Validation and properties of the verbal numeric scale in children with acute pain

Although the verbal numeric scale (VNS) is used frequently at patients’ bedsides, it has never been formally validated in children with acute pain. In order to validate this scale, a prospective cohort study was performed in children between 8 and 17 years presenting to a pediatric emergency department (ED) with acute pain. Pain was graded using the VNS, the visual analogue scale (VAS), and the verbal rating scale (VRS). A second assessment was done before discharge. We determined a priori that in order to be valid, the VNS would need to: correlate with the VAS (concurrent validity); decrease after intervention to reduce pain (construct validity); and be associated with the VRS categories (content validity). The VNS interchangeability with the VAS, its minimal clinically significant difference, and test–retest reliability were also determined. A total of 202 patients (mean age: 12.2 ± 2.6 years) were enrolled. The VNS correlated with the VAS: r_ic = 0.93, p < 0.001. There were differences in the VNS before versus after interventions (p < 0.001), and between VRS categories (mild versus moderate, p < 0.001; moderate versus severe, p < 0.001). The 95% limits of agreement (interchangeability) between VNS/VAS were outside the a priori set limit of ±2.0: −1.8, 2.5. The VNS minimal clinically significant difference was 1. The VNS had good test–retest reliability with 95% limits of agreement of −0.9 and 1.2. In conclusion, the VNS provides a valid and reliable scale to evaluate acute pain in children aged 8–17 years but is not interchangeable with the VAS.     

Reliability of the visual analog scale in children with acute pain in the emergency department

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain. Pain was graded 4 times using a paper VAS (0-100mm): T(0), T(3), T(6), and T(≥ 36)minutes. After T(6), patients were asked if their pain had changed since T(0)minute. The primary analysis was the repeatability coefficient of the VAS, determined according to the Bland-Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T(0), T(3), and T(6). In order to appropriately estimate the within-subject SD, 96 patients were required if we obtained 3 measurements for each patient. A total of 151 patients with a mean age of 12.2 ± 2.5 years were enrolled. Among them, 100 mentioned that their pain was the same for T(0), T(3), and T(6)minutes. The repeatability coefficient of the VAS for these children was 12 mm when the pain did not change. This implies that, for a child, all pain intensity measurements within 12 mm should be considered the same pain intensity on a paper VAS. This measure should also be evaluated on other types of VAS.     

Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry

Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55 years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7–10) on a 0–10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients’ actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions.     

手术后患者疼痛控制满意度状况及影响因素的研究

目的描述手术后患者对疼痛控制的满意度状况,探讨影响疼痛控制满意度的因素。方法采用多阶段抽样方法,随机抽取北京地区5家综合性三级甲等医院,对符合入选标准的304例手术后第2天的住院疼痛患者进行了调查,问卷由休斯顿疼痛情况调查表、疼痛治疗指数和病历资料核查表3个部分组成。结果术后患者对疼痛控制总体满意度平均评分为7.3。疼痛控制教育、医生对疼痛的处理、疼痛减轻、患者受到的所有针对疼痛的照料、医生或护士是否告诉患者要优先有效地控制疼痛以及手术次数共6个因素进入回归方程,是影响疼痛控制满意度的主要因素。结论患者对术后疼痛控制较为满意;疼痛控制服务因素是影响手术后患者疼痛控制满意度的主要因素。建议制订术后疼痛控制制度和标准,采取针对性措施,改善术后疼痛控制质量,提高术后患者对疼痛控制的满意度。     

