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BACKGROUND: The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia. METHODS: Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement. RESULTS: PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35-0.50; transfer: 0.38-0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer. CONCLUSIONS: Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results.
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Afasia , Dimensión del Dolor , Humanos , Afasia/diagnóstico , Afasia/etiología , Afasia/psicología , Femenino , Masculino , Anciano , Reproducibilidad de los Resultados , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Anciano de 80 o más Años , Persona de Mediana Edad , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Disfunción Cognitiva/etiología , Autoinforme/normas , Dolor/diagnóstico , Dolor/psicología , Dolor/etiología , Expresión FacialRESUMEN
BACKGROUND: There is little experience on the use of the WHO Standards for improving the quality of care (QOC) for children. We describe the use of four prioritised WHO Standard-based Quality Measures to assess the provision of care for children with pain in emergency departments (EDs). METHODS: In a multicentre observational study in 10 EDs with different characteristics in Italy, we collected data on 3355 children accessing the EDs between January 2019 and December 2020. The association between children and facility characteristics and quality measures was analysed through multivariate analyses. RESULTS: The proportion of children whose pain was measured was 68.7% (n=2305), with extreme variations across different centres (from 0.0% to 99.8%, p<0.001). The proportion of children treated for pain was 28.9% (n=970) again with a wide range (5.3%-56.3%, p<0.001). The difference between the frequency of children with pain measured and pain treated varied widely between the facilities (ranging from -24.3 to 82). Children with moderate and severe pain were more frequently treated (48.9% and 62.9% of cases, respectively), although with large variations across centres (ranges: 0%-74.8% and 0%-100% respectively, p<0.001). After correction for children's characteristics, the variable more strongly associated with analysed outcomes was the facility which the child accessed for care. Being a facility in Northern Italy was associated with a higher rate of pain measurement (67.3%-95% CI: 39.9% to 94.6%, p<0.001) compared with facilities in South Italy (-22.1% lower (95% CI: -41.7% to -2.50%, p=0.03). CONCLUSIONS: The use of few WHO Standard-based measures related to pain can help identifying priority gaps in QOC for children and in monitoring it over time. There is a need for more implementation research to establish which are the most sustainable and effective interventions to improve the QOC for acute pain in children.
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Dolor Agudo , Servicio de Urgencia en Hospital , Organización Mundial de la Salud , Humanos , Italia/epidemiología , Niño , Masculino , Femenino , Preescolar , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Dolor Agudo/terapia , Dolor Agudo/diagnóstico , Adolescente , Lactante , Calidad de la Atención de Salud/normas , Manejo del Dolor/normas , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Dimensión del Dolor/normasRESUMEN
ABSTRACT: Facial grimacing is used to quantify spontaneous pain in mice and other mammals, but scoring relies on humans with different levels of proficiency. Here, we developed a cloud-based software platform called PainFace ( http://painface.net ) that uses machine learning to detect 4 facial action units of the mouse grimace scale (orbitals, nose, ears, whiskers) and score facial grimaces of black-coated C57BL/6 male and female mice on a 0 to 8 scale. Platform accuracy was validated in 2 different laboratories, with 3 conditions that evoke grimacing-laparotomy surgery, bilateral hindpaw injection of carrageenan, and intraplantar injection of formalin. PainFace can generate up to 1 grimace score per second from a standard 30 frames/s video, making it possible to quantify facial grimacing over time, and operates at a speed that scales with computing power. By analyzing the frequency distribution of grimace scores, we found that mice spent 7x more time in a "high grimace" state following laparotomy surgery relative to sham surgery controls. Our study shows that PainFace reproducibly quantifies facial grimaces indicative of nonevoked spontaneous pain and enables laboratories to standardize and scale-up facial grimace analyses.
