27 January 2021, https://classic. CLINICALTRIALS gov/ct2/show/NCT04726228?term=nct04726228&draw=2&rank=1.
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Affiliation(s)
- Marco Cascella
- Department of Medicine, Surgery and Dentistry, Anesthesia and Pain Medicine, University of Salerno, Via Salvador Allende 43, Baronissi Salerno, 84081, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola 53, Naples, 80131, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola 53, Naples, 80131, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino GesĂą IRCCS, Piazza S. Onofrio 4, Rome, 00165, Italy.
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, Coppito L'Aquila, 67100, Italy
| | - Francesco Sciorio
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, Piazzale Salvatore Tommasi, 1,, Coppito, AQ, 67100, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, Piazzale Salvatore Tommasi, 1,, Coppito, AQ, 67100, Italy
| | - Alfonso Maria Ponsiglione
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Corso Umberto I, 40, Napoles, 80138, Italy
| | - Maria Romano
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Corso Umberto I, 40, Napoles, 80138, Italy
| | - Concetta Ovetta
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Corso Umberto I, 40, Napoles, 80138, Italy
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, INT IRCCS Foundation "G. Pascale", Via Mariano Semmola 53, Naples, 80131, Italy
| | - Francesco Sabbatino
- Department of Medicine, Surgery and Dentistry, Oncology Unit, University of Salerno, Via Salvador Allende 43, Baronissi Salerno, 84081, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Via Mariano Semmola 53, Naples, 80131, Italy
| | - Ornella Piazza
- Department of Medicine, Surgery and Dentistry, Anesthesia and Pain Medicine, University of Salerno, Via Salvador Allende 43, Baronissi Salerno, 84081, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola 53, Naples, 80131, Italy
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Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact On Acute Pain and Pain Services. Curr Pain Headache Rep 2023; 27:429-436. [PMID: 37405553 PMCID: PMC10462520 DOI: 10.1007/s11916-023-01125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.
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Affiliation(s)
- Rahel Rogger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S. Romero
- Anesthesia, Critical Care and Pain Department, Hospital General Universitario de Valencia, Universitad Europea de Valencia, Valencia, Spain
| | - Richard D. Urman
- Department of Anaesthesiology, The Ohio State University, Columbus, OH USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Mark G. Filipovic
- Department of Anaesthesiology and Pain Medicine, Pain Center, Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Poehlmann JR, Avery G, Antony KM, Broman AT, Godecker A, Green TL. Racial disparities in post-operative pain experience and treatment following cesarean birth. J Matern Fetal Neonatal Med 2022; 35:10305-10313. [PMID: 36195464 DOI: 10.1080/14767058.2022.2124368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate racial/ethnic differences in post-operative pain experience and opioid medication use (morphine milligram equivalent) in the first 24 h following cesarean birth. METHODS This study was a single-center retrospective cohort of birthing persons who underwent cesarean deliveries between 1/1/16 and 12/31/17. A total of 2,228 cesarean deliveries were analyzed. The primary outcome was average pain, which was the mean of all documented self-reported pain scores (0-10 scale) during the first 24 h post-delivery. The secondary outcome included oral morphine equivalents used in the first 24 h post-delivery. Linear regression was performed to examine whether the race/ethnicity of the birthing parent was associated with mean pain scores and oral morphine equivalents, controlling for confounding variables. RESULTS In multivariate analyses non-Hispanic Black birthing persons reported higher mean pain scores (Coefficient: 0.61, 95% confidence interval [0.39-0.82], p < .001]) than non-Hispanic White birthing persons, but received similar quantities of morphine milligram equivalent (Coefficient: -0.98 mg, 95% confidence interval [-5.93-3.97], p = .698]). Non-Hispanic Asian birthing persons reported similar reported mean pain scores to those of non-Hispanic White birthing persons (Coefficient: 0.02 mg, 95% confidence interval [-0.17-0.22], p = .834]), but received less morphine milligram equivalent (Coefficient: -5.47 mg, 95% confidence interval [-10.05 to -0.90], p = .019). When controlling for reported mean pain scores, both non-Hispanic Black (Coefficient: -6.36 mg, 95% confidence interval [-10.97 to -1.75], p = .007) and non-Hispanic Asian birthing persons (Coefficient: -5.66 mg, 95% confidence interval [-9.89 to -1.43], p = .009) received significantly less morphine milligram equivalents. CONCLUSION Despite reporting higher mean pain scores, non-Hispanic Black birthing persons did not receive higher quantities of morphine milligram equivalent. Non-Hispanic Asian birthing persons received lower quantities of morphine milligram equivalent despite reporting similar pain scores to non-Hispanic White birthing persons. These differences suggest disparities in post-operative pain management for birthing persons of color in our study population.
