1
|
El-Tallawy SN, Pergolizzi JV, Vasiliu-Feltes I, Ahmed RS, LeQuang JK, El-Tallawy HN, Varrassi G, Nagiub MS. Incorporation of "Artificial Intelligence" for Objective Pain Assessment: A Comprehensive Review. Pain Ther 2024; 13:293-317. [PMID: 38430433 PMCID: PMC11111436 DOI: 10.1007/s40122-024-00584-8] [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: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024] Open
Abstract
Pain is a significant health issue, and pain assessment is essential for proper diagnosis, follow-up, and effective management of pain. The conventional methods of pain assessment often suffer from subjectivity and variability. The main issue is to understand better how people experience pain. In recent years, artificial intelligence (AI) has been playing a growing role in improving clinical diagnosis and decision-making. The application of AI offers promising opportunities to improve the accuracy and efficiency of pain assessment. This review article provides an overview of the current state of AI in pain assessment and explores its potential for improving accuracy, efficiency, and personalized care. By examining the existing literature, research gaps, and future directions, this article aims to guide further advancements in the field of pain management. An online database search was conducted via multiple websites to identify the relevant articles. The inclusion criteria were English articles published between January 2014 and January 2024). Articles that were available as full text clinical trials, observational studies, review articles, systemic reviews, and meta-analyses were included in this review. The exclusion criteria were articles that were not in the English language, not available as free full text, those involving pediatric patients, case reports, and editorials. A total of (47) articles were included in this review. In conclusion, the application of AI in pain management could present promising solutions for pain assessment. AI can potentially increase the accuracy, precision, and efficiency of objective pain assessment.
Collapse
Affiliation(s)
- Salah N El-Tallawy
- Anesthesia and Pain Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
- Anesthesia and Pain Department, Faculty of Medicine, Minia University & NCI, Cairo University, Giza, Egypt.
| | | | - Ingrid Vasiliu-Feltes
- Science, Entrepreneurship and Investments Institute, University of Miami, Miami, USA
| | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
2
|
Sabater-Gárriz Á, Molina-Mula J, Montoya P, Riquelme I. Pain assessment tools in adults with communication disorders: systematic review and meta-analysis. BMC Neurol 2024; 24:66. [PMID: 38368314 PMCID: PMC10873938 DOI: 10.1186/s12883-024-03539-w] [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: 08/01/2023] [Accepted: 01/15/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. METHODS A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. RESULTS Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. CONCLUSIONS While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. TRIAL REGISTRATION This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .
Collapse
Affiliation(s)
- Álvaro Sabater-Gárriz
- Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of Balearic Islands, Palma, 07122, Spain.
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma, 07122, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Palma, 07010, Spain.
| |
Collapse
|
3
|
De Sario GD, Haider CR, Maita KC, Torres-Guzman RA, Emam OS, Avila FR, Garcia JP, Borna S, McLeod CJ, Bruce CJ, Carter RE, Forte AJ. Using AI to Detect Pain through Facial Expressions: A Review. Bioengineering (Basel) 2023; 10:bioengineering10050548. [PMID: 37237618 DOI: 10.3390/bioengineering10050548] [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: 03/27/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Pain assessment is a complex task largely dependent on the patient's self-report. Artificial intelligence (AI) has emerged as a promising tool for automating and objectifying pain assessment through the identification of pain-related facial expressions. However, the capabilities and potential of AI in clinical settings are still largely unknown to many medical professionals. In this literature review, we present a conceptual understanding of the application of AI to detect pain through facial expressions. We provide an overview of the current state of the art as well as the technical foundations of AI/ML techniques used in pain detection. We highlight the ethical challenges and the limitations associated with the use of AI in pain detection, such as the scarcity of databases, confounding factors, and medical conditions that affect the shape and mobility of the face. The review also highlights the potential impact of AI on pain assessment in clinical practice and lays the groundwork for further study in this area.
Collapse
Affiliation(s)
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Omar S Emam
- Division of AI in Health Sciences, University of Louisville, Louisville, KY 40292, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| |
Collapse
|
4
|
Wojnar-Gruszka K, Sega A, Płaszewska-Żywko L, Wojtan S, Potocka M, Kózka M. Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10894. [PMID: 36078609 PMCID: PMC9517797 DOI: 10.3390/ijerph191710894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. METHODS In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. RESULTS It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622-0.907). CONCLUSIONS Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.