超前镇痛对扁桃体切除术后镇痛效果及满意度的研究

目的探讨超前镇痛对扁桃腺切除术后镇痛的效果及满意度。方法选择扁桃腺切除术的患者103例,随机分为实验组53例和对照组50例。两组患者术前由责任护士指导使用0～10疼痛数字量表评估疼痛程度,对照组术后在患者提出需要镇痛药时,护士遵医嘱给药。实验组手术前责任护士对患者进行疼痛认知与态度的评价,术后当疼痛程度达到3时护士遵医嘱给药。两组镇痛药均选择双氯芬酸钾25～50mg口服。比较两组患者术后疼痛情况及用药量。结果实验组术后3h疼痛程度（3．900±1．207）分,术后第1天早餐前疼痛程度（4．830±1．845）分,均低于对照组（4．960±1．611）分和（5．590±1．681）分,两组比较差异有统计学意义（t=-3．657,-2．067;P〈0．05）;术后24h内实验组用药量为（90．25±31．25）mg,对照组为（62．5±33）nag。两组比较差异有统计学意义（t=3．01,P〈0．01）。实验组术后镇痛满意度为90．6％,对照组为82．0％,两组比较差异有统计学意义（x2=11．2,P〈0．05）。结论超前镇痛能有效减轻患者疼痛程度,提高扁桃腺切除术后患者镇痛满意度。     

An evaluation of postoperative epidural analgesia in acute pain service in an Indian cancer hospital (a preliminary experience of patient satisfaction survey)

Quality improvement approaches have been used to evaluate pain management. The purpose of this study was two-fold: to obtain a baseline data of incidence of severity of pain and patient's level of satisfaction during postoperative period and also to evaluate the changes over time on pain severity, in pain interference with function, patient satisfaction, and time required to deliver the analgesics after implementation of pain protocols. Two hundred patients were administered a questionnaire adapted from American Pain Society's patient outcome questionnaire in a two-phased manner. One hundred patients were included in the survey during January 2004 and a year later a similar cohort of 100 were administered the same questionnaire to evaluate for changes in quality of postoperative management over time. This self-report survey found a significantly high patient satisfaction in the setting of significant postoperative pain. There is a statistically significant reduction in the severity of ‘average pain’ after implementation of pain protocols, however, it did not translate into improvement in the patient satisfaction. The issue of patient satisfaction is complex and needs a systematic program recommended by American Pain society's quality improvement guidelines.     

Nurses' assessment of pain in surgical patients

AIM: This paper reports a study to compare nurses' ratings of pain intensity and suffering (affect) in adult surgical patients with patients' own ratings of these variables, and to investigate whether pain ratings were influenced by cultural and ethnic differences. BACKGROUND: Studies show that postoperative pain continues to be under-treated in a large proportion of cases. The problem may be partly due to inaccurate pain assessment by nurses. METHOD: A convenience sample of 95 patients and 95 nurses in adult surgical units was selected from four hospitals in Jerusalem, Israel in 2003-2004. A questionnaire was administered to each patient by the researcher. The questionnaire included: (a) a Hebrew translation of the Short-Form McGill Pain Questionnaire for pain sensation, pain affect, and present pain intensity at rest and on movement; (b) visual analogue scales for overall pain intensity, suffering, and satisfaction with treatment; and (c) demographic and cultural data. Within a few minutes of the patient completing the questionnaire, a nurse who had been allocated to care for that patient made an independent assessment of the patient's pain. The nurse then left the patient's room and filled in the same questionnaire. FINDINGS: Nurses significantly underestimated all dimensions of pain on the above scales, but accurately assessed patient treatment satisfaction. There were no statistically significant effects for cultural and ethnic differences in pain assessment. Both types of clinical area where nurses worked and nurses' level of nursing education were found not to influence their assessment. CONCLUSION: The findings have implications for the management of postoperative pain by highlighting the need for more accurate pain assessment. Further research is required to elucidate the way in which nurses and patients conceptualize pain and to understand better the process of pain assessment in clinical nursing practice.     

术前疼痛教育对腹部手术病人疼痛控制满意度调查与分析

目的:通过对腹部手术病人进行疼痛教育,提高病人对术后疼痛及疼痛控制的认知度,改善术后镇痛质量,提高病人的舒适度及满意度,为探索提高病人术后生活质量的宣教方案提供科学依据。方法:采用问卷方式对我院普外科、妇科择期手术病人120例进行调查,将其随机分为实验组和对照组,各60例。实验组术前给予疼痛相关知识教育,术后疼痛控制及疼痛镇痛药物相关知识教育;对照组采取常规术前教育。评估并比较两组病人对术后疼痛控制满意度的变化。结果:两组病人对疼痛的期望基本一样,分别为(85.0%,83.3%),希望手术后是轻度疼痛;在目前疼痛控制方面,实验组无痛及轻度疼痛的比例占75.0%,对照组占51.6%,实验组的疼痛控制较对照组好,疼痛程度较对照组低;实验组对疼痛教育的满意度为100%,对照组满意度为66.7%,实验组的满意度明显高于对照组(均P0.01)。结论:对病人进行术前疼痛教育可提高其术后疼痛控制的满意度及对手术室护理服务的满意度。     

