A systematic review of the pain scales in adults: Which to use?

Objective

The study analysed the Visual Analogue Scale (VAS), the Verbal Rating Scale (VRS) and the Numerical Rating Scale (NRS) to determine: 1. Were the compliance and usability different among scales? 2. Were any of the scales superior over the other(s) for clinical use?

Scoring systems in acute pancreatitis: Which one to use in intensive care units?

Purpose

The aim of the study was to assess and compare the efficacy of various scoring systems in predicting the severity and outcome of patients with acute pancreatitis (AP) admitted in intensive care unit (ICU).

Methods

Prospective, single institution review of 55 consecutive AP patients admitted in ICU during a 2-year period. Disease severity scores and mortality predictions were calculated using the collected data in the first 48 hours of ICU admission for Ranson and Glasgow scores and in the first 24 hours for other scores.

Results

Forty-two patients (76.4%) developed severe pancreatitis. Intensive care unit and 30-day mortality was 18.2% and 27.3%, respectively. Use of mechanical ventilation (MV) was an independent predictor of outcome on multivariate analysis with lack of MV being protective (adjusted odds ratio, 0.003; 95% confidence interval [CI], 0.00001-0.67; P = .04). All scoring systems had comparable accuracy in predicting severity and 30-day mortality, but sequential organ failure assessment (SOFA) score had greater efficacy with its area under curve for predicting severity and 30-day mortality being 0.81 (95% CI, 0.69-0.92) and 0.93 (95% CI, 0.85-0.99), respectively. Sensitivity and specificity (SOFA score, >4) was 76.2% and 69.2%, respectively, for predicting severity, and sensitivity and specificity (SOFA score, >8) was 86.7% and 90%, respectively, for predicting 30-day mortality.

Conclusions

Use of MV is an independent predictor of outcome in AP patients admitted to ICU. Although all scoring systems had reliable accuracy in predicting severity and outcome, SOFA score performed better with additional advantages of easy applicability and timely assessment.     

Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature

OBJECTIVES: The chest pain observation unit (CPOU) has been developed in the United States to allow rigorous assessment of patients presenting with chest pain, thus expediting their discharge if assessment is negative. This review aims to examine the evidence for effectiveness and economic efficiency of the CPOU and to explore whether data from the United States can be extrapolated to the UK. METHOD: Search of the literature using Medline and critical appraisal of the validity of the data. RESULTS: Five studies comparing outcomes of CPOU care with routine practice showed no significant difference in objective measures including mortality or missed pathology. Eleven studies described outcomes of a cohort of CPOU patients. Follow up was comprehensive and demonstrated no clinically significant evidence of missed pathology. Nine studies comparing CPOU costs with routine care demonstrated impressive cost savings that were more modest when randomised comparisons were made. CONCLUSION: CPOU care is safe and costs are well defined. There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK.     

Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature

Objectives—The chest pain observation unit (CPOU) has been developed in the United States to allow rigorous assessment of patients presenting with chest pain, thus expediting their discharge if assessment is negative. This review aims to examine the evidence for effectiveness and economic efficiency of the CPOU and to explore whether data from the United States can be extrapolated to the UK.

Method—Search of the literature using Medline and critical appraisal of the validity of the data.

Results—Five studies comparing outcomes of CPOU care with routine practice showed no significant difference in objective measures including mortality or missed pathology. Eleven studies described outcomes of a cohort of CPOU patients. Follow up was comprehensive and demonstrated no clinically significant evidence of missed pathology. Nine studies comparing CPOU costs with routine care demonstrated impressive cost savings that were more modest when randomised comparisons were made.

Conclusion—CPOU care is safe and costs are well defined. There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK.

     

Effects of meditation on pain intensity,physical function,quality of life and depression in adults with low back pain – A systematic review with meta-analysis

BackgroundLow back pain (LBP) is a common biopsychosocial health problem. Meditation may provide a complementary treatment option for LBP patients.ObjectivesThe aim of this systematic review with meta-analysis was to examine the effects of meditation on pain intensity, functional disability, quality of life, and depression in LBP populations.MethodsThis systematic review was conducted according to the PRISMA Guidelines. PubMed, Web of Science, CENTRAL, CamQuest and PubPsych were searched up to a publication date of June 2020. Inclusion criteria were RCTs or non-RCTs with LBP patients, aged at least 18 years, the application of a specific meditation technique, and pain intensity and/or functional disability as outcomes. Pooled SMDs were calculated at post-treatment and follow up. The Cochrane risk-of-bias tool was used to estimate risk of bias. The overall quality of evidence was assessed using the GRADE approach.Results12 studies with a total of 1005 participants were included in this review. Compared to controls, meditation solely showed a significant positive effect on pain intensity (SMD = −0.27 [CI −0.43; −0.11]; p = 0.001; based on 10 studies with 934 participants) and physical quality of life (SMD = 0.21 [CI 0.07; 0.36]; p = 0.005; based on 5 studies with 756 participants) at post-treatment. At follow up (mean 20 weeks, range 4–52) there were no significant effects anymore. The quality of the evidence was moderate due to study limitations and imprecision.ConclusionsMeditation seems to be promising with regard to reducing short-term pain intensity in patients with LBP. However, additional well-designed and large trials are required in order to draw more reliable conclusions.     

Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis

BackgroundA growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined.ObjectivesThe aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain.MethodsFor this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsMeta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain.ConclusionsMovement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.     

The patient and their family’s perspectives on agitation and its management in adult critical care: A qualitative study

BackgroundAgitation is frequently experienced by patients during critical illness, this is distressing for both the patient and their family. In addition, an acute episode of agitation can create management dilemmas for clinical teams. What is not understood is the patient and family’s perspective of agitation and any subsequent management strategies employed.ObjectiveTo understand the perspectives of patients and family members on the experience of agitation in adult critical care.MethodAn interpretive qualitative study using semi-structured interviews was undertaken with 13 participants, patient participants (n = 7) with the mean critical care length of stay 59 days (±70.88 days). Family members (n = 6) all opted to be interviewed with the patient present.FindingsThree themes generated from the data: 1) The recollection of sensations and delusions. 2) Communication and its impact. 3) Managing agitation, what helped and what did not.ConclusionThe presence of family members has a positive effect on the patient during episodes of agitation. Their involvement in care requires promotion.     

Cancer pain management in ambulatory care: can we link assessment and action to outcomes?

Purpose  

Good cancer pain control requires appropriate assessment and treatment. The purpose of this study was to examine the relationships among physician, nurse practitioner, and nurse knowledge, documentation of assessment, treatment, and pain reduction in cancer patients seen in ambulatory settings.     

Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature)

RATIONALE, AIMS AND OBJECTIVES: The burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care. Identifying appropriate quality measures is the first step in this direction. We identified process measures currently available to assess the quality of diagnosis and management of CRC. We also evaluated the extent to which these measures are ready to be implemented in clinical practice, and identified areas for future research. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, and relevant grey literature. We identified 3771 abstracts and reviewed 74 articles that included quality measures for diagnosis or management of CRC. Measures from traditional quality improvement literature, and from epidemiological and other studies that included quality measures as part of their research agenda, were considered. In addition, we devised a summary rating scale (IST) to appraise the extent of a measure's importance and usability, scientific acceptability and extent of testing. RESULTS: The coverage of general process measures in CRC is extensive. Most measures are important, but need to be developed and field-tested. The best available measures relate to pathology and chemotherapy. No measures are available for assessing quality of management of stage IV rectal cancer and hepatic metastasis; chemotherapy for stage II colon cancer; and procedure notes. CONCLUSIONS: There is an urgent need to refine existing measures and to develop scientifically accurate quality measures for a comprehensive assessment of the quality of CRC care. The role of the federal government and professional societies is critical in pursuing this goal.     

Compliance with US asthma management guidelines and specialty care: a regional variation or national concern?

The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eight health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross-sectional survey in a managed care environment. The participants were 6703 respondents (ages 14–65) with moderate or severe asthma. The main outcome measures were compliance with the NAEP guidelines on the use of inhaled steroids, inhaled beta₂-agonists, peak flow measurement, and allergy evaluations. Among the results of this survey we found that although these health plans are located from the West Coast to the East Coast and the socioeconomic status of their members varied greatly, compliance with the NAEP guidelines was low among asthmatic members across all geographical regions. The major areas of low compliance identified were inappropriate pharmacological therapy, lack of objective measurement of lung function through peak flow meter, and insufficient environmental trigger control. The regression analyses indicated that the effect of the health plan explained little of the variation in compliance across these regions (only 0.3% at maximum). Low compliance was associated with young age, smoking, moderate asthma, being asthmatic for a few years, currently working, and being treated by a generalist rather than a specialist. In conclusion, this study showed that the compliance with the national guidelines for asthma care was consistently low across different geographical regions in the nation. Improvement in care for asthmatics will require greater commitment and involvement by all stakeholders including physicians, patients, health plans, and employers. We suggest a need for a national strategy to disseminate clinical guidelines not only to the medical community but also to patients themselves.     

Is adherence to pain self‐management strategies associated with improved pain,depression and disability in those with disabling chronic pain?