Collapse
Affiliation(s)
- Katarzyna Wojnar-Gruszka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Lucyna Płaszewska-Żywko
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Stanisław Wojtan
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
- Department of Anaesthesiology and Intensive Therapy, University Hospital in Kraków, 30-688 Kraków, Poland
| | - Marcelina Potocka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| |
Collapse
|
5
|
Validation Testing of the European Portuguese Critical-Care Pain Observation Tool. Healthcare (Basel) 2022; 10:healthcare10061075. [PMID: 35742126 PMCID: PMC9222682 DOI: 10.3390/healthcare10061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in mechanically ventilated patients who were admitted to an intensive care unit. A consecutive sample of 110 patients was observed at rest pre-procedure, during a nociceptive procedure (NP) which includes turning/positioning and endotracheal or tracheal suctioning and 20 min post-procedure. Two raters participated in the data collection. The discriminative validity, criterion validity, convergent validity and inter-rater reliability of the CPOT were examined. Results. The inter-rater reliability was excellent (0.93 ≤ α ≤ 1.00) at rest and fair to moderate (0.39 ≤ α ≤ 0.60) during the NP. The CPOT could discriminate between conditions with higher scores during the NP when compared to CPOT scores at rest (p < 0.001). The optimal CPOT cut-off score was >2, with a sensitivity of 71% and a specificity of 80%, and self-reported pain was the gold standard criterion. Significant correlations (<0.40) were found between CPOT scores, the heart rate and the respiratory rate during the nociceptive procedure. Conclusions. The CPOT appears to be a valid alternative for both ventilated and non-ventilated patients who are unable to communicate.
Collapse
|
6
|
Kerbage SH, Garvey L, Lambert GW, Willetts G. Pain assessment of the adult sedated and ventilated patients in the intensive care setting: A scoping review. Int J Nurs Stud 2021; 122:104044. [PMID: 34399307 DOI: 10.1016/j.ijnurstu.2021.104044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
Collapse
Affiliation(s)
| | - Loretta Garvey
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Georgina Willetts
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design; Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
7
|
Birkedal HC, Larsen MH, Steindal SA, Solberg MT. Comparison of two behavioural pain scales for the assessment of procedural pain: A systematic review. Nurs Open 2020; 8:2050-2060. [PMID: 34388865 PMCID: PMC8363347 DOI: 10.1002/nop2.714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/23/2020] [Accepted: 11/05/2020] [Indexed: 01/15/2023] Open
Abstract
AIM To examine the clinical utility and measurement properties of the Critical-Care Pain Observation Tool and the Behavioural Pain Scale when used to assess pain during procedures in the intensive care unit. DESIGN A systematic review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS A systematic search was conducted in CINAHL, MEDLINE, EMBASE and PsychINFO (01 October 2019). Study selection, data extraction and assessment of methodological quality were performed by a pair of authors working independently. Different psychometric properties were addressed: inter-rater reliability, internal consistency, test-retest reliability, discriminant validity and criterion validity. RESULTS Eleven studies were included. Both Critical-Care Pain Observation Tool and the Behavioural Pain Scale showed good reliability and validity and were good options for assessing pain during painful procedures with intensive care unit patients unable to self-report on pain. The Critical-Care Pain Observation Tool is to be preferred since this tool was shown to have particularly good reliability and validity in assessing pain during procedures, but the Behavioural Pain Scale is an appropriate alternative.
Collapse
Affiliation(s)
- Hanne Cathrine Birkedal
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.,Diakonhjemmet Hospital, Oslo, Norway
| | - Marie Hamilton Larsen
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Simen A Steindal
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Marianne Trygg Solberg
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| |
Collapse
|
8
|
Pinheiro ARPDQ, Marques RMD. Behavioral Pain Scale and Critical Care Pain Observation Tool for pain evaluation in orotracheally tubed critical patients. A systematic review of the literature. Rev Bras Ter Intensiva 2020; 31:571-581. [PMID: 31967234 PMCID: PMC7008990 DOI: 10.5935/0103-507x.20190070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/24/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: To describe the appropriateness of two behavioral scales, the Behavioral Pain Scale and the Critical Care Pain Observation Tool, for pain assessment in orotracheally intubated patients admitted to intensive care units. Method: Using the methodology recommended by the Cochrane Center, a systematic literature review was performed in the electronic database EBSCO Host (CINAHL Complete; MEDLINE® Complete; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; Library, Information Science & Technology Abstracts; MedicLatina). Two searches were conducted using the following English terms in the search field: “behavioral pain scale” AND “critical care pain observation tool” AND “behavioral pain scale” OR “critical care pain observation tool”. Two independent reviewers performed the critical evaluation and data extraction and synthesis. Results: Fifteen studies were included that showed that the Behavioral Pain Scale and the Critical Care Pain Observation Tool are valid and reliable scales for pain assessment in orotracheally intubated patients admitted to the intensive care unit. The scales showed similar psychometric properties and good reliability. Conclusion: Both scales are adequate for assessing pain in orotracheally intubated patients admitted to intensive care units; however, they exhibit limitations in specific populations, such as trauma, burn and neurosurgical patients. Further studies on the subject and in specific populations are suggested.