Imaging and laboratory testing in acute abdominal pain

When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process (eg, acute appendicitis, cholecystitis). Because studies on the accuracy of diagnostic tests are of necessity related to the presence or absence of specific diagnoses, and because clinicians frequently look to tests to help them rule in or rule out specific conditions, this article is organized by region of pain and common abdominal diagnoses. It focuses on the contributions that laboratory testing and imaging make in the emergency management of abdominal complaints.     

MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain

Purpose  To retrospectively assess the performance of MR imaging in the evaluation and triage of pregnant patients presenting with acute abdominal or pelvic pain. Method and materials  MRI studies of pregnant patients who were referred for acute abdominal pain between 2001 and 2007 were included. MR images were retrospectively reviewed and compared with surgical and pathologic findings and clinical follow-up data. Analysis of imaging findings included evaluation of the visceral organs, bowel and mesentery, appendix (for presence of appendicitis), ovaries (detection and adnexal masses were evaluated), focal inflammation, presence of abscesses, and any other abnormal findings. Results  A total of 118 pregnant patients were included. MR findings were inconclusive in 2 patients and were positive for acute appendicitis in 11 patients (n = 9 confirmed by surgery, n = 2 improved without surgery). One patient with inconclusive MR had surgically confirmed appendicitis; the other patient with inconclusive MR had surgically confirmed adnexal torsion. Other surgical/interventional diagnoses suggested by MR imaging were adnexal torsion (n = 4), abscess (n = 4), acute cholecystitis (n = 1), and gastric volvulus (n = 1). Two patients with MR diagnosis of torsion improved without surgery. One patient with MR diagnosis of abscess had biliary cystadenoma at surgery. The rest of the MR diagnoses above were confirmed surgically or interventionally. MR imaging was normal in 67 patients and demonstrated medically treatable etiology in 28 patients: adnexal lesions (n = 9), urinary pathology (n = 6), cholelithiasis (n = 4), degenerating fibroid (n = 3), DVT (n = 2), hernia (n = 1), colitis (n = 1), thick terminal ileum (n = 1), rectus hematoma (n = 1). Three of these patients had negative surgical exploration and one had adnexal mass excision during pregnancy. Other patients were discharged with medical treatment. The sensitivity, specificity, accuracy, positive predictive values (ppv), and negative predictive values (npv) of MR imaging for acute appendicitis, and surgical/ interventional diagnoses were 90.0% vs. 88.9%, 98.1% vs. 95.0%, 97.5% vs. 94.1%, 81.8% vs. 76.2%, 99.1% vs. 97.9%, respectively. Conclusion  MR imaging is an excellent modality for diagnosis of acute appendicitis and exclusion of diseases requiring surgical/interventional treatment. Therefore MR imaging is useful for triage of pregnant patients with acute abdominal and pelvic pain.     

