Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting

Scand J Caring Sci; 2010; 24; 380–391
Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self‐report capacity. Recently, the development and psychometric property testing of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID) Pain Scale was described using video‐recording. The purpose of this article was to present the further development of this instrument. In MOBID‐2 Pain Scale, the assessment of inferred pain intensity is based on patient’s pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID‐2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID‐2 Pain Scale, like inter‐rater and test–retest reliability, internal consistency, as well as face‐, construct‐ and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID‐2 Pain Scale. Characteristics of the patients’ pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID‐2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (κ = 0.41–0.90 and κ = 0.46–0.93). Inter‐rater and test–retest reliability for pain intensity was very good, ICC (1, 1) ranging 0.80–0.94 and 0.60–0.94. Internal consistency was highly satisfactory; Cronbach’s α ranging 0.82–0.84. Face‐, construct‐ and concurrent validity was good. Overall pain intensity by MOBID‐2 was well correlated with physicians’ clinical examination and defined pain variables (rho = 0.41–0.64). Conclusion: On the basis of pain behaviours, standardized movements and pain drawings, MOBID‐2 Pain Scale was shown to be sufficiently reliable, valid and time‐effective for nurses to assess pain in patients with severe dementia.     

Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): development and validation of a nurse-administered pain assessment tool for use in dementia

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (alpha=0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient=0.70-0.96), but varied between poor and excellent for pain behavior indicators (kappa=0.05-0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable and valid pain intensity scores in patients with SCI.     

Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes

PurposeThe Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US.DesignCross-sectional study.SettingsSixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama.ParticipantsOne hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment.MethodsValidity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician’s pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach’s alpha.ResultsMOBID overall scores were significantly associated with expert clinician’s rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83).Conclusions and Clinical ImplicationsResult of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.     

A Psychometric Evaluation of Three Pain Rating Scales for People with Moderate to Severe Dementia

Little comparative information exists regarding the reliability and validity of pain rating scales for nurses to assess pain in people with moderate to severe dementia in residential aged care facilities. The objective of this study was to evaluate the relative psychometric merits of the Abbey Pain Scale, the DOLOPLUS-2 Scale, and the Checklist of Nonverbal Pain Indicators Scale, three well-known pain rating scales that have previously been used to assess pain in nonverbal people with dementia. An observational study design was used. Nurses (n = 26) independently rated a cross-section of people with moderate to severe dementia (n = 126) on two occasions. The Abbey Pain Scale and the DOLOPLUS-2 Scale showed good psychometric qualities in terms of reliability and validity, including resistance to the influence of rater characteristics. The Checklist of Nonverbal Pain Indicators Scale also had reasonable results but was not as psychometrically strong as the Abbey Pain Scale and DOLOPLUS-2 Scale. This study has provided comparative evidence for the reliability and validity of three pain rating scales in a single sample. These scales are strong, objective adjuncts in making comprehensive assessments of pain in people who are unable to self-report pain due to moderate to severe dementia, with each having their own strengths and weaknesses. The DOLOPLUS-2 Scale provides more reliable measurement, and the Abbey Pain Scale may be better suited than the other two scales for use by nurse raters who only occasionally use pain rating scales or who have lower level nursing qualifications.     

Pain assessment in older people with dementia: literature review

Title.  Pain assessment in older people with dementia: literature review.
Aim.  This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers.
Background.  Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain.
Data sources.  Searches were conducted of CINAHL, Medline and other databases for the period 1993–2007 using the search terms pain, dementia, assess*, barrier* and obstacle*.
Methods.  Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute.
Results.  Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools.
Conclusion.  More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.     