There is generally good evidence that pain management interventions that include self‐management strategies can substantially reduce disability and improve psychological well‐being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear‐avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self‐management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self‐management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3‐week cognitive‐behavioural pain management program. The post‐treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear‐avoidance beliefs, and increased pain self‐efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self‐management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self‐management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear‐avoidance and pain self‐efficacy beliefs.     

Making pain assessment more accessible to children and parents: can greater involvement improve the quality of care?

OBJECTIVES: To determine whether nursing and parental pain assessment documentation and analgesia administration increased with the use of a temporary tattoo of a pain intensity scale (TTPS) compared with a paper version of the pain scale (PPS). To document any adverse skin reactions from the use of the TTPS and to assess the feasibility and acceptability of the PPS and TTPS for use as postoperative pain assessment tools in the home and clinical setting. METHODS: Two pilot randomized controlled trials were conducted to test the TTPS intervention and the PPS control condition in children aged 6 to 12 years, after surgery. Trial 1 involved children admitted to hospital for planned inpatient surgery (n=86). Trial 2 involved children discharged home following day case surgery (n=25). RESULTS: The TTPS was well accepted and there were no adverse effects. Our hypothesis that the TTPS would increase documentation of pain assessment or analgesic administration was not supported. However, a number of confounding factors may explain the findings. Children in both trials indicated greater overall satisfaction with the TTPS and responses from both parents and children suggested some aspects of the quality of the pain management experience were enhanced with use of the TTPS in both trials. DISCUSSION: The TTPS is a new method to engage children in pain assessment, which may have positive effects on the quality of postoperative pain assessment and management in hospital and home settings. Larger trials are needed to determine the effectiveness of the TTPS across all pediatric settings and for children with nonsurgical and also surgical pain. The findings from these pilot trials provide useful information for design and power estimation for further research in inpatient and home settings.     

Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain?: Psychosocial factors related to severe low back pain

BackgroundLow back pain (LBP) is a global public health issue. Psychosocial factors are linked to LBP. However, there is a lack of knowledge about the relation of psychosocial factors to clinical outcomes of patients with severe LBP.ObjectiveTo investigate the relationship between specific psychosocial factors with severe pain and functional limitation of patients with LBP.MethodsA cross-sectional study of 472 participants with LBP was conducted. Participants completed self-reported questionnaires, including psychosocial factors, characteristics of pain, and functional limitations. Two multivariable logistic regression models were performed with severe pain intensity (≥ 7 out of 10) and functional limitation (≥ 7 out of 10) (dependent variables) and 15 psychosocial factors (independent variables).ResultsOne hundred twenty-five (26.5%) participants had severe LBP. Patients with catastrophising symptoms were 2.21 [95%Confidence Interval (CI): 1.30, 3.77] times more likely to have severe pain and 2.72 (95%CI: 1.75, 4.23) times more likely to have severe functional limitation than patients without catastrophising symptoms. Patients with maladaptive beliefs about rest were 2.75 (95%CI: 1.37, 5.52) times more likely to present with severe pain and 1.72 (95%CI: 1.04, 2.83) times more likely to have severe functional limitation. Patients with kinesiophobia were 3.34 (95%CI: 1.36, 8.24) times more likely to present with severe pain, and patients with social isolation were 1.98 (95%CI: 1.25, 3.14) times more likely to have severe functional limitation.ConclusionCatastrophising, kinesiophobia, maladaptive beliefs about rest, and social isolation are related to unfavourable clinical outcomes of patients with LBP.     

Are neck pain scales and questionnaires compatible with the international classification of functioning,disability and health? A systematic review

Purpose.?To identify neck-pain-specific questionnaires and scales that measure functioning and disability and assess whether their contents are comparable to the international classification of functioning, disability and health (ICF).

Methods.?A systematic search was conducted in LILACS, MEDLINE, CINAHL, and SPORTSDISCUS databases, identifying questionnaires and scales used to assess neck-related functioning and disability from 1966 to November 2007. Each item of each scale or questionnaire was extracted and classified according to the ICF categories.

Results.?The databases yielded a total of 888 articles, of which seven questionnaires were identified and included in the review. A total of 74 items were analyzed, 27 linked to body function, 46 to activities and participation, 1 to environmental factors, and 5 to non-classified items. While the pain disability index tends to focus on limitations to body functions, the functional rating index and the Copenhagen neck functional disability scale appear to be limited to measuring activity. Three questionnaires (the neck Bournemouth Questionnaire, the neck disability index, and the neck pain and disability scale) have demonstrated a well-balanced distribution of items across the ICF components.

Conclusion.?Most identified questionnaires reflect limitations or restrictions in one component only. These results provide valuable information on the content quality of these questionnaires for health-care providers and researchers.