APS护士对自控镇痛患者满意度影响因素的研究

目的 探讨急性疼痛服务组织(Acute Pain Service,APS)护理质量持续改进对自控镇痛患者满意度的影响,找出APS工作中存在的护理问题,提高患者满意度.方法 回顾性分析我院2013年6月至2014年9月术后自控镇痛患者(Patient-Controlled Analgesia,PCA)满意度调查结果,针对存在的问题,采取相应的护理改进措施,比较采取措施前后患者满意度的调查结果.结果 2013年的1320份满意度调查表中,满意度不达标184例(占13.9%),其中因服务态度导致不满28例,占2.1%;健康宣教导致不满31例,占2.3%;设备故障导致不满占28例,占2.1%;镇痛效果及其他方面导致不满97例,占7.3%.2014年的1320份满意度调查表中,满意度不达标95例(占7.3%),其中因服务态度导致不满26例,占2.0%;健康宣教导致不满21例,占1.6%;设备故障导致不满占19例,占1.4%;镇痛效果及其他方面导致不满29例,占2.2%.护理质量改进措施实施前患者的每月满意度低于实施后(P<0.05),差异有统计学意义.结论 APS护士对术后自控镇痛患者满意度调查结果表明,患者满意度调查的问题及时反馈、分析和改进,有利于提高自控镇痛患者满意度及护理质量.     

The influence of perceived pain on satisfaction with community participation after hospital discharge

OBJECTIVE: To examine the association between pain and satisfaction with community participation for patients with stroke approximately 4 months after discharge from inpatient medical rehabilitation. DESIGN: A cross-sectional study from 2001 to 2002 using information from the IT HealthTrack database. SETTING: Community based. PARTICIPANTS: The study included 1673 patients with stroke aged 40 years or older discharged from inpatient medical rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Primary measures included pain ratings and satisfaction with community participation. RESULTS: The sample was 49.4% female and 81.1% non-Hispanic white. One third of the sample reported mild to severe pain. Pain ratings showed a significant and inverse association with satisfaction with community participation. The association remained significant with adjustment for possible confounding factors and with stratification by right and left body involvement. Each 1-level increase in pain rating score (range, 0-10) was associated with a 12% decreased odds ratio (OR=.88; 95% confidence interval, .84-.93) of being satisfied with community participation after adjustment for age, sex, marital status, ethnicity, and motor and cognitive functional status. CONCLUSIONS: In persons with stroke, high pain rating scores were significantly associated with lower satisfaction with community participation. Effective pain management may increase level of satisfaction with community participation in persons with stroke.     

盐酸屈他维林对痉挛性腹痛疗效的初步评价

目的本文旨在评价盐酸屈他维林对腹部痉挛性疼痛的治疗效果,为进一步的临床应用提供依据。方法３８３例患者均因急性腹痛就诊,其中男２１６例,女１６７例,年龄１７～７５岁,平均４４１岁。随机分成治疗组（２５８例）和对照组（１２５例）进入研究,治疗组采用盐酸屈他维林针剂４０～６０ｍｇ肌注或静注。对照组用阿托品０５ｍｇ和颅通定６０ｍｇ联合肌肉注射。结果①治疗组：急性胃肠炎组（１１３例）、肾绞痛组（６５例）、胆绞痛组（５２例）和肠粘连组（２８例）疼痛缓解有效率分别为９３８％、８６２％、８８５％和９２８％。除９例出现一过性头晕外未发现其他不良反应。②对照组：急性胃肠炎组（４０例）、肾绞痛组（３０例）、胆绞痛组（３０例）和肠粘连组（２５例）疼痛缓解有效率分别为７７５％、５６７％、６３３％和７６％。两组疗效比较有显著性差异。结论盐酸屈他维林是一种有效、适应性广且副作用少的解痉止痛剂。     

Comparison of daily and weekly retrospectively reported pain intensity in patients with localized and generalized musculoskeletal pain

The purpose of the study was to compare daily and weekly recalled pain intensity over time and their correspondence with real-time pain intensity in patients with localized (LP) and generalized (GP) musculoskeletal pain. Daily recalled pain, averaged over seven consecutive days, and weekly recalled pain at day 8 were recorded on 100 mm visual analogue scales monthly over 4 months for 40 LP and 50 GP patients. Multiple real-time pain ratings on numerical rating scales (0–10) were averaged over the week for 23 LP and 33 GP patients in Month 4. Reliability was assessed using the intraclass correlation coefficients (ICC) and the standard deviations of the repeated measurements.Daily pain ratings were lower than weekly ratings across the 4-month period. Reliability was lower for weekly than for daily recalled pain in the GP group, and lower than in the LP group. These results were independent of the magnitude of pain intensity. No difference was found between daily recalled and real-time ratings. The ICC was higher between daily and real-time ratings than between weekly and real-time ratings in Month 4. Weekly ratings were higher than real-time ratings in the GP group, and the overestimation increased with increasing pain intensity.The results of the present study indicated that reliability was improved by using ratings of daily recalled pain averaged over a week rather than single ratings of weekly recalled pain in subjects with localized or generalized pain. Weekly recalled pain was overestimated in subjects exhibiting generalized pain and high pain intensity.     

