scholarly journals Prospective Study Evaluating a Pain Assessment Tool in a Postoperative Environment: Protocol for Algorithm Testing and Enhancement

10.2196/17783 ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. e17783
Author(s):  
Emad Kasaeyan Naeini ◽  
Mingzhe Jiang ◽  
Elise Syrjälä ◽  
Michael-David Calderon ◽  
Riitta Mieronkoski ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Elective Surgery ◽  
Electrodermal Activity ◽  
Vital Signs ◽  
Assessment Tools ◽  
Second Phase ◽  
Moderate Pain ◽  
Management Interventions

Background Assessment of pain is critical to its optimal treatment. There is a high demand for accurate objective pain assessment for effectively optimizing pain management interventions. However, pain is a multivalent, dynamic, and ambiguous phenomenon that is difficult to quantify, particularly when the patient’s ability to communicate is limited. The criterion standard of pain intensity assessment is self-reporting. However, this unidimensional model is disparaged for its oversimplification and limited applicability in several vulnerable patient populations. Researchers have attempted to develop objective pain assessment tools through analysis of physiological pain indicators, such as electrocardiography, electromyography, photoplethysmography, and electrodermal activity. However, pain assessment by using only these signals can be unreliable, as various other factors alter these vital signs and the adaptation of vital signs to pain stimulation varies from person to person. Objective pain assessment using behavioral signs such as facial expressions has recently gained attention. Objective Our objective is to further the development and research of a pain assessment tool for use with patients who are likely experiencing mild to moderate pain. We will collect observational data through wearable technologies, measuring facial electromyography, electrocardiography, photoplethysmography, and electrodermal activity. Methods This protocol focuses on the second phase of a larger study of multimodal signal acquisition through facial muscle electrical activity, cardiac electrical activity, and electrodermal activity as indicators of pain and for building predictive models. We used state-of-the-art standard sensors to measure bioelectrical electromyographic signals and changes in heart rate, respiratory rate, and oxygen saturation. Based on the results, we further developed the pain assessment tool and reconstituted it with modern wearable sensors, devices, and algorithms. In this second phase, we will test the smart pain assessment tool in communicative patients after elective surgery in the recovery room. Results Our human research protections application for institutional review board review was approved for this part of the study. We expect to have the pain assessment tool developed and available for further research in early 2021. Preliminary results will be ready for publication during fall 2020. Conclusions This study will help to further the development of and research on an objective pain assessment tool for monitoring patients likely experiencing mild to moderate pain. International Registered Report Identifier (IRRID) DERR1-10.2196/17783

scholarly journals Prospective Study Evaluating a Pain Assessment Tool in a Postoperative Environment: Protocol for Algorithm Testing and Enhancement (Preprint)

2020 ◽  
Author(s):  
Emad Kasaeyan Naeini ◽  
Mingzhe Jiang ◽  
Elise Syrjälä ◽  
Michael-David Calderon ◽  
Riitta Mieronkoski ◽  
...  
Keyword(s):  
Electrical Activity ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Elective Surgery ◽  
Electrodermal Activity ◽  
Vital Signs ◽  
Assessment Tools ◽  
Second Phase ◽  
Moderate Pain ◽  
Management Interventions