Pain Self‐Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain

The purpose of this study was to investigate cross‐sectional associations of pain self‐efficacy and fear of movement with pain intensity and disability in Italian patients with chronic low back pain (CLBP). One hundred and three adult outpatients with nonspecific CLBP were included in the study. Socio‐demographic and clinical characteristics were assessed, together with Italian versions of self‐reported questionnaires to measure the four constructs of interest. Multiple linear regression models were built with psychosocial constructs as main determinants, and pain intensity and disability as outcomes. Potential confounding of socio‐demographic and clinical characteristics was assessed. Pain self‐efficacy and fear of movement displayed moderate correlations with pain intensity (r = ?0.41 and 0.42, respectively) and disability (?0.55 and 0.54). Association models adjusted for pain intensity showed that both pain self‐efficacy (β = ?0.35, 95% CI = ?0.5; ?0.2, R² = 41%) and fear of movement (β = 0.65, 95% CI = 0.36; 0.93, R² = 40%) are significantly and strongly associated with disability. Pain self‐efficacy was no longer significantly associated with pain intensity when disability was added as a confounder to the model, whereas fear of movement retained its significant association (β = 0.06, 95% CI = 0.00;0.11, R² = 30%). No other variables acted as confounders in these associations. Pain self‐efficacy and fear of movement are very similarly associated with main outcomes in this sample of Italian patients with CLBP. The results of this study suggest that both psychosocial constructs should be considered in clinical management. Future studies should investigate whether these findings can be replicated in other samples, in longitudinal designs and if other variables not measured in this study confound the associations.     

The development of a measurement tool for the assessment of pain behaviour in real time

Background and purpose Chronic pain is a multifactorial problem. It is therefore important to assess the chronic pain patient from a variety of perspectives. A reduction in pain behaviour is a specifically cited aim of some clinical interventions. Pain behaviour measures have involved video recordings and subsequent ratings, or observations over a prolonged period of time. These methods have been criticised as time consuming and impractical in the clinical setting. The present pilot study developed a pain behaviour measurement tool, which could be delivered in ‘real time’ during a standardised functional assessment to give immediate feedback to clinicians and that could be used as an outcome measure.Methods Frequently occurring pain behaviours were identified, criteria were standardised, and a measurement tool and scoring system were developed. Forty-seven subjects with chronic pain were included in the inter-rater reliability study. Each subject was observed by 2 raters as they carried out a standardised physiotherapy functional assessment before and after a pain management programme. The occurrence of pain behaviour was scored using the developed measurement tool. Inter-rater reliability and internal consistency were assessed.Results and conclusion There was a high level of inter-rater reliability. 84% of the Kappa scores obtained fell between 0.61 and 1.0. Internal consistency was excellent (Alpha score 0.85 pre-programme and 0.84 post-programme). Given the limitations of self-report and self-monitoring methods of pain, pain behaviour and disability, a tool that more reliably captures this additional dimension of pain is appealing, and would be a valuable adjunct in the clinical assessment of the chronic pain patient.     

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population. The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety-two infants born between 23 and 32 weeks GA were assessed during 3, 1 min Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software. Scores on the BIIP changed significantly across Phases of blood collection (p<0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r=0.64, p<0.01) as were correlations between the BIIP and mean heart rate (r=0.45, p<0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU.     

Factor structure and psychometric properties of the Chinese version of the 20-item Pain Anxiety Symptoms Scale (ChPASS-20)

ContextThe Pain Anxiety Symptoms Scale (PASS) was designed to assess pain-related anxiety and fear. Although the scale is a reliable measure with good psychometric properties, its validity among ethnic Chinese has yet to be evaluated.ObjectivesThis study aimed to translate the English-language version of the 20-item PASS into Chinese (ChPASS-20) and evaluate its factor structure, reliability, and validity.MethodsA total of 223 Chinese patients with chronic musculoskeletal pain attending orthopedic specialist clinics completed the ChPASS-20, the Chronic Pain Grade questionnaire, the Chinese version of the 11-item Tampa Scale of Kinesiophobia, the Hospital Anxiety and Depression Scale, and questions assessing sociodemographic and pain characteristics.ResultsConfirmatory factor analyses showed that all the five-factor solutions tested met the minimum acceptable fit criterion. The four ChPASS-20 subscales and the entire scale demonstrated good internal consistency (Cronbach’s αs: 0.72–0.92). All ChPASS-20 scales showed significant positive correlations with depression, pain intensity, and disability. Hierarchical multiple regression analyses showed that the ChPASS-20 total score predicted concurrent depression [F(4,159) = 11.97, P < 0.001], pain intensity [F(4,161) = 2.47, P < 0.05], and pain disability [F(4,191) = 5.47, P < 0.001] scores, and the ChPASS-20 Avoidance subscale (standardized beta coefficient = 0.21, P < 0.05) emerged as a significant independent predictor of concurrent pain disability.ConclusionOur data support the factorial validity, reliability, and construct validity of the ChPASS-20 in a Chinese population.     

