Pain measurement: an overview

The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study. The advantages and limitations of both physiological and behavioral methods are discussed in each area, and subjective report procedures are evaluated in human laboratory and clinical areas. The need for procedures that bridge these areas is emphasized and specific issues are identified. Progress in the technology of pain measurement over recent decades is reviewed and directions for future work are suggested.     

The Foundations for Chronic Low Back Pain Management may Start in Early Life. Exploring the Role of Caregiver Parental Leave on Future Low Back Pain in the Offspring

Chronic low back pain is difficult to treat and despite increased spending on health services, clinical outcomes for people with low back pain have not improved. Innovative, large scale initiatives seem necessary to stem the cost of low back pain. Psychological health contributes to the development and persistence of chronic low back pain and psychological interventions are important in the management of low back pain. Given the contribution of psychological health to low back pain development and management, it raises the question; can we support psychological health in later life by bolstering emotional development in early life, and reduce the burden of this common condition? Positive early life experiences, including those induced by extended paid parental leave, could bolster emotional development and support the psychological health necessary to manage low back pain in later life. We present the current state of evidence demonstrating the potential value of increasing support for parent-child relationships in early life to reduce the burden of low back pain in future generations. The current evidence is limited to cross-sectional associations, but strong preclinical data clearly shows the potential negative impacts of maternal separation on rodent pup health that compels consideration in human populations.PerspectiveThe benefits stemming from enhanced child development include stable emotional foundations, possibly improving psychological health and low back pain management in the future. This perspective raises questions for future studies – within the context of low back pain, what ingredients bolster stable psychological health? And are these ingredients influenced by parental leave?     

Development and Implementation of an Online Pain Management Continuing Education Program

BackgroundMultiple studies indicate a lack of pain management training across a range of healthcare specialties. The online Joint Pain Education Program (OJPEP) was created to provide content covering various topics that range from general pain science to integrative care to pain management. The present study evaluates the feasibility of an interdisciplinary, self-guided, online pain management continuing education program, the OJPEP.Participants/SubjectsA total of 228 learners participted in this study. Of the 228 learners, 58 learners identified as registered nurses and 12 learners identified as nurse practitioners.DesignProspective single-arm education feasibility study.MethodsPotential learners were provided invitations to participate via emails from clinic leadership and postings to hospital intranet websites. Learners registered online and could select up to eight modules, based on the materials developed from a Department of Defense/Veterans Administration project. Learners evaluated their satisfaction with module quality and applicability.ResultsA variety of providers, predominately non-prescribers, across many health care specialties, registered for modules. Across all modules except one, less than half of participants who registered completed the selected module. Time stamps indicated many learners skipped module content. Of those who completed the continuing education evaluation to obtain certificates, the majority indicated the content was of high-quality, appropriate, and evidence-based. One-third to approximately one-half of learners indicated that they would apply content in their clinical practice. Completion of the intended 3-month follow-up survey was poor.ConclusionsThough modules were acceptable per learner responses, future work is needed to: develop modules that are more engaging (e.g., interactive) and applicable to learners; and improve implementation methods to include dissemination and evaluation metrics.     

Pain assessment: an interdisciplinary perspective

Pain is a very real problem affecting a large percentage of patients in home care settings. Pain has no mercy, and does not discriminate by age or condition. Although pain is often initiated by an organic condition (primary diagnosis), this trigger situation can produce multiple primary pain. Contrary to some common belief, medication or bed rest or reduction of physical activity is not always effective or indicated in some types of biomechanical pain, for example, neck, shoulder, low back, contractures. How people feel about themselves, how they see themselves fitting into the scheme of life as a purposeful and contributing member who has worth and value, has a powerful influence on how they perceive and manifest pain. When a person is allowed to work collaboratively with the interdisciplinary team in setting goals, compliance with treatment regimens is likely to be considerably higher. As health professionals we have a responsibility that we all take very seriously: to provide the best and most appropriate care for our patients. When working in collaboration with each other, this goal can be realized.     

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BackgroundPain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.AimExamine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.MethodsA sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.ResultsSignificant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).ConclusionsPatients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.     

