Pediatric pain assessment

Pain in children is frequently underrecognized or undertreated based on misconceptions and misjudgments about the experience of pain in this age group. The goal of pain assessment is to obtain sufficient and accurate data, depending on the developmental stage of the child. This information can come from questioning the child directly, including using pain rating scales, and evaluating physiological and behavioral changes. Assessing the emotional state of the family and caregivers is also crucial. Health care providers need to be persistent and thorough when evaluating pain in children and use this information to formulate and modify an appropriate treatment plan.     

乳头疼痛评估工具在临床中的应用现状

乳头疼痛是困扰女性工作、生活尤其是哺乳的常见问题,一直是相关领域关注和研究重点。运用适当工具进行乳头疼痛的定量评估,可以有效帮助医务人员进行针对性地诊疗、护理和健康教育。本文综述了目前应用于乳头疼痛评估的11种工具,从单维和多维两个层面对其在国内外临床中的应用现状进行总结,以期为临床研究、选择和开发乳头疼痛评估工具提供理论依据和实践指导。     

Low back pain disability assessment tools]

OBJECTIVES: To identify and compare low back pain functional assessment tools and to determine their characteristics and the selection criteria for their use. MATERIALS AND METHOD: We systematically searched Medline with the key words: low back pain, scale validity, questionnaire, assessment, outcome, and functional evaluation and with some data from the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation", which allowed us to complete the search on specific tools including the Roland Disability Questionnaire, Dallas Pain Questionnaire, Quebec Back Pain Questionnaire, and Oswestry Back Pain Questionnaire. We restricted our analysis to studies about the psychometric properties of functional tools. RESULTS: We identified 19 scales or questionnaires, 9 specifically for low back pain and with a concept of functional incapacity. Four tools are recognised as having good psychometric properties and are widely used with linguistic adaptations in different countries. We also identified 10 generic tools proposed to assess outcome in low back pain, which are more conceptually linked to perceived health status, quality of life, and pain assessment. CONCLUSION: A "gold standard" to evaluate disability in low back pain does not exist, but only 4 tools (the Dallas Pain Questionnaire, Roland Disability Questionnaire, Quebec Back Pain Disability Scale and Oswestry Low Back Pain Disability Questionnaire) demonstrated strong qualities (content and construct validity, feasibility, linguistic adaptation and international use).     

Pediatric pain assessment: trends and research directions

A number of methodologies to assess pain in children are available. These are analyzed from both a clinical and a research standpoint. Research related to factors influencing the response to pain, including age, developmental stage, gender, culture, prior experience, anxiety level, the painful stimulus, and the role of significant others, are reviewed. A range of pain assessment instruments are presented with consideration given to the indications for use, issues of reliability and validity, and practical concerns. The need for further research is defined, particularly in regard to children of ethnically diverse populations.     

Factors influencing the selection of appropriate pain assessment tools

Pain is one of the most complex human experiences. Nurses have a moral, ethical, humanitarian and professional responsibility to provide an adequate standard of pain assessment and documentation. In order to obtain an accurate pain assessment from patients, they need to feel that their expression of pain will be listened to, accepted and acted on. It is therefore vital that nurses are educated in the process of pain assessment.     

Postoperative pain assessment tools in day surgery: literature review

BACKGROUND: Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. AIM: This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. FINDINGS: A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. CONCLUSIONS: Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.     

ICU患者疼痛评估工具研究进展

疼痛是ICU患者的常见问题,有效的评估是疼痛管理的基础。由于镇静或其他原因,ICU患者的疼痛评估往往比较复杂。能获得患者主诉时可以使用主观疼痛评估工具,不能获得患者主诉时宜使用客观疼痛评估工具。本文就ICU患者常用的主观和客观疼痛评估工具进行综述,为完善ICU患者的疼痛评估和疼痛管理流程提供科学的依据。     

认知障碍病人疼痛评估工具研究进展

介绍了国外认知障碍病人疼痛评估工具研究进展,对痴呆病人疼痛评估工具和语言交流障碍病人疼痛评估工具进行了综述.     

认知障碍病人疼痛评估工具研究进展

介绍了国外认知障碍病人疼痛评估工具研究进展，对痴呆病人疼痛评估工具和语言交流障碍病人疼痛评估工具进行了综述。     

Pediatric nurses: the assessment and control of pain in preverbal infants

Pediatric nurses practicing in a children's hospital participated in this exploratory study investigating nurses' attitudes regarding postoperative pain in infants, including recognition of pain cues and strategies for pain management. Three instruments developed by us were used to obtain data: the Pain Questionnaire, a demographic and attitudinal profile; a self-directed videotape; and the Videotape Questionnaire, an interactive tool to obtain participant responses to videotaped vignettes of infants recovering from surgery. Three independent variables yielded significant results: critical care versus noncritical care nurses, agreement versus disagreement to administer pain medication to infants expected to have pain but not exhibiting pain behaviors, and classes on pediatric versus adult/pediatric pain since licensure. Noncritical care nurses, nurses agreeing to administer pain medication, and nurses attending pediatric pain classes recognized a greater number of cues on videotaped vignettes. Nurses attending pediatric pain classes administered more narcotics. Noncritical care nurses rated the pain experienced by the infants in the vignettes to be more severe compared with ratings made by critical care nurses.     

小儿疼痛与镇痛

从胎儿期开始,人体感知疼痛的中枢、末梢和传导系统就已形成,并且具备功能。目前对小儿疼痛的认识及其治疗方法的掌握都不尽人意。本文将从小儿疼痛的评估小儿常用镇痛方法及小儿常见疼痛的治疗等方面对小儿疼痛与镇痛加以综述。     

Clinical tools for the assessment of pain in sedated critically ill adults

Aim: This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice. Background: Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently. Search strategy: In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’. Conclusions: The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS). Implications for practice: The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.     

Pediatric poisonings: recognition, assessment, and management

Poisoning represents one of the most common medical emergencies encountered in young children in the United States, and accounts for a significant proportion of emergency room visits for the adolescent population. Poisoning is a significant and persistent cause of morbidity and mortality in children and adolescents. The scope of toxic substances involved in poisoning is broad, and requires health care providers to have an extensive knowledge of signs and symptoms of poisoning and specific therapeutic interventions and antidotes. Most children who ingest poisons suffer no harm; however, health care providers must recognize, assess, and manage those exposures that are most likely to cause serious injury, illness, or death and initiate appropriate management to minimize the physical injury that may occur.