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Expresión Facial , Ratones Endogámicos C57BL , Dimensión del Dolor , Programas Informáticos , Animales , Ratones , Femenino , Programas Informáticos/normas , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Masculino , Dolor/diagnósticoRESUMEN
BACKGROUND: The Nurses' Cancer Pain Management Competency Scale (NCPMCS) is a tool to explore nurses' competencies and subjective experiences in cancer pain management, and to help nurses understand their current shortcomings in cancer pain management. The scale, currently available only in English and translated into Chinese for wider adoption abroad, provides a tool for Chinese nurses to assess their level of cancer pain management. Furthermore, based on the scale's specific score, they can evaluate their lack of understanding about cancer pain management, advance research into this area, and enhance their capacity to control cancer pain while providing patient care. OBJECTIVE: The purpose of this study was to translate and localize the new scale, and to measure its reliability and validity. The study was also to provide a way to quickly and accurately measure the competency of cancer pain management among nursing staff in China. METHODS: The Bristling translation approach was used to translate, translate back, and culturally modify the English version of the cancer pain management competency scale for nurses to create the Chinese version. A convenience sample was used for the study, 220 clinical nurses from three Grade III hospitals in Zhengzhou, Henan Province, China, were chosen by convenience sampling. The Chinese version of the scale was used for this investigation. RESULTS: The Cancer Pain Management Competency Scale for Nurses has 14 items over 4 dimensions in its Chinese form. From the exploratory factor analysis, four common components were recovered; the cumulative variance rate was 81.994%, the scale's Cronbach's α coefficient was 0.902, and the Cronbach's α coefficient for each dimension ranged from 0.800 to 0.938. Retest reliability was 0.915, scale content validity was 0.865, and Spearman-Brown's broken half reliability was 0.808. CONCLUSION: Nurses' cancer pain management competency in clinics can be assessed using the Chinese version of the Nurses' Cancer Pain Management Competency Scale, which has strong validity and reliability.
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Dolor en Cáncer , Competencia Clínica , Manejo del Dolor , Humanos , Reproducibilidad de los Resultados , China , Adulto , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Femenino , Dolor en Cáncer/enfermería , Masculino , Encuestas y Cuestionarios , Manejo del Dolor/métodos , Manejo del Dolor/normas , Manejo del Dolor/estadística & datos numéricos , Manejo del Dolor/enfermería , Persona de Mediana Edad , Psicometría/instrumentación , Psicometría/métodos , Psicometría/normas , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , TraducciónRESUMEN
BACKGROUND: Research reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses' pain assessment practices in Saudi Arabia. AIM: To assess the nurses' pain assessment practices in the NICU in Saudi Arabia. DESIGN: This study used a descriptive cross-sectional design. SETTINGS: Research was conducted using an online survey. PARTICIPANTS/SUBJECTS: This study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. METHODS: Data on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. RESULTS: The majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). CONCLUSIONS: NICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.
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Unidades de Cuidado Intensivo Neonatal , Dimensión del Dolor , Humanos , Arabia Saudita , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Estudios Transversales , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Recién Nacido , Femenino , Masculino , Adulto , Encuestas y Cuestionarios , Manejo del Dolor/métodos , Manejo del Dolor/normas , Manejo del Dolor/estadística & datos numéricos , Enfermería Neonatal/normas , Enfermería Neonatal/métodos , Enfermería Neonatal/estadística & datos numéricosRESUMEN
OBJECTIVE: Quantitative sensory testing is widely used in clinical and research settings to assess the sensory functions of healthy subjects and patients. It is of importance to establish normative values in a healthy population to provide reference for studies involving patients. Given the absence of normative values for pain thresholds in Taiwan, the aim of this study was to report the normative values for future reference in the Taiwanese population and compare the differences between male and female participants. METHODS: Healthy adults without any chronic or acute pain condition were recruited. The pain thresholds were assessed over the cephalic (supraorbital area and masseter muscle) and extracephalic (medio-volar forearm and thenar eminence) areas. The heat, cold, mechanical punctate, and pressure pain thresholds were measured with a standardized protocol. Comparisons between male and female participants were performed. RESULTS: One hundred and thirty healthy participants (55 males: 30.4 ± 7.4 years; 75 females: 30.5 ± 8.1 years) finished the assessments. Male participants were less sensitive to mechanical stimuli, including pressure over masseter muscle (male vs. female: 178.5 ± 56.7 vs. 156.6 ± 58.4 kPa, p = .034) and punctate over medio-volar forearm (male vs. female: 116.4 ± 45.2 vs. 98.7 ± 65.4 g, p = .011), compared to female participants. However, female participants were less sensitive to cold stimuli, indicated by lower cold pain thresholds over the supraorbital area (male vs. female: 18.6 ± 8.4 vs. 13.6 ± 9.3°C, p = .004), compared to male participants. No significant differences were found between sexes in other pain threshold parameters. CONCLUSIONS: We provided the normative values of healthy male and female adults in Taiwan. This information is crucial for comparison in future pain-related studies to identify potential hypoalgesia or hyperalgesia of tested subjects.