BACKGROUND Assessment of pain is critical to its optimal treatment. There is a high demand for accurate objective pain assessment for effectively optimizing pain management interventions. However, pain is a multivalent, dynamic, and ambiguous phenomenon that is difficult to quantify, particularly when the patient’s ability to communicate is limited. The criterion standard of pain intensity assessment is self-reporting. However, this unidimensional model is disparaged for its oversimplification and limited applicability in several vulnerable patient populations. Researchers have attempted to develop objective pain assessment tools through analysis of physiological pain indicators, such as electrocardiography, electromyography, photoplethysmography, and electrodermal activity. However, pain assessment by using only these signals can be unreliable, as various other factors alter these vital signs and the adaptation of vital signs to pain stimulation varies from person to person. Objective pain assessment using behavioral signs such as facial expressions has recently gained attention. OBJECTIVE Our objective is to further the development and research of a pain assessment tool for use with patients who are likely experiencing mild to moderate pain. We will collect observational data through wearable technologies, measuring facial electromyography, electrocardiography, photoplethysmography, and electrodermal activity. METHODS This protocol focuses on the second phase of a larger study of multimodal signal acquisition through facial muscle electrical activity, cardiac electrical activity, and electrodermal activity as indicators of pain and for building predictive models. We used state-of-the-art standard sensors to measure bioelectrical electromyographic signals and changes in heart rate, respiratory rate, and oxygen saturation. Based on the results, we further developed the pain assessment tool and reconstituted it with modern wearable sensors, devices, and algorithms. In this second phase, we will test the smart pain assessment tool in communicative patients after elective surgery in the recovery room. RESULTS Our human research protections application for institutional review board review was approved for this part of the study. We expect to have the pain assessment tool developed and available for further research in early 2021. Preliminary results will be ready for publication during fall 2020. CONCLUSIONS This study will help to further the development of and research on an objective pain assessment tool for monitoring patients likely experiencing mild to moderate pain. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17783

Adoption of a Pain Assessment Tool in Older Homebound Patients With Dementia in a Housecall Practice: A Dissemination Study

2012 ◽  
Vol 5 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Jean-Claude K. Provost
Keyword(s):  
Older Adults ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Selection Process ◽  
Pain Scale ◽  
Assessment Tools ◽  
Advanced Dementia ◽  
Pain Diagnosis

This article describes the steps of a pilot dissemination study toward adopting a pain assessment tool for older homebound adults with dementia. The chosen practice site had not previously used adequate pain assessment tools for older adults with dementia. After the selection process by a pain assessment tool committee, providers (N = 20) were asked to choose between three tools: pain assessment in advanced dementia (PAINAD), the Abbey Pain Scale, and DOLOPLUS-2/ DOLOSHORT. Providers voted to use the PAINAD (54%) for the following 2 weeks. A preintervention audit showed that without the use of a pain assessment tool, 97.7% of the charts did not have any documentation of a pain diagnosis nor an intervention. Postintervention using PAINAD, 91.3% of the charts had both (χ2[1] = 18.645, p < .001). The feedback obtained from providers (n = 10) after 2 weeks of testing the tool was unanimously positive. Many providers reported increased confidence in identifying pain and some changed their practice by placing pain assessment in the forefront of their encounter with their older clients with dementia. PAINAD was adopted as the pain assessment tool for this practice.

scholarly journals Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

2018 ◽  
Vol 7 (4) ◽  
pp. e000304 ◽  
Author(s):  
Mairi Mascarenhas ◽  
Michelle Beattie ◽  
Michelle Roxburgh ◽  
John MacKintosh ◽  
Noreen Clarke ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Assessment ◽  
Best Practice ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Self Report ◽  
Process Measures ◽  
Adult Intensive Care Unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

scholarly journals N-PASS Versus mPAT in Assessment and Management of Neonatal Pain at Neonatal ICUs in Palestine

2019 ◽  
Vol 4 (06) ◽  
Author(s):  
Khamis Elessi ◽  
Shireen Abed ◽  
Tayseer Jamal Afifi ◽  
Rawan Utt ◽  
Mahmood Elblbessy ◽  
...  
Keyword(s):  
Pain Score ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Disease Process ◽  
Reliability And Validity ◽  
Internal Consistency Reliability ◽  
Assessment Tools ◽  
Therapeutic Interventions ◽  
P Value ◽  
Neonatal Pain