Alternatives to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction

Objective

The objective of this study was to assess opioid use in an emergency department following the development and implementation of an alternative to opioids (ALTO)-first approach to pain management. The study also assessed how implementation affected patient satisfaction scores.

超前镇痛对肺癌剖胸术后疼痛控制满意度及慢性疼痛的影响

目的探讨超前镇痛对肺癌剖胸患者术后疼痛控制满意度及慢性疼痛的影响。方法选择肺癌手术患者100例,随机分为对照组（n=50）和实验组（n=50）。对照组实施传统镇痛模式,实验组实施超前镇痛模式。手术后48h进行术后疼痛控制总体满意度评价;术后3个月,通过电语回访,记录患者疼痛情况,了解患者慢性疼痛的发生率。结果实验组术后疼痛控制满意度为78．0％高于对照组52．0％,差异有统计学意义（x2=10．16,P〈0．05）;实验组术后慢性疼痛发生率为13．6％,低于对照组33．3％,差异有统计学意义（X2=4．79,P〈0．05）。结论超前镇痛能提高肺癌剖胸术后患者疼痛控制满意度,减少慢性疼痛的发生率。     

Estimation of pain intensity in emergency medicine: a validation study

This study was designed to estimate the validity of an 11-point verbal numerical rating scale (VNRS) and a 100 Unit (U) plasticized visual analogue scale (VASp) using a 100mm paper visual analogue scale (VAS) as a gold standard, to recommend the best method of reporting the intensity of acute pain in an emergency department (ED). A convenience sample of 1176 patients with acute pain were recruited in the ED of a teaching hospital. Patients >18 years and able to use the different scales were included. Scales were presented randomly. Results were converted to a 0-100 U scale and validity was quantified using the Bland-Altman method and the intra-class correlation (ICC). The limits of acceptability were previously set for the limits of agreement at +/-20 U, with a constant bias. The Bland-Altman method revealed a small bias of -4 U for the VNRS and +1 U for VASp. However, the bias of the VNRS varied with the intensity of pain from -10 to +1 U. The limits of agreement between the VNRS&VAS and the VASp&VAS were -25; +17 U and -17; +18 U, respectively. The ICC was excellent between the VNRS&VAS (0.88) and the VASp&VAS (0.92). In conclusion, the VASp has a small bias, acceptable limits of agreement and an excellent intra-class correlation. It is probably a valid tool to estimate acute pain in the ED. However, the VNRS is less valid in that context because of its wide limits of agreement and variable bias (mainly in lower scores).     

Marital satisfaction and psychophysiological responsiveness in spouses of patients with chronic pain

The primary purpose of this study was to investigate the relationship between spouse marital satisfaction and spouse solicitousness to their physiological responsiveness during marital interactions about pain. Twenty-six couples engaged in a series of structured marital interactions about neutral and pain-related topics while monitored for skin conductance (SC) and heart rate (HR). There was strong support for the role of spouses’ marital satisfaction in predicting their physiological responsiveness. The more satisfied a spouse, the more physiologically reactive the spouses were when listening to the patient describe pain, and the less reactive when responding to it. Dissatisfied spouses demonstrated the opposite pattern. They autonomically deactivated when hearing about the pain and became reactive when responding to it. Solicitousness was not a significant predictor of the spouses’ physiological responsiveness. Block’s (1981) proposed physiological mechanism for the origin of solicitousness in spouses did not receive support. It appears that responding in any fashion may lessen the magnitude of arousal in maritally satisfied spouses, whereas dealing with pain-related topics produces unpleasant arousal in dissatisfied spouses.