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Umbral del Dolor , Humanos , Masculino , Umbral del Dolor/fisiología , Femenino , Adulto , Taiwán , Valores de Referencia , Adulto Joven , Factores Sexuales , Voluntarios Sanos , Dimensión del Dolor/normas , Dimensión del Dolor/métodosRESUMEN
Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often through surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved 2 steps: 1) 4 fetuses with the indication of surgery were evaluated in 3 conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; 2) assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and 2 fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of .99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient was .95, and inter-rater reliability was .99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third-trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of postoperative pain in fetuses and its effects after birth. PERSPECTIVE: Recordings with 3-dimensional ultrasound of human fetuses undergoing preoperative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.
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Dolor Agudo , Dimensión del Dolor , Humanos , Femenino , Dolor Agudo/diagnóstico , Embarazo , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Reproducibilidad de los Resultados , Ultrasonografía Prenatal , Expresión Facial , Feto , Sensibilidad y Especificidad , AdultoRESUMEN
PURPOSE: To assess the matching and content validity of a pain quality pictogram tool with a Hmong community. DESIGN: A Qualtrics survey was administered to two groups of participants. METHODS: Sixty Hmong participants (n = 49 limited English proficiency and bilingual Hmong community members in group 1; n = 11 bilingual Hmong healthcare practitioners in group 2) participated in this study. Hmong community members in group 1 were asked to identify the pain pictogram that best matched a pre-recorded Hmong pain quality phrase. The practitioners in group 2 were asked to evaluate how well each pain pictogram represented the pre-recorded Hmong pain quality phrase it intended to measure. To assess the matching, we assessed agreement between the pain concept in the phrase and the pictogram intended to represent it, using group 1. A content validity index (CVI) was calculated to assess the content validity of the tool using group 2. RESULTS: Among the community participants, 8 of the 15 pictograms were matched with the intended phrase almost perfectly, and 3 were matched by a substantial majority. There were no differences in matching by patient gender and language proficiency. Among practitioners, 11 of 15 pain pictograms met the CVI threshold of 0.70 for all three dimensions (i.e., representativeness, relevance, and comprehension). CONCLUSION: Findings support including most of the pain pictograms in the tool but suggest specific areas for improvement. CLINICAL IMPLICATIONS: Findings provide insights for redesigning the selected pain pictogram tool to be used in clinical settings with LEP Hmong patients.
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Dominio Limitado del Inglés , Multilingüismo , Dimensión del Dolor , Psicometría , Humanos , Masculino , Femenino , Adulto , Psicometría/instrumentación , Psicometría/métodos , Psicometría/normas , Encuestas y Cuestionarios , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Reproducibilidad de los Resultados , Personal de Salud/estadística & datos numéricos , Personal de Salud/psicología , Dolor/psicologíaRESUMEN
Pain intensity is the most commonly used outcome domain in pain clinical trials. To minimize the chances of type II error (ie, concluding that a treatment does not have beneficial effects, when in fact it does), the measure of pain intensity used should be sensitive to changes produced by effective pain treatments. Here we sought to identify the combination of pain intensity ratings that would balance the need for reliability and validity against the need to minimize assessment burden. We conducted secondary analyses using data from a completed 4-arm clinical trial of psychological pain treatments (N = 164 adults). Current, worst, least, and average pain intensity in the past 24 hours were assessed 4 times before and after treatment using 0 to 10 numerical rating scale-11. We created a variety of composite scores using these ratings and evaluated their reliability (Cronbach's alphas) and validity (ie, associations with a gold standard score created by averaging 16 ratings and sensitivity for detecting between-group differences in treatment efficacy). We found that for each measure, reliability increased as the number of ratings used to create the measures increased and that ratings from 3 or more days were needed to have adequately strong associations with the gold standard. Regarding sensitivity, the findings suggest that composite scores made up of ratings from 4 days are needed to maximize the chances of detecting treatment effects, especially with smaller sample sizes. In conclusion, using data from 3 or 4 days of assessment may be the best practice. PERSPECTIVE: Composite scores made up of at least 3 days of pain ratings appear to be needed to maximize reliability and validity while minimizing the assessment burden. TRIAL REGISTRATION: clinicaltrials.gov NCT01800604.