Using Drink Size to Talk about Drinking during Pregnancy: Early Start Plus

Heavy drinking during pregnancy can cause birth defects and other alcohol-related effects. Because costs associated with fetal complications are high, health care organizations are invested in finding ways to intervene with pregnant drinkers. We describe a computerized intervention tested at prenatal clinics that uses drink size as a way of creating dialogue about pregnancy drinking. The intervention helps pregnant women screened as at-risk for alcohol use recognize how much they actually drink, using calibrated glassware and beverage containers along with computer graphics designed to define true volume for specific alcoholic beverage types. The intervention promotes abstinence; however, if that is not an obtainable goal, women are taught ways to cut down as much as possible during the rest of their pregnancy. Clinician feedback has been very positive, and the few women who continued to drink did not drink frequently or engage in binge drinking. Further, their average daily volume was 1 drink per day.     

The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

Background: Emergency department (ED) patients are frequently asked to provide a self‐report of the level of pain experienced using a verbal numeric rating scale. Objectives: To determine the effects of patient education regarding the verbal numeric rating scale on self‐reports of pain among ED patients. Methods: In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n= 155) or a novel print brochure (n= 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty‐five consecutive participants were enrolled as controls and received no educational intervention but gave a self‐reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education. Results: Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI =?0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful). Conclusions: Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self‐reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.     

Getting going with clinical supervision: an introductory seminar

Clinical supervision is an emerging force in nursing practice in the United Kingdom. However, much of the nursing literature suggests uncertainty with regards to what clinical supervision is and the resources needed for safe professional practice. This paper explores a method of introducing clinical supervision to nurses in such a way as to model the skills and competencies required for developing productive working relationships. The main recommendation of this paper is that procedures for introducing clinical supervision mirror qualities required for developing effective nursing relationships.     

Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland,UK

The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n = 97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn–Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.     

The Dartmouth Pain Questionnaire: an adjunct to the McGill Pain Questionnaire

The Dartmouth Pain Questionnaire is presented as an adjunct to the McGill Pain Questionnaire. It adds assessment of 4 objective measurements (pain complaints, somatic interventions, impaired functioning, and remaining positive aspects of function) and 1 subjective measure (changes in self-esteem since onset of pain). The entire device fits on one piece of paper and patients easily learn to self-administer it. Standardization results show acceptable levels of reliability and validity.     

Intravenous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain

Objective: To determine whether morphine affects evaluation or outcome for patients with acute abdominal pain.
Methods: Prospective, double-blind, placebo-controlled administration of morphine sulfate (MS) or normal saline (NS) in the setting of acute abdominal pain. The study was performed at a military ED with an annual census of 60, 000 visits. Patients ±18 years old who had abdominal pain for ± 48 hours were included. Patients who were allergic to MS or who had systolic blood pressures < 90 mm Hg were excluded. The physicians indicated a provisional diagnosis, a differential diagnosis, and a provisional disposition. Study solution was titrated to the patient's assessment of adequate analgesia (up to a volume equivalent of 20 mg of MS); pain response was monitored using a visual analog scale (VAS). The patients were followed until diagnosis occurred or symptoms resolved.
Results: Of 75 patients enrolled, 71 completed the study; 35 patients received MS and 36 received NS. More than half (44; 62%) of the patients were admitted from the ED: 28 patients underwent surgery. The VAS pain level improved more for the MS group, 3.9 2 2.8 cm, than it did for the NS group, 0.8 ± 1.5 cm (p < 0.01). Study solution dose was less in the MS group than it was in the NS group, 1.5 ± 0.5 mL vs 1.8 ± 0.4 mL (p <0.01). There was no difference between the groups when comparing accuracy of provisional or differential diagnosis with that of final diagnosis. Differences between provisional and actual dispositions were the same in all groups. There were 3 diagnostic or management errors in each group.
Conclusions: When compared with saline placebo, the administration of MS to patients with acute abdominal pain effectively relieved pain and did not alter the ability of physicians to accurately evaluate and treat patients. Key words: abdominal pain; analgesia; analgesics; emergency department; morphine; opiates; pain.     

Pain: an account of nurses' talk

This paper examines how nurses refer to pain and pam management in their talk The documentation of talk was established after engaging a group of five nurses in a series of in-depth unstructured interviews lastmg approximately 1 hour, in which they were encouraged to discuss their ideas regarding how postoperative pain should be managed, to render it more effective as an aspect of patient care However, the talk revealed that nurses tended to categorize patients according to symptoms or overt pain behaviours This essentially resulted in patients not being believed when they signalled that pam was becoming a distressing symptom The paper also discusses how nurses' knowledge regarding pain and pain management influences the way in which they manage postoperative pain