Pain Assessment in Noncommunicative Elderly persons--PAINE

OBJECTIVES: We describe the validation of an informant-based pain assessment for persons suffering from dementia called Pain Assessment in Noncommunicative Elderly persons (PAINE) using 2 different samples. METHODS: In the first study, the participants included 80 residents from one nursing home. We assessed internal consistency using Cronbach alpha, interrater and test-retest reliability using Pearson correlations, and validity using receiver operating characteristic curve analyses, comparing PAINE to these criteria on the basis of reports from physicians, nurses, relatives, and the residents themselves. In the second study, the participants included 91 residents from 2 different nursing homes. We assessed validity by correlating scores on PAINE with those from other assessments designed to detect pain. RESULTS: PAINE shows adequate internal consistency and both interrater and test-retest reliability. It also shows adequate receiver operating characteristic curve results and reasonable correlations with the existing measures of pain in persons with dementia. DISCUSSION: PAINE has the advantage of using a comprehensive list of pain symptoms on the basis of systematic questioning of direct caregivers from several institutions. The validity results suggest that this assessment could be a useful tool in detecting pain in persons with dementia.     

Pain, demographics, and clinical characteristics in persons who received hospice care in the United States

Pain in persons who receive hospice care is not fully understood. The purpose of this study was to describe the demographics, clinical characteristics, and pain intensity of persons who received hospice care in the United States from 2000–2004. Data for this study were obtained from a provider of hospice pharmacy services and included information about the hospice organization, demographics and clinical characteristics, pain intensity, and opioid analgesic prescribing. Worst pain intensity during the previous 24 hours was assessed using a 0–10 numeric rating scale (0 = none, 10 = worst) periodically during hospice care. During the study period, 347,555 persons received hospice services; 55.2% of these persons were female, 87.4% were Caucasian, and mean age was 75.3 years. At least one pain score was available for 156,887 (45.1%) individuals. Among persons with at least one pain score, pain was reported a mean of 2.9 times per person. Overall, mean pain intensity was mild, but severe pain was reported at least once by 20.3% of persons. Of individuals who reported severe pain at least once, mean age was 68.9 years, 53.7% were female, 78.0% were Caucasian, 7.4% were cared for in long-term care hospices, and 73.9% had a primary diagnosis of cancer. Severe pain was reported at least once by a substantial percentage of persons in this study. These data provide insight into pain reported by persons who received hospice care, and may be useful as process indicators of the quality of care.     

Assessment of pain: can caregivers or relatives rate pain in nursing home residents?

Aim. To compare pain reports of nursing home residents to ratings by proxies. Background. It is not easy to assess pain in cognitively impaired residents. For residents who are unable to report pain intensity themselves, proxies (i.e. relatives or caregivers) might serve as sources of information. The utility of these proxies in assessing residents’ pain is not clear however. Design. A multicenter cross‐sectional study. Methods. Pain intensity was rated on a Numeric Rating Scale; proxies were asked how certain they were about their observations. Agreements on ratings were computed by means of intra class correlation (ICC) coefficients for continuous variables and multiple linear regression analyses were performed with the level of pain intensity by proxies as the dependent variable. Results. The sample consisted of 174 residents (median age 82 years), of whom 124 were cognitively impaired and 50 intact, and 293 proxies: 171 caregivers and 122 relatives. All three parties reported median pain intensity during the preceding week as 6·0. Data were consistent with low‐to‐moderate correlation coefficients between residents and caregivers (ICC = ?0·12 to 0·25), residents and relatives (ICC = ?0·51 to 0·48) and caregivers and relatives (ICC = 0·03 to 0·31). Residents themselves judged pain intensity at rest significantly higher than did proxies (p = 0·05). Caregivers scored significantly higher ratings for residents on analgesics (p = 0·001) and significantly lower pain ratings if they were more satisfied with the prescribed analgesics (p = 0·01). Conclusions. Proxy report of relatives and caregivers on presence and intensity of pain is unreliable, especially for cognitively impaired persons. The use of a standardised pain observation scale could be helpful. Relevance to clinical practice. Pain management in nursing home residents could be improved by educating caregivers about assessment and treatment of chronic pain. Relatives should be informed about chronic pain and learn how to alleviate pain through non‐pharmacological interventions.     