Collapse
|
9
|
Gélinas C, Joffe AM, Szumita PM, Payen JF, Bérubé M, Shahiri T S, Boitor M, Chanques G, Puntillo KA. A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults. AACN Adv Crit Care 2020; 30:365-387. [PMID: 31951666 DOI: 10.4037/aacnacc2019952] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.
Collapse
Affiliation(s)
- Céline Gélinas
- Céline Gélinas is Associate Professor, Ingram School of Nursing, McGill University, 680 Sherbrooke West, Room 1838, Montréal, Québec, Canada, H3A 2M7; and Researcher, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Aaron M Joffe
- Aaron M. Joffe is Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Paul M Szumita
- Paul M. Szumita is Clinical Pharmacy Practice Manager and Program Director - PGY2 Critical Care Pharmacy Practice Residency, Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Francois Payen
- Jean-Francois Payen is Professor, Department of Anesthesiology and Critical Care, and Researcher, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Bérubé
- Mélanie Bérubé is Assistant Professor, Faculty of Nursing, Université Laval; and Researcher, CHU de Québec, Université Laval Research Center (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Shiva Shahiri T
- Shiva Shahiri T is a PhD Student, Ingram School of Nursing, McGill University
| | - Madalina Boitor
- Madalina Boitor is a Student, Faculty of Dentistry, McGill University
| | - Gerald Chanques
- Gerald Chanques is Professor, Department of Anesthesia & Critical Care Medicine, Montpellier University Hospital Saint Eloi, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Kathleen A Puntillo
- Kathleen A. Puntillo is Professor of Nursing Emeritus, University of California San Francisco School of Nursing, San Francisco, California
| |
Collapse
|
10
|
Palikova YA, Palikov VA, Dyachenko IA. Maximum tolerant dose and analgesic activity of PT1 peptide. RESEARCH RESULTS IN PHARMACOLOGY 2019. [DOI: 10.3897/rrpharmacology.5.38520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The article presents the results of the study of the maximum tolerant dose (MTD) and the analgesic activity of peptide PT1 isolated from Alopecosa marikovskyi spider venom. PT1 is the first compound of polypeptide nature, capable of exerting a selective modulating effect on purinergic P2X3 receptors.
Materials and methods: The study was conducted on 174 ICR mice. The analgesic activity of the peptide was evaluated in a thermal hypersensitivity test triggered by CFA and in a model of chemical irritation.
Results and discussion: The determined MTD for the peptide PT1 when administered intravenously provides evidence to attribute it to low-toxic compounds. The maximum analgesic activity of PT1 using the biomodel of hypersensitivity induced by CFA when tested 15 minutes after the administration was recorded at doses of 0.1 and 0.5 mg/kg. In the visceral pain test, the maximum analgesic activity 15 minutes after the administration of the chemical stimulus was observed at a dose of 0.01 mg/kg.
Conclusions: According to the results of testing peptide PT1, it is shown that it belongs to low-toxic compounds, has a pronounced analgesic activity in a wide range of doses of 0.0001–10 mg/kg.
Collapse
|
11
|
Emsden C, Schäfer UB, Denhaerynck K, Grossmann F, Frei IA, Kirsch M. Validating a pain assessment tool in heterogeneous ICU patients: Is it possible? Nurs Crit Care 2019; 25:8-15. [PMID: 31397952 DOI: 10.1111/nicc.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. AIM The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. METHODS The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. RESULTS The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. CONCLUSION This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. RELEVANCE TO CLINICAL PRACTICE The German CPOT version can be recommended for ICUs in German-speaking countries.