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Dimensión del Dolor , Humanos , Dimensión del Dolor/normas , Dimensión del Dolor/métodos , Reproducibilidad de los Resultados , Femenino , Masculino , Adulto , Persona de Mediana Edad , Dolor/diagnóstico , Ensayos Clínicos como Asunto/normas , Ensayos Clínicos como Asunto/métodos , AncianoRESUMEN
The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low < medium-or-high; P < .01). For predictive validity, intake STarT MSK tool scores explained additional variability in pain intensity (11.2%, 20.0%), pain interference (7.5%, 14.1%), and SF-8 PCS (8.2%, 12.8%) scores at 2 and 6 months, respectively. This study contributes to the existing literature by providing additional evidence of STarT MSK tool cross-sectional construct validity and longitudinal predictive validity. PERSPECTIVE: This study presents STarT MSK risk stratification tool validity findings from a U.S. outpatient physical therapy sample. The STarT MSK tool has the potential to help physical therapists identify individuals presenting with the most common MSK pain conditions who may require more targeted interventions or closer monitoring.
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Dolor Musculoesquelético , Modalidades de Fisioterapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/terapia , Pacientes Ambulatorios , Dimensión del Dolor/normas , Dimensión del Dolor/métodos , Modalidades de Fisioterapia/normas , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo , Encuestas y Cuestionarios/normas , Estados UnidosRESUMEN
Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.
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Equipos de Comunicación para Personas con Discapacidad , Dimensión del Dolor , Dolor , Programas Informáticos , Humanos , Equipos de Comunicación para Personas con Discapacidad/normas , Trastornos de la Comunicación , Dolor/diagnóstico , Dolor/enfermería , Dimensión del Dolor/instrumentación , Dimensión del Dolor/enfermería , Dimensión del Dolor/normas , Masculino , Femenino , Adulto , Persona de Mediana Edad , China , Programas Informáticos/normas , Encuestas y Cuestionarios , Factores de Tiempo , Computadoras de ManoRESUMEN
Nocebo refers to non-pharmacological adverse effects of an intervention. Well-intended procedural warnings frequently function as a nocebo. Both nocebo and placebo are integral to the generation of 'real' treatment effects and their associated 'real' side-effects. They are induced or exacerbated by: context; negative expectancy; and negative conditioning surrounding treatment. Since the late 1990s, the neuroscience literature has repeatedly demonstrated that the nocebo effect is mediated by discrete neurobiological mechanisms and specific physiological modulations. Although no single biological mechanism has been found to explain the nocebo effect, nocebo hyperalgesia is thought to initiate from the dorsal lateral prefrontal cortex subsequently triggering the brain's descending pain modulatory system and other pain regulation pathways. Functional magnetic resonance imaging shows that expectation of increased pain is accompanied by increased neural activity in the hippocampus and midcingulate cortex which is not observed when analgesia is expected. Functional magnetic resonance imaging studies have shown that the anterior cingulate cortex is pivotal in the perception of affective pain evoked by nocebo words. Research has also explored neurotransmitters which mediate the nocebo effect. The neuropeptide cholecystokinin appears to play a key role in the modulation of pain by nocebo. Hyperalgesia generated by nocebo also increases the activity of the hypothalamic-pituitary-adrenal axis as indicated by increases in plasma cortisol. The avoidance or mitigation of nocebo needs to be recognised as a core clinical skill in optimising anaesthesia care. Embracing the evidence around nocebo will allow for phrases such as 'bee sting' and 'sharp scratch' to be thought of as clumsy verbal relics of the past. Anaesthesia as a profession has always prided itself on practicing evidence-based medicine, yet for decades anaesthetists and other healthcare staff have communicated in ways counter to the evidence. The premise of every interaction should be 'primum non nocere' (first, do no harm). Whether the context is research or clinical anaesthesia practice, the nocebo can be ignored no longer.