The Indonesian version of the Premature Infant Pain Profile–Revised: Translation and adaptation of a neonatal pain assessment

PurposePain assessment is a key component of good pain management in hospitalized infants. This study aimed to translate and adapt a version of pain measurement in infants, the Premature Infant Pain Profile Revised (PIPP-R) into Indonesian.MethodThe adaptation process of the measuring instrument used a modified Brislin method which included forward translation, back translation 1, group discussion 1, back translation 2, group discussion 2, and pilot testing on neonatal nurses: feasibility test, inter-rater reliability using intraclass correlation (ICC), and internal consistency using Cronbach's α coefficient.ResultsThe PIPP-R version in English has been translated into Indonesian. In general, nurses assessed this measuring instrument as feasible. The inter-rater reliability showed a high agreement (ICC = 0.968, P = 0.001) and this measuring instrument had good internal consistency (Cronbach's α = 0.856).ConclusionThe Indonesian version of PIPP-R is easy to use and shows good psychometric properties. The use of this measuring instrument will help nurses and researchers obtain accurate infant pain intensity measurement values.     

Development and Psychometric Evaluation of the Pain Impact Inventory

Objectives:   The aim of this study was to develop and psychometrically evaluate an instrument for measuring the impact of chronic pain on daily life.
Methods:   The study comprised 384 respondents (aged between 18–102 years) who reported chronic pain. The instrument "Pain Impact Inventory" (PII) was evaluated in terms of face, content, construct and criterion validity, as well as two reliability measures. Reliability was measured by means of test–retest (with a 2-week interval) while Cronbach's alpha was used to measure internal consistency.
Results:   The results showed that the PII had acceptable validity and reliability. The PII contains 20 items and was found to have a nested design with five sub-scales (Physical impact, Psychological impact, Impact on social life, Social support, and Control) and two overarching dimensions ("Impact" and "Support").
Conclusions:   The initial tests showed that the PII seems to be a psychometrically sound instrument for measuring the impact of pain on daily life from a multidimensional perspective.     

A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD)

BackgroundThere is currently no gold standard instrument for assessing pain in severely cognitively impaired adults who are unable to provide self-report.AimsTo determine interrater reliability of the PACSLAC and PAINAD in assessing pain behaviors in patients with the same pain stimulus, determine the consistency of the reliable changes between and within the instruments and assess nurse preference for either instrument.DesignA single-group, within-subjects repeated-measures design was implemented.SettingThe study took place in a small suburban hospital.Participants/SubjectsPain levels were observed at 24, 48, and 72 hours postsurgery using two instruments: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). These instruments were selected because they are among the most commonly recommended tools for clinical use. Interrater reliability was analyzed along with reliable changes in pain for each period, and the study concluded with the nurse raters completing a preference survey.MethodsA convenience sample of 30 patients was used with a diagnosis of severe dementia rendering the patient unable to reliably express pain, 60+ years of age, recovering from hip fracture surgery.ResultsGreater interrater reliability was found for the PACSLAC, with reliable change potentially affected by the type and level of pain medication. The nurses’ preference for the tool was split.ConclusionsThe results of this study indicate that the PACSLAC may be the more reliable tool over the PAINAD; however, rater training and familiarity with the tool is critical.     

Development and psychometric evaluation of the Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians

Many epidemiological surveys on playing-related musculoskeletal disorders (PRMDs) have been conducted on professional musicians, but none have evaluated or confirmed the psychometric properties of the self-report instruments that were used. The aim of the present study was to develop and validate a self-report instrument for professional orchestra musicians to measure musculoskeletal (MSK) pain and pain interference in terms of function and psychosocial constructs. 183 professional orchestra musicians in Scotland were eligible to participate in the study, of which 101 (55% response rate) took part. Development of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) involved the selection and modification of the most appropriate instruments measuring MSK pain, followed by psychometric evaluation of the new instrument. Face and content validity were ascertained by expert panels. 37 participants completed the questionnaire. The percentage of missing scores was very low (2.7%). Exploratory factor analysis revealed that the MPIIQM had a strong and stable two-factor structure, with nine retained items explaining 71.3% of the variance in the data set. “Pain intensity” and “pain interference” were the two emerging factors. High internal consistency was achieved for each subscale (Cronbach's alpha = 0.91). Substantial test–retest reliability for the pain intensity items (range 0.78–0.82), and moderate to substantial test–retest reliability for the pain interference items (range 0.56–0.76) were obtained. The MPIIQM is a valid and reliable self-report instrument for the measurement and evaluation of MSK pain and pain interference in a population of professional orchestra musicians.     

