Pain Indicators for Persisting Pain in Hospitalized Infants in a South African Setting: An Explorative Study

In the developing world, there is a high incidence of human immunodeficiency virus (HIV), gastroenteritis, pneumonia, meningitis, and other inflammatory diseases in infants, the conditions of which may induce persisting pain. The primary objective was to estimate the reliability and validity of the Touch Visual Pain (TVP) scale to measure persisting pain. This prospective observational study was performed in hospitalized 0–3-year-old infants in South Africa. The Numeric Rating Scale (NRS) pain, NRS distress, and the TVP scale were applied and scores were compared. The TVP scale consists of 10 behavioral indicators scored as present or not present. Associations between the different scales were tested with logistic regression analyses. We analyzed 337 assessments in 151 patients. The NRS pain score was 4 or higher in 82 (24%) assessments. The NRS distress score was 4 or higher in 242 (72%) assessments. The mean TVP score was 3.7 (SD = 1.6). Four TVP items were statistically significantly associated with NRS pain; three other TVP items with NRS distress. The behaviors “cry/moaning” and “alertness” were also significantly associated with NRS distress. Two TVP items were not sensitive to assess pain or distress and were replaced in a revised TVP version. We conclude that our study identified sensitive and specific indicators of persisting pain in hospitalized children under the age of 3 years in a South African setting. Psychometric properties of the revised TVP need to be studied before its use in clinical practice can be recommended.     

Validity of Simplified Versus Standard Self-Report Measures of Pain Intensity in Preschool-Aged Children Undergoing Venipuncture

There are inadequate age-specific data to support the use of current self-report pain scales in 3- and 4-year-old children. Most preschool-aged children also lack the necessary cognitive development to use standard scales. We aimed to evaluate the validity and feasibility of 2 novel simplified scales (Simplified Faces Pain Scale, S-FPS; Simplified Concrete Ordinal Scale, S-COS) for preschool-aged children. These simplified scales used a 2-step self-report method: children were first asked whether they have pain (yes/no); only if yes, then pain intensity was self-reported using a 3-point scale with visual aids signifying mild/moderate/severe. We recruited 180 3- to 6-year-old children undergoing routine blood collection. Each child was randomly assigned 2 of 3 scales—S-FPS, S-COS, Faces Pain Scale-Revised (FPS-R)—to self-report pain before venipuncture, immediately after, and 5 minutes later, using both scales at each time-point. Pain was also assessed using observation (Face Legs Activity Cry Consolability) at each time point. The ability to discriminate pain from no pain was improved with S-FPS and S-COS, compared with the FPS-R, among 4-year-olds, but not 3-year-olds. Correlation with Face Legs Activity Cry Consolability was moderate to strong and cooperation rates were similar for all self-report scales. The simplified scales can improve and simplify pain assessment for 4-year-olds. Quantitative pain rating remains challenging for 3-year-olds.

Psychologische Schmerzdiagnostik bei Kindern

Pain in premature infants, neonates, and young children impairs their development to a great extent and may lead to long-lasting pain memories and undertreatment of pain. Up to 15 years ago, the opinion prevailed that babies -- especially neonates -- could not feel pain generally, because they could not report their pain sensations to adults and were not able to verbalize their feelings. In the past decade, standardized scales have been developed to assess pain in children. While in neonates and children up to 2 years standardized scales were developed for observation of their reactions, for children 3 years and older self-report scales are used to assess pain sensations. The text describes a variety of standardized pain assessment scales which fulfil the requirements of reliability and validity.     