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Anestesia/psicología , Anestesia/normas , Motivación , Dimensión del Dolor/psicología , Dimensión del Dolor/normas , Ciencia Traslacional Biomédica/normas , Anestesia/métodos , Humanos , Efecto NoceboRESUMEN
BACKGROUND: A culturally validated Korean version of the PainDETECT Questionnaire (PD-Q) was used to identify neuropathic pain components (NeP) in patients suffering from chronic pain. The purpose of this study was to determine if the Korean PD-Q can be used to subgroup patients with peripheral NeP according to sensory symptom profiles. METHODS: This study included 400 Korean patients with peripheral neuropathic pain diagnosed as probable or definite NeP. The total scores and subscores for each item in PD-Q were transformed into a Z-score for standardization. Hierarchical cluster analysis was performed to identify clusters of subjects by PD-Q scores. RESULTS: The mean total PD-Q score of the study participants was 14.57 ± 6.46. A hierarchical cluster analysis identified 5 clusters with distinct pain characteristic profiles. Cluster 1 had relatively severe burning and tingling sensations. The mean total PD-Q score for cluster 2 was the lowest of the 5 clusters. Cluster 3 tended to be vulnerable to pain in response to cold/heat stimulation. Cluster 4 showed relatively severe pain induced by physical stimuli, such as light touch or slight pressure. Cluster 5 had high scores for all NeP symptoms. CONCLUSION: This study demonstrates the ability of patients to cluster by symptoms using the Korean PD-Q. Subgrouping of peripheral neuropathic pain by sensory symptom profile may be useful in making effective drug treatment decisions.
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Dimensión del Dolor/instrumentación , Enfermedades del Sistema Nervioso Periférico/complicaciones , Trastornos de la Sensación/etiología , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Manejo del Dolor/estadística & datos numéricos , Dimensión del Dolor/normas , Dimensión del Dolor/estadística & datos numéricos , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , República de Corea/epidemiología , Trastornos de la Sensación/epidemiología , Trastornos de la Sensación/fisiopatología , Encuestas y CuestionariosRESUMEN
Patient Reported Outcomes (PROs) are utilized in clinical registries and trials, necessitating development of benchmarks to enhance interpretability. This study aimed to 1) examine if PROMIS measures administered via computer adaptive testing (CAT) were responsive to change, and 2) highlight one method of assessing clinically significant change for youth seen in a tertiary pain clinic. Clinically significant change was achieved if patients had significantly reliable pre-to-post-changes greater than Reliable Change Index (RCI) value and reported decreased symptoms by at least one severity level (e.g., moderate to mild). Participants were 328 youth (8-17 years old) seen in a tertiary pediatric pain management clinic. Small to moderate effect sizes were noted across PROMIS measures (except Peer Relations). Reliable magnitudes of change were estimated for this sample as approximately 6 point reduction for Pain Interference and Mobility, 9 for Fatigue, and 11 for Anxiety and Depression. Depending on the measure, 10 to 24% were categorized as improved, 3 to 6% as deteriorated, and 68 to 81% were either not clinically elevated at baseline or remained unchanged at 3 months. Overall, PROMIS CAT measures demonstrated responsiveness to change over time. Estimation of clinically significant change offers preliminary yet rigorous benchmarks for evaluating treatment response and sets the stage for understanding treatment effects. PERSPECTIVE: This study assesses responsiveness of CAT administered PROMIS measures and highlights one methodological approach of presenting clinical significance for assessing treatment outcomes in pediatric chronic pain. These benchmarks will allow clinicians and researchers to evaluate treatment response utilizing PROs while allowing for a deeper understanding of treatment effects.