Collapse
Affiliation(s)
- Christian Emsden
- Medical Intensive Care Unit, University of Basel, Basel, Switzerland.,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | - Kris Denhaerynck
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Florian Grossmann
- Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Irena Anna Frei
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Practice Development Unit Nursing, University Hospital Basel, Basel, Switzerland
| | - Monika Kirsch
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
12
|
Barzanji A, Zareiyan A, Nezamzadeh M, Mazhari MS. Evaluation of Observational and Behavioural Pain Assessment Tools in Nonverbal Intubated Critically Adult Patients after Open - Heart Surgery: A Systematic Review. Open Access Maced J Med Sci 2019; 7:446-457. [PMID: 30834018 PMCID: PMC6390157 DOI: 10.3889/oamjms.2019.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Over 70% of patients hospitalised in an intensive care unit (ICU) often experience moderate to severe pain due to pre-existing diseases, trauma, surgery, aggressive procedures, and routine ICU care. Many patients hospitalised in ICU are not able to speak and express their pain due to various causes, including mechanical ventilation, reduced consciousness, and administration of sedative drugs. Therefore, the use of observational and behavioural pain tools is recommended in this group of patients given their inability to express pain. AIM To examine the existing observational and behavioural tools for assessment of in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery. METHODS A systematic review of available observational and behavioural tools for assessment of pain was undertaken using the COSMIN checklist. A literature search was conducted using the following databases: Ovid, Science Direct, Scopus, PubMed, and CINHAL databases, Google Scholar search engine as well as Persian resources Sid, Magiran, Iran doc, and IranMedex up to the end of 2017 were reviewed. RESULTS A total of 47 studies that had examined five tools used in intensive care units after cardiac surgery in patients under mechanical ventilation were reviewed. Each of the five tools included behavioural and observational items, and only one tool had physiological items. All the tools had been evaluated regarding validity and reliability. In the three tools, sensitivity, specificity, responsiveness, and satisfaction were considered. CONCLUSION Based on available evidence and investigations, CPOT and BPS tools have good validity and reliability to be used in pain assessment in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery. The NVPS tool requires more studies to be further confirmed before the assessment of pain in this group of patients.
Collapse
Affiliation(s)
- Arvin Barzanji
- Nursing Faculty, AJA University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Armin Zareiyan
- Department of Community and Public Health, Nursing Faculty, AJA University of Medical Science, Tehran, Iran
| | - Maryam Nezamzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Marjan Seyed Mazhari
- Department of Medical-Surgical Nursing, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury. Pain Manag Nurs 2018; 20:152-157. [PMID: 30528364 DOI: 10.1016/j.pmn.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/24/2018] [Accepted: 09/02/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience. AIMS To investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury. METHODS This was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury. RESULTS The BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001). CONCLUSIONS Our results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.
Collapse
|
14
|
Sharifi H. Letters to the Editor. AACN Adv Crit Care 2018; 28:134. [PMID: 28592471 DOI: 10.4037/aacnacc2017299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
15
|
Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoran M, Karimollahi M. The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs 2017; 44:123-128. [PMID: 28927578 DOI: 10.1016/j.iccn.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/08/2017] [Accepted: 07/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Critical-Care Pain. OBSERVATION Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS -3 to +2), 2. Sedated patients (RASS -3 to -1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). RESULTS Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from -3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS.
Collapse
Affiliation(s)
- Hoda Chookalayia
- Student Research Committee of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Heidarzadeh
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | | | - Mansoreh Karimollahi
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
16
|
Khelemsky Y, Evans AS. Pain in the ICU; Can We Adequately Treat What We Can't Hear? J Cardiothorac Vasc Anesth 2017; 31:1153-1154. [PMID: 28800980 DOI: 10.1053/j.jvca.2017.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yury Khelemsky
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam S Evans
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Cardiothoracic Surgery, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
17
|
Ito Y, Teruya K, Kubota H, Yorozu T, Nakajima E. Factors affecting pain assessment scores in patients on mechanical ventilation. Intensive Crit Care Nurs 2017; 42:75-79. [PMID: 28347628 DOI: 10.1016/j.iccn.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine how respiratory status and other aspects of the patients' condition affect pain assessments. METHODS Pain was assessed in 20 patients aged ≥20 years who underwent cardiovascular surgery, and required postoperative mechanical ventilation in an intensive care unit using the Behavioral Pain Scale (BPS). A BPS score of ≥6 (pain) versus <6 (no pain) was the dependent variable for determining the effect on pain. RESULTS Multiple logistic regression analysis showed that in 99 observations made at rest, pre- and post-turning and pre- and post-tracheal suctioning, the BPS score was significantly affected by gender, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, Richmond Agitation-Sedation Scale score, PaCO2, and HCO3-. The associations between BPS scores and APACHE II scores and HCO3- demonstrated that pain results from biological responses to invasion. Increases in PaCO2 affecting only the total BPS score suggests that PaCO2 is associated with other pain responses, regardless of respiratory status. CONCLUSION The BPS score was significantly associated with disease severity and ventilatory capacity, demonstrating a need to examine pain assessment methods tailored to the severity of underlying disease, degree of respiratory failure and other aspects of individual patient's condition for effective pain management.
Collapse
Affiliation(s)
- Yumi Ito
- Department of Nursing, Faculty of Health Sciences, Kyorin University, Tokyo, Japan.
| | - Koji Teruya
- Department of Public Health, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Hiroshi Kubota
- Department of Cardiovascular Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Emiko Nakajima
- Department of Nursing, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| |
Collapse
|