Pain in cognitively impaired nursing home patients

Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. Subjects underwent a cross-sectional interview and chart review for the prevalence of pain complaints, etiology, and pain management strategies. Pain was assessed using the McGill Pain Questionnaire and four unidimensional scales previously utilized in younger adults. Thirty-three percent (33%) of subjects were excluded because they were either comatose (21%), non-English speaking (3.7%), temporarily away (sick in hospital) (4.3%), or refused to participate (3.7%). Of 217 subjects in the final analysis, the mean age was 84.9 years, 85% were women, and most were dependent in all activities of daily living. Subjects demonstrated substantial cognitive impairment (mean Folstein Mini-Mental State exam score was 12.1 ± 7.9), typically having deficits in memory, orientation, and visual spatial skills. Sixty-two percent reported pain complaints, mostly related to musculoskeletal and neuropathic causes. Pain was not consistently documented in records, and pain management strategies appeared to be limited in scope and only partially successful in controlling pain. None of the four unidimensional pain-intensity scales studied in this investigation had a higher completion rate than the Present Pain Intensity Scale of the McGill Pain Questionnaire (65% completion rate). However, 83% of subjects who had pain could complete at least one of the scales. We conclude that cognitive impairment among elderly nursing home residents presents a substantial barrier to pain assessment and management. Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.     

5种疼痛强度评估量表应用于老年腰痛患者的重测信度

目的探讨5种疼痛强度评估量表在老年腰痛患者疼痛评估中的重测信度。方法对30例有腰痛症状的老年患者在24 h内用5种疼痛强度评估量表进行两次测试,包括视觉模拟评分(VAS)、数字评定量表(NRS)、词语描述量表(VDS)、修改版面部表情疼痛量表(FPS-R)和组合型疼痛评估表(MIX)。进行组内相关系数(ICC)分析。结果 5种量表的ICC为0.543~0.754,从高到低依次为NRS、FPS-R、MIX、VAS、VDS。结论 5种疼痛强度评估量表评估老年腰痛的重测信度均满意,建议优先选择NRS和FPS-R。     

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.     

Preliminary validation of a German version of pain stages of change questionnaire.

This study describes the development of the German questionnaire FF-STABS (Freiburg Questionnaire--Stages of Chronic Pain Management), which documents the willingness of chronic pain patients to use cognitive-behavioural methods for pain management independently. The newly constructed assessment instrument, modified from a similar instrument developed by Kerns and his colleagues, was administered to a heterogeneous sample of 118 chronic pain patients. Item and factor analysis support the identification of four reliable scales: precontemplation, preparation, action and maintenance. All scales evidenced sufficient indices of reliability and discriminant validity. Deviations from the original American version and suggestions for future refinements in the new measure are discussed.     

Reliability and sensitivity measures of the Greek version of the short form of the McGill Pain Questionnaire.

The translation of existing healthcare measurement scales is considered a feasible, efficient and popular approach to produce internationally comparable measures. The short form of the McGill Pain Questionnaire is one of the most widely used and translated instruments to measure the pain experience. The Greek version of the short form of the McGill Pain Questionnaire (GR-SFMPQ) has recently been developed and demonstrated satisfactory levels of internal consistency.The objective of the present study was to assess the instrument's reliability and sensitivity.Eighty patients with spinal or knee pain were included. The test-retest reliability of the instrument was estimated for measurements within the same day and after 15 days. The sensitivity of the measure was examined before and after the application of a physiotherapy therapeutic regime.The correlation coefficients (Intraclass Correlation Coefficient and Spearman's) ranged from 0.87-0.98 for within-day measurements and from 0.70-0.92 for administrations between days. All indexes of the GR-SFMPQ (total score, sensory and affective scores, total count of used words, visual analogue score, present pain index) managed consistently to detect the changes in pain experienced (p<0.05), after a therapeutic intervention, when assessing for the sensitivity of the questionnaire. An explorative discriminant analysis of the GR-SFMPQ indexes managed to correctly classify up to 85% of the patients; a classification rate comparable to the full version MPQ rating capacity.It can be argued from the results of this study that the Greek version of the SFMPQ fulfils the criteria of reliability and sensitivity to fluctuations of pain and can be utilized with confidence in cross-cultural comparative research trials.     

MMPI profiles in patients with headache or craniofacial pain: a comparative study

Our purpose was to examine the MMPI profiles of 157 patients with chronic headache or facial pain. The following diagnostic groups were considered: tension-type headache (n = 44); migraine + cluster headache + chronic paroxysmal hemicrania (20); trigeminal neuralgia (7); atypical facial pain (AFP) (33); temporomandibular joint dysfunction (TMJ) (53). There were two control groups: C1 of 27 healthy individuals and C2 of 18 patients with chronic pain located elsewhere. A "Pain Index" was calculated (0-10) which quantified pattern, duration and frequency of pain. The Italian MMPI abbreviated version was administered to all subjects. One-way Anova, the Duncan test and correlation analysis were performed. Of the diagnostic groups, AFP scored highest and TMJ lowest in all except three scales. In the AFP group, all neurotic scales scored above 70. The Pain Index correlated with higher scores on most scales. Chronic pain may lead to personality alterations, but some features of craniofacial pain correlate with specific personality disturbances.     

Psychometric evaluation of the Inventory of Negative Thoughts in Response to Pain (INTRP) with a community sample

We investigated the factor structure and psychometric properties, of the Inventory of Negative Thoughts in Response to Pain (INTRP) with a sample of 99 men and 125 women. Confirmatory factor analyses provided support for the empirically derived three factors: Negative Self-Statements, Negative Social Cognitions, and Self-Blame. The factor scales had satisfactory internal consistency reliability. We found no differences between men and women on the factor scales. The INTRP factor scales did not relate significantly to age, ethnicity, marital status, or educational level. We examined the relationships between the INTRP and specific pain-related indices using partial correlational analyses, and we conducted stepwise multiple regression analyses to evaluate the relative contributions of the INTRP factor scales and self-report measures of depression and anxiety to the prediction of three pain indices.     

The Toddler-Preschooler postoperative pain scale: an observational scale measuring postoperative pain in children aged 1–5. Preliminary report

This study evaluates the reliability and validity of the Toddler-Preschooler Postoperative Pain Scale (TPPPS), an observational scale developed to be a clinically useful measure of postoperative pain in children aged 1–5 years.

The TPPPS consists of 7 items divided among 3 pain behavior categories: (1)Vocal pain expression; (2) Facial pain expression; and (3) Bodily pain expression. These items were derived from preliminary studies by the authors and from other observational studies of children's pain behavior. Seventy-four children between the ages of 12 and 64 months seen for inguinal hermia or hydrocele repair were the subjects of the study. Subjects were observed postoperatively for six 5-min intervals, commencing with their awakening from anesthesia, using the TPPPS. Two raters independently observed 28 of the children to assess inter-rater reliability. Validity was assessed by relating TPPPS scores to the timing and type of analgesics used, visual analog and numerical scale pain ratings made by parents and nurses, and perioperative vital signs.

The TPPPS was found to possess satisfactory internal reliability (Cronbachs's alpha = 0.88). Inter-rater reliability was good, with kappas for the pain behavior items ranging from 0.53 to 0.78. Preliminary evidence of the scale's validity is provided by the sensitivity of the scale to analgesic regimen, the convergence between TPPPS scores and nurse and parent ratings of postoperative pain, and the associations found between TPPPS scores and perioperative vital signs.     

Pain behaviors in infants and toddlers

The purposes of this qualitative study were to describe behaviors of infants and toddlers when in acute pain and to describe changes in those behaviors across the 3-yr span. With the use of naturalistic observation, 32 children, birth to 36 mo of age, were observed following surgery, fractures, or burns. Purposeful sampling of children, who were inpatients of a private midwestern hospital, was used. Data sources included child observations, parent interviews, and patient records. The research method used was grounded theory. Three pain behavior categories were developed, and characteristics of each category were identified. Pain categories included motor movement, communication, and facial expression. Theoretic implications were proposed. It is concluded that predictable changes in pain behaviors occur within infancy and toddlerhood. A matrix of pain behavior is presented.     