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Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Técnicas de Diagnóstico Neurológico/normas , Dimensión del Dolor/normas , Medición de Resultados Informados por el Paciente , Adolescente , Niño , Femenino , Humanos , Estudios Longitudinales , MasculinoRESUMEN
OBJECTIVE: To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic. STUDY DESIGN: Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication. RESULTS: We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10). CONCLUSIONS: We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.
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Dolor Agudo/psicología , Dimensión del Dolor/normas , Dolor Agudo/diagnóstico , Adolescente , Niño , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Estudios Prospectivos , AutoinformeRESUMEN
Reliable, clinic-friendly screening for Chronic postsurgical pain (CPSP) risk is unavailable. Within a prospective, observational study, we evaluated Pediatric Pain Screening Tool (PPST), a concise 9-item questionnaire, as a preoperative screening tool to identify those at higher risk for CPSP (Numerical Rating Scale > 3/10 beyond 3 months post-surgery) and poor function (disability/Functional Disability Inventory [FDI]/quality of life/ Pediatric Quality of Life) after spine fusion and Nuss procedures. Incidence of CPSP was 34.86% (38/109). We confirmed PPST scale stability, test re-test reliability (ICC = 0.68; P< .001); PPST measures were positively correlated with known CPSP risk factors (P< .001) preoperative pain (Pearson or Spearman Correlation Coefficient [SCC]:0.672), Child anxiety sensitivity index (SCC:0.357), Patient Related Outcome Measures Information System pain interference (SCC:0.569), Patient Related Outcome Measures Information System depression (SCC:0.501), Pediatric Quality of Life (SCC:-0.460) and insomnia severity index (SCC0.567). Preoperative PPST and PPST physical sub-scores (median(IQR) were higher in CPSP (2[0.5,4], 1[0,2]) compared to non-CPSP (1[0,3], 0[0,1.5]) groups (P= .026, P= .029) respectively. PPST scores/sub-scores positively correlated with higher FDI at 6 months but only PPST total and PPST psychosocial subscore correlated with higher FDI at 12 months. Based on ROC, optimal PPST cutoff for CPSP was 2 (63.9% sensitivity, 64.7% specificity). CPSP risk was high (48.94% risk) if PPST ≥ 2 (n = 47) and medium (22.81%) if PPST < 2 (n = 57) after spine/pectus surgery. General and risk-strata specific, targeted psychosocial non-pharmacological interventions, need to be studied. Findings need validation in diverse, larger cohorts. CLINICALTRIALS.GOV IDENTIFIER: NCT02998138. PERSPECTIVE: The article supports Pediatric Pain Screening Tool, a simple 9-item questionnaire, as a preoperative screening tool for CPSP and function 6-12 months after spine/pectus surgeries. PPST measures correlate with known risk factors for CPSP. Risk stratification and targeted preventive interventions in high-risk subjects are proposed.
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Enfermedades Musculoesqueléticas/cirugía , Dolor Musculoesquelético/diagnóstico , Dimensión del Dolor/normas , Dolor Postoperatorio/diagnóstico , Evaluación del Resultado de la Atención al Paciente , Procedimientos Quirúrgicos Operativos/efectos adversos , Adolescente , Niño , Dolor Crónico , Femenino , Humanos , Masculino , Cuidados Preoperatorios , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To evaluate current international practice in PICUs regarding components of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Sedation, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Engagement/Empowerment" (ABCDEF) bundle. DESIGN: Online surveys conducted between 2017 and 2019. SETTING: One-hundred sixty-one PICUs across the United States (n = 82), Canada (n = 14), Brazil (n = 27), and Europe (n = 38) participating in the Prevalence of Acute Rehabilitation for Kids in the PICU study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 161 participating PICUs, 83% were in academic teaching hospitals and 42% were in free-standing children's hospitals. Median size was 16 beds (interquartile range, 10-24 beds). Only 15 PICUs (9%) had incorporated all six ABCDEF bundle components into routine practice. Standardized pain assessment (A) was the most common (91%), followed by family engagement (F, 88%) and routine sedation assessment (C) with validated scales (84%). Protocols for testing extubation readiness or conducting spontaneous breathing trials (B) were reported in 57%, with 34% reporting a ventilator weaning protocol. Routine delirium monitoring with a validated screening tool (D) was reported by 44% of PICUs, and 26% had a guideline, protocol, or policy for early exercise/mobility (E). Practices for spontaneous breathing trials were variable in 29% of Canadian PICUs versus greater than 50% in the other regions. Delirium monitoring was lowest in Brazilian PICUs (18%) versus greater than 40% in other regions, and family engagement was reported in 55% of European PICUs versus greater than 90% in other regions. CONCLUSIONS: ABCDEF bundle components have been adopted with substantial variability across regions. Additional research must rigorously evaluate the efficacy of specific elements with a focus on B, D, E, and full ABCDEF bundle implementation. Implementation science is needed to facilitate an understanding of the barriers to ABCDEF implementation and sustainability with a focus on specific cultural and regional differences.