A scale to measure pain in non-verbally communicating older patients: the EPCA-2 Study of its psychometric properties

We have constructed and validated the Elderly Pain Caring Assessment 2 (EPCA-2) an 8 items behavioural scale to rate the intensity of pain in non-verbally communicating older (age 65 years) patients (NVC-OP). It was postulated that the assessed pain had two dimensions (signs outside and during caregiving). The first version of the scale was constructed on the basis of the results of a survey among 48 experienced nurses and caregivers and of a review of the literature. After testing of three intermediate versions, the psychometrics properties of the final version were studied on 340 NVC-OP. The face and content validities were good. Convergent validity: the total score was well correlated both with a pain global clinical score given by two highly experienced observers (r(s)=0.846) and with the opioid dose prescribed in a sub-group of patients (r(s)=0.698). The discriminant and divergent validities were satisfactory. After factor analysis, the internal structure of the scale was consistent with the postulated two-dimensional structure of the construct. The inter-rater reliability was very good (ICC=0.877) and is always equally good irrespective of the status (doctor, nurse and caregiver) of the raters. The internal consistency was highly satisfactory (alpha=0.79). The responsiveness evaluated in 4 ways was always very good. EPCA-2 may provided nurses, caregivers and doctors with a validated instrument for pain assessment in NVC-OP.     

Interrater reliability of the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes

OBJECTIVE: To determine the interrater reliability of the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes. METHODS: A total of 64 pain sites reported by 29 individuals were classified using International Association for the Study of Pain and Tunks' classification schemes. Three raters independently categorized each pain site. RESULTS: In general, disagreement in pain classification between the three raters was found for about 50-70% of the pain sites. Disagreement between rater pairs (two raters at a time) was somewhat better, ranging from about 20% to 50%. The kappa statistic for interrater agreement was in the marginally acceptable range (i.e., 0.3 to 0.65). Although disagreement tended to be somewhat higher using the Tunks scheme, both classification schemes showed low interrater agreement. CONCLUSIONS: Consistent with our previous research using the Donovan spinal cord injury pain classification scheme, considerable variability between raters was demonstrated using the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes.     

Postoperative Pain in Children: Association Between Anxiety Sensitivity,Pain Catastrophizing,and Female Caregivers' Responses to Children's Pain

This study investigated the association between anxiety sensitivity and pain catastrophizing in children, caregivers' anxiety sensitivity and catastrophizing about children's pain and responses to children's pain, pain intensity reported by children, and pain intensity estimated by caregivers. The participants were 102 children scheduled for outpatient surgery and their female caregivers. Before the operation, caregivers' catastrophizing about children's pain, children's pain catastrophizing, and their anxiety sensitivity were assessed, as well as caregivers' responses to children's pain. Pain intensity reported by children and estimated by caregivers was evaluated after the operation and 24 hours afterward. Analyses were performed via path analysis. The results indicated that children and caregivers characterized by higher levels of anxiety sensitivity reported higher levels of pain catastrophizing and catastrophic thinking about children's pain, respectively. Caregivers with higher levels of catastrophic thinking about the children's pain reported higher levels of solicitousness and higher estimations of the children's pain intensity after the operation. Higher levels of children's pain catastrophizing were associated with more frequent responses of discouragement and higher pain intensity reported after the operation. These findings highlight the relevance of catastrophizing about children's pain and children's pain catastrophizing in the experience of postoperative pain in children.PerspectivePath analysis was used to test a hypothetical model of the associations between anxiety sensitivity, catastrophizing, parental responses, and postoperative pain in children. The results highlight the association between children's and parents' pain catastrophizing and discouragement and solicitous responses and the role of anxiety sensitivity as a traitlike factor associated with catastrophizing.     

Acute Pain and Availability of Analgesia in the Prehospital Emergency Setting in Italy: A Problem to be Solved

Objectives:   The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy.
Methods:   First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters.
Results:   Pain symptoms were present in two-thirds of the patients ( n  = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs] and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen.
Conclusions:   There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications.