Comparison of three preverbal scales for postoperative pain assessment in a diverse pediatric sample

The purposes of this study were to compare the reliability and validity of three pain measurement scales for assessing pain in preverbal and nonverbal children and to determine which of the scales was mos tappropriate in a clinical setting to evaluate pain for infants and young children regardless of developmental stage or cognitive or physical disability. Pain scales tested were revised versions of the Riley Infant Pain Scale (RIPS), the Nursing Assessment of Pain Intensity (NAPI), and the Postoperative Pain Score (POPS). Purposive sampling of 391 postoperative infants and children was used for evaluation of pain in a midwestern children's hospital. Four assessments with each scale were done 1 hr apart by trained observers blinded to pain medications. Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.     

Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta‐Analysis

Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population‐based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into “0 to 3 months” and “3 months and above.” Meta‐analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.     

Validation of the Dutch Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain

Difficulties in diagnosing neuropathic pain in routine clinical practice support the need for validated and easy‐to‐use diagnostic tools. The DN4 neuropathic pain diagnostic questionnaire aims to discriminate neuropathic pain from nociceptive pain, but needs clinical validation. A total of 269 patients with chronic pain in three pain clinics were included in the study of which 248 had analyzable data. The mean duration of pain was 4.9 years. The most frequent etiologies were posttraumatic (36%), (pseudo) radicular (14%), and mechanical back pain (12%). The mean intensity of pain at visit was 5.6 on a 0–10 scale. Hundred and ninety‐six of 248 patients had an identical pain diagnosis from both physicians: 85 had neuropathic pain, 57 had nociceptive pain, and 54 had mixed pain. Among patients with identical diagnoses of neuropathic or nociceptive pain, using a receiver operating characteristic curve analysis, the area under the curve (AUC) was 0.81 for the DN4 7‐item and 0.82 for the 10‐item version. A cutoff point of 5/10 for the full questionnaire resulted in a sensitivity of 75% and a specificity of 79%, while a cutoff point of 4/7 for the partial questionnaire resulted in a sensitivity of 74% and a specificity of 79%. The items “brushing,” “painful cold,” and “numbness” were most discriminating. The DN4 is an easy‐to‐use screening tool that is reliable for discriminating between neuropathic and nociceptive pain conditions in daily practice. Item‐specific scores provide important information in addition to the total score.     

Comparison of Indicators for Achievement of Pain Control With a Personalized Pain Goal in a Comprehensive Cancer Center

Context

The achievement of a personalized pain goal (PPG) is advocated as an individualized pain relief indicator.

Congruence between health professionals' and patients' pain ratings: a review of the literature

The literature suggests that health professionals have a tendency to underestimate pain when performing clinical assessments. In addition, it appears that the more clinical experience one has, the greater will be the underestimation of pain. Pain assessment is difficult because of the complex interaction between environment, patient and practitioner variables. Although there is a need for further research in this area, there are clinical implications worthy of consideration. Health professionals need to use a variety of valid and reliable measures, use measures of pain behaviour and disability to complement self-report measures and examine how their own biases and values may influence pain judgements.     

Reliability of a Continuous Pain Score Meter: Real Time Pain Measurement

We present a newly developed continuous pain score meter (CPSM). The CPSM is based on the principles of the visual analog score (VAS), and electronically measures pain score in a continuous, instead of a single, manner. In this study, we determine the test–retest reliability of this meter. Thirty-two healthy volunteers received a reproducible pain stimulus on the right thumbnail and forearm. After a 1-minute interval the procedure was repeated. During the stimulus, pain was continuously measured with the CPSM, providing values of peak continuous pain score (CPS) and area under the CPS curve (AUC CPS). The intra-class correlation coefficient (ICC) and the 95% limits of agreement were used to assess the agreement between measurements. ICC of peak CPS (0.89 and 0.83) and AUC CPS (0.79 and 0.86) for nail and arm showed a good reproducibility. This study has successfully established the test–retest reliability of the CPSM. The real-time continuous pain measurement may provide more detailed information on a subjects' pain perception compared to a single VAS, in particular during an interval of pain stimuli.     

颈肩痛患者颈肩部肌肉的表面肌电图特征

背景：颈肩痛是由颈肩部软组织（主要是肌肉）的慢性劳损所引起的常见临床症状.表面肌电图是一种新型、无创的肌肉活动检查手段,能测量肌肉的活动和功能.目的：评价颈肩疼痛患者颈肩部肌肉功能,为表面肌电图的应用和颈肩疼痛患者合理防治与康复提供理论依据.方法：应用表面肌电图对32例单侧颈肩疼痛的办公室工作人员在站立下,进行低头、头后伸、双手上举时颈竖脊肌、斜方肌上支的表面肌电测试.在测试前,对患者的颈肩疼痛进行目测类比评分.然后根据收集的数据,比较受试者颈肩部疼痛侧与非疼痛侧测试肌肉的肌电活动.结果与结论：测试前,受试者颈肩疼痛目测类比评分（平均分）为5.03分;受试者在低头、头后伸、双手上举过程中,其疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号较非疼痛侧的颈竖脊肌、斜方肌上支的肌电原始信号弱;疼痛侧颈竖脊肌、斜方肌上支肌电的平均振幅值与非疼痛侧相比差异有显著性意义（P＜0.05）;疼痛侧颈竖脊肌、斜方肌上支肌电的平均频率斜率值与非疼痛侧相比差异无显著性意义（P＞0.05）.提示颈肩疼痛患者疼痛侧的颈肩肌肉的活动能力下降,长期坐位作业的办公室人员要定时进行颈肩部肌肉锻炼.     

Postoperative Pain Trajectories in Chronic Pain Patients Undergoing Surgery: The Effects of Chronic Opioid Pharmacotherapy on Acute Pain

For 2 weeks following surgery, 55 patients with preexisting chronic pain (CP) reported daily postoperative pain with movement and at rest. Of these, 30 CP patients used opioid pharmacotherapy for CP management and 25 did not. We modeled pain resolution in each patient using a linear fit so that each patient yielded 2 scores for each pain rating: 1) an intercept, or initial level of pain, immediately after surgery; and 2) a slope, or rate of pain resolution. The patients not using opioid pharmacotherapy had a mean pain with movement intercept of 5.4 and a slope of −.20, while the patients using opioid pharmacotherapy had a significantly higher mean intercept of 7.68 (P = .001) and a slope of −.21, sustaining higher pain levels over days. The opioid pharmacotherapy patients had the same rate of pain resolution as the other CP patients, and both groups resolved their pain more slowly than normal surgery patients. Preexisting CP may predispose a patient undergoing surgery to a slower rate of postoperative pain resolution. Chronic pain patients who use opioids share this predisposition but in addition, they are at risk for markedly higher postoperative pain across the entire pain resolution trajectory.

Perspective

This is an observational rather than a randomized controlled study, and as such is less definitive. Nonetheless, these findings are consistent with those of animal studies showing that prolonged exposure to opioids can produce opioid-induced hyperalgesia. Patients with opioid pharmacotherapy for chronic pain who undergo surgery merit special attention for acute pain management.     

Patterns of experimentally induced pain in pericranial muscles

Nociceptive mechanisms in the craniofacial muscle tissue are poorly understood. The pain pattern in individual pericranial muscles has not been described before. Experimental muscle pain was induced by standardized infusions of 0.2 ml 1 m hypertonic saline into six craniofacial muscles (masseter, anterior temporalis, posterior temporalis, trapezius, splenius capitis and sternocleidomastoid) in 20 healthy subjects. The pressure pain thresholds (PPTs) were determined before and after infusions. The subjects continuously reported intensity of saline-induced pain on an electronic visual analogue scale (VAS) and the perceived area of pain was drawn on anatomical maps. The pain areas were measured and the localization determined by a new centre-of-gravity method. The PPTs were lowest on the sternocleidomastoid muscle (anova: P<0.001), but the saline-evoked VAS pain scored highest following injection into the masseter muscle (anova: P<0.05). The centre-of-gravity measures demonstrated significantly different localization of the pain areas (anova: P<0.001). The trigeminally vs. the cervically innervated muscles had significantly different patterns of spread and referral of pain according to trigeminally vs. cervically innervated dermatomes (P<0.005). In conclusion, there appear to be characteristic pain patterns and pain sensitivity in different craniofacial muscles in healthy volunteers, which may be of importance for further research on different craniofacial pain conditions.     

Pathophysiology of acute pain: Implications for clinical management

To effectively treat acute pain, emergency medicine practitioners must have a thorough understanding of both the pathophysiology and terminology of the pain experience. The pathophysiology of pain is discussed with an emphasis on the mechanisms of acute, inflammatory pain. The various types of pain receptors, pathways and neurotransmitters are also discussed. See Commentary, page 271.