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Enfermedad Crítica/terapia , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Paquetes de Atención al Paciente/estadística & datos numéricos , Anestesia/normas , Protocolos Clínicos , Delirio/diagnóstico , Delirio/prevención & control , Delirio/terapia , Familia , Humanos , Unidades de Cuidado Intensivo Pediátrico/normas , Dimensión del Dolor/normas , Dimensión del Dolor/estadística & datos numéricos , Paquetes de Atención al Paciente/normas , Desconexión del Ventilador/normasRESUMEN
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus. It often causes symmetrical paresthesia, loss of sensation, and hyperalgesia. Without early intervention, it might lead to diabetic foot ulceration, gangrene, and subsequent amputation in people with diabetes. DPN is an insidious disease and often underdiagnosed. This paper reviews the current national and international prevalence of DPN, screening methods for early DPN, including quantitative sensory measurement, neurological function scoring system, confocal microscopy, and high-frequency ultrasound, and summarizes the related research progress, clinical application, and development prospects of these methods in recent years.
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Neuropatías Diabéticas/diagnóstico , Técnicas de Diagnóstico Endocrino/normas , Técnicas de Diagnóstico Neurológico/normas , Neuropatías Diabéticas/epidemiología , Humanos , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Guías de Práctica Clínica como Asunto/normas , Prevalencia , Estándares de Referencia , Proyectos de Investigación , Ultrasonografía/métodos , Ultrasonografía/normasRESUMEN
OBJECTIVE: The aim of this report was to evaluate the psychometric properties of the Pain Frequency, Intensity, and Burden Scale (P-FIBS), a brief measure of pain, as well as the association of pain with irritability and depression and how these symptoms relate to functional impairments. METHODS: Participants of 2 randomized controlled trials (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care [EMBARC; n = 251 with DSM-IV diagnosis of major depressive disorder; study duration: August 2011-December 2015] and STimulant Reduction Intervention Using Dosed Exercise [STRIDE; n = 302 with DSM-IV diagnosis of stimulant abuse or dependence; study-duration: July 2010-February 2013]) and treatment-seeking patients in primary care clinics from an ongoing quality-improvement project (VitalSign6; n = 4,370; project duration: August 2014-July 2019) were included. Psychometric properties of the P-FIBS were evaluated with confirmatory factor and item response theory analyses in EMBARC and VitalSign6. The approach of Baron and Kenny was used to assess whether irritability accounted for the effect of pain on depression. RESULTS: Cronbach α (0.84-0.89) and model fits for single-factor structure of P-FIBS were acceptable. Pain was positively correlated with irritability (r = 0.22-0.29) and depression (r = 0.10-0.33). Irritability accounted for 40.7%-65.5% of the effect of pain on depression. Higher irritability and depression were associated with poorer social functioning, quality of life, and productivity in work- and non-work-related activities. Pain was associated with non-work-related activity impairments even after controlling for irritability and depression. CONCLUSIONS: The P-FIBS is a brief and reliable measure of pain. Irritability is associated with pain and accounts for a large proportion of the effect of pain on depression. Symptoms of pain, irritability, and depression are associated with functional impairments. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT01407094 (EMBARC), NCT01141608 (STRIDE).