Cross-validation of the Children's and Infants' Postoperative Pain Scale in Brazilian Children

Objective: To validate CHIPPS (Children's and Infants' Postoperative Pain Scale) in Brazilian children. Background: Cross‐validation is needed in order to apply this scale in a different language and culture. Methods: We applied a Portuguese version of CHIPPS to 100 children aged 0 to 5 years. The scale was translated and tested for inter‐rater reliability, internal consistency, and construct, content, and concurrent validity. The children's behavior was videotaped before, during and after a procedure in a primary care unit. Three observers then rated pain behavior from videotapes. Results: The scale showed excellent inter‐rater reliability (intraclass correlation coefficient: 0.89) and a very good internal consistency, with Cronbach's alpha of 0.86. The positive correlation between CHIPPS and Modified Behavior Pain Scale supports concurrent (criterion) validity (Spearman coefficient 0.70 before and 0.81 after vaccinations). Construct validity was determined by comparing the scores of each child before vaccination (without pain) and during the procedure (experiencing pain), and the difference in pain scores was statistically significant (Wilcoxon signed rank test; P < 0.001). Content validity (by expert review) was very good. Conclusions: Based on the results obtained, we can infer that CHIPPS is a valid and reliable tool for Brazilian children aged 0 to 5 years old. ?     

Assessment of pain,depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis

Assessment of pain, depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis Visual analogue scales (VAS) of depression and anxiety were compared with standard full-length measures of these variables and with VAS of pain (VAS Pain). This was a good way to develop a practical methodology for the routine assessment of pain and affect in rheumatoid arthritis (RA) patients. The reliability of VAS Pain was studied by test-retest. The validity of VAS Pain in our sample was proved by correlations with the results of other tests. We also investigated the relationship between VAS Pain and C-reactive protein (CRP). In 145 female RA patients, VAS of depression and anxiety were significantly correlated with full-length measures of these variables, and accounted for the majority of the explained variance in VAS Pain, while the full-length standard measures contributed little more. In conclusion, VAS measurements of pain and affect were comprehensible, easily filled-out, and reliable in a sample of Japanese women with RA, and could capture some aspect of affective distress unique to RA patients.     

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.     

Measuring the Pain Area: An Intra‐ and Inter‐Rater Reliability Study Using Image Analysis Software

Pain drawings have frequently been used for clinical information and research. The aim of this study was to investigate intra‐ and inter‐rater reliability of area measurements performed on pain drawings. Our secondary objective was to verify the reliability when using computers with different screen sizes, both with and without mouse hardware. Pain drawings were completed by patients with chronic neck pain or neck–shoulder–arm pain. Four independent examiners participated in the study. Examiners A and B used the same computer with a 16‐inch screen and wired mouse hardware. Examiner C used a notebook with a 16‐inch screen and no mouse hardware, and Examiner D used a computer with an 11.6‐inch screen and a wireless mouse. Image measurements were obtained using GIMP and NIH ImageJ computer programs. The length of all the images was measured using GIMP software to a set scale in ImageJ. Thus, each marked area was encircled and the total surface area (cm²) was calculated for each pain drawing measurement. A total of 117 areas were identified and 52 pain drawings were analyzed. The intrarater reliability between all examiners was high (ICC = 0.989). The inter‐rater reliability was also high. No significant differences were observed when using different screen sizes or when using or not using the mouse hardware. This suggests that the precision of these measurements is acceptable for the use of this method as a measurement tool in clinical practice and research.     

State Versus Trait: Validating State Assessment of Child and Parental Catastrophic Thinking About Children's Acute Pain

Pain catastrophizing has emerged as one of the most robust predictors of child pain outcomes. Although assessments of state (ie, situation-specific) pain catastrophizing in children and parents are often used, their psychometric properties are unknown. This study aimed to assess factor structure, reliability, and predictive validity of state versions of Pain Catastrophizing Scales for children and parents relative to corresponding trait versions for child and parental pain-related outcomes. Data were pooled from 8 experimental pain studies in which child and/or parent state catastrophizing (measured immediately before application of a pain stimulus) and trait catastrophizing were assessed in community-based samples of children aged 8 to 18 years (N = 689) and their parents (N = 888) in Dutch or English. Exploratory factor analyses were conducted to examine the underlying factor structure of the state versions of the Pain Catastrophizing Scale for parents/children, revealing a single factor solution that explained 55.53% of the variance for children and 49.72% for parents. Hierarchical linear regression analyses were used to examine relative influence of state versus trait catastrophizing on child and parent pain-related outcomes. Child and parent state catastrophizing were significantly associated with child pain intensity, child state anxiety and parental distress. State catastrophizing scores showed stronger associations than trait scores for most outcomes.