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Affiliation(s)
- John R Poehlmann
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gabrielle Avery
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kathleen M Antony
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy Godecker
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tiffany L Green
- Departments of Population Health Sciences and Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
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Navarro-Prado S, Sánchez-Ojeda MA, Marmolejo-MartĂn J, Kapravelou G, Fernández-GĂłmez E, MartĂn-Salvador A. Cultural influence on the expression of labour-associated pain. BMC Pregnancy Childbirth 2022; 22:836. [PMID: 36376827 PMCID: PMC9664611 DOI: 10.1186/s12884-022-05173-1] [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: 10/11/2021] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Every woman expresses pain differently during birth since it depends on a multitude of predictive factors. The medical care received, companionship during birth, cultural background and language barriers of the women in labour can influence on the expression of pain. This study aims to evaluate the expression of pain during birth and its associated factors in women treated in a Spanish border town. Methods The study included 246 women in labour. The expression of pain during labour was evaluated using the validated ESVADOPA scale. A descriptive analysis and association study were performed between cultural identity and dimensions of the scale. Multiple linear regression models were performed to assess the association between cultural identity, origin, language barrier, and companionship during labour. Results The women included in the study comprised 68.7% Berbers, 71.5% Muslims and 82.1% were accompanied during labour. An association between cultural identity and greater body expression of pain (p = 0.020; Cramer’s V = 0.163) in addition to its verbal expression was found during the latent phase of labour, (p = 0.028; Cramer’s V = 0.159). During the active phase of labour, cultural identity was associated with pain expression through greater body response, verbal expression, expression of the facial muscles, anxiety, inability to relax and vegetative symptoms. The different factors studied that had a predictive value were companionship (p = 0.027) during the latent phase of labour and Berber origin (p = 0.000), language barrier (p = 0.014) and companionship (p = 0.005) during the active phase of labour. The models designed predict pain expression in the latent phase by companionship and type of companionship (β = 1.483; 95%CI = 0.459–2.506, β = 0.238; 95%CI = 0.029–0. 448, respectively), and in the active phase by background, language barrier and companionship (β = 0.728; 95%CI = 0.258–1.198, β = 0.738; 95%CI = 0.150–1.326, β = 1.888; 95%CI = 0.984–2.791, respectively). Conclusion Culture, origin, language barrier and companionship during labour influences the manner in which women in labour express their pain. An understanding of this may help midwives correctly interpret the signs of pain expression and be able to offer the appropriate assistance depending on a woman's particular characteristics. There is a clear need for new models of maternity care that will take the cultural and language characteristics of women in labour into consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05173-1.
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Evaluation of the practical clinical use of the Horse Grimace Scale translated into French. Vet Anaesth Analg 2022; 49:615-623. [DOI: 10.1016/j.vaa.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/11/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022]
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Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals. Healthcare (Basel) 2021; 9:healthcare9020171. [PMID: 33562852 PMCID: PMC7914438 DOI: 10.3390/healthcare9020171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.
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Lor M, Vang X, Rabago D, Brown RL, Backonja M. “It Hurts as If…”: Pain-Associated Language, Visual Characterization, and Storytelling in Hmong Adults. PAIN MEDICINE 2019; 21:1690-1702. [DOI: 10.1093/pm/pnz268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractObjectivePain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communicate their pain to providers in primary care settings.MethodsA qualitative study with 67 Hmong participants (63% female and x̄ age = 53.7 years) were recruited from a Midwestern state. Semistructured interviews on pain communication were conducted, audio-recorded, transcribed, and analyzed using directed content analysis.ResultsThe Hmong participants described pain using stories that generally had the same dimensions of information that providers require for pain assessment. These included references to time, causality, associated symptoms or related experiences, intensity, and consequences of pain. However, the participants expressed some pain dimensions in language that was not shared by providers: visual metaphors that were generally in reference to pain quality and fewer words for pain location, intensity, and some qualities. Participants used two strategies to decide whether they should tell their pain story: assessing the provider and determining whether their story was appreciated. The perception that providers underappreciated their stories resulted in dissatisfaction and undertreatment of pain. Ultimately, this resulted in having less frequent contact with providers or changing providers.ConclusionsFindings demonstrate a discordance in the expected process and content of the clinical interaction between LEP Hmong patients and providers, suggesting the need for culturally appropriate pain assessments in this population.
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Affiliation(s)
- Maichou Lor
- Columbia University School of Nursing, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Xia Vang
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Rabago
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Backonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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