Background: Neonates frequently experience pain as a result of diagnostic or therapeutic interventions or as a result of a disease process. Neonates cannot verbalize their pain experience and depend on others to recognize, assess and manage their pain. Neonates may suffer immediate or long-term consequences of unrelieved pain. Accurate assessment of pain is essential to provide adequate management. Observational scales, which include physiological and behavioral responses to pain, are available to aid consistent pain management. Pain assessment is considered as the fifth vital sign. Objectives: Aims of the present study were (1) to compare two commonly cited neonatal pain assessment tools, Neonatal Pain, Agitation and Sedation Scale (N-PASS) and modified Pain Assessment Tool (mPAT), with regard to their psychometric qualities, (2) to explore intuitive clinicians' ratings by relating them to the tools' items and (3) to ensure that neonates receive adequate pain control. Methods: Two coders applied both pain assessment tools to 850 neonates while undergoing a painful or a stressful procedure. Each neonate was assessed before, during and after the procedure. The evaluation before and after the procedure was done using NPASS, while pain score during the procedure was assessed by mPAT. Analyses of variances and regression analyses were used to investigate whether tools could discriminate between the procedures and whether tools' items were predictors of pain severity. Results: Internal consistency, reliability and validity were high for both assessment tools. N-PASS tool discriminated between painful and stressful situations better than mPAT. There was no relation between the age of neonate and the pain score. Moreover, P-value was statistically significant between mPAT score and post procedural assessment score as well as between pre and post procedural assessment scores. Conclusion: Both assessment tools performed equally well regarding physiologic parameters. However, N-PASS makes it possible to assess pain during sedation. It was noticed that gaps exist between practitioner knowledge and attitude regarding neonatal pain.

scholarly journals Pain Assessment Tool with Electrodermal Activity for Post-Operative Patients: A Method Validation Study (Preprint)

10.2196/25258 ◽  
2020 ◽  
Author(s):  
Seyed Amir Hossein Aqajari ◽  
Rui Cao ◽  
Emad Kasaeyan Naeini ◽  
Michael-David Calderon ◽  
Kai Zheng ◽  
...  
Keyword(s):  
Method Validation ◽  
Validation Study ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Electrodermal Activity

Putting the plain into pain language in English for Medical Purposes: Learner inquiry into patients’ online descriptive accounts

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Anna Franca Plastina
Keyword(s):  
Medical Care ◽  
Support Groups ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Pedagogical Practice ◽  
Plain Language ◽  
Pain Education ◽  
Pain Communication ◽  
Pain Descriptors

AbstractThe need to teach medical students plain language for their future engagement in pain communication can no longer be underestimated. Pain education has traditionally neglected the teaching of pain language, yet patients’ descriptive accounts have been acknowledged as the standard in medical care. English for Medical Purposes (EMP) can make its contribution to tertiary pain education, especially at a time when the plain language paradigm is considered key for health literacy. This is not to say that teaching specialized language and plain language for specific purposes are mutually exclusive. Yet, developing EMP learners’ understanding of the use of authentic plain pain language is also crucial for their future professional practice. This study reports on a pedagogical experiment conducted with the aim of enhancing EMP learners’ understanding of the lexico-grammatical features of pain language in patients’ descriptive accounts and in the use of pain assessment tools. The experiment was framed by the Hallidayan lexico-grammatical model of pain. Following a data-driven learning approach, students compiled a small DIY corpus of accounts from online health support groups and exploited its direct use through corpus-based tasks. These were designed to facilitate learners’ understanding of the features of pain language and of patients’ use of pain descriptors related to those in the McGill Pain assessment tool currently employed in medical care. Learners further broadened their understanding of pain language in other contexts of use while taking notes to fulfil the designed tasks. These helped shed light on the pedagogical practice here proposed.

CRIES: A Neonatal Postoperative Pain Measurement Score

2018 ◽  
pp. 263-267
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Assessment ◽  
Reliable Method ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Neonatal Pain ◽  
Reliable Assessment ◽  
Assessment And Treatment ◽  
Neonatal Population

This case focuses on neonatal pain management by asking the question: Is the CRIES score a valid and reliable method for assessing neonatal postoperative pain? Regular pain assessment and treatment in the neonatal population are important postoperatively. The CRIES scale was designed to measure pain in the neonatal population, and this study demonstrated CRIES to be a valid and reliable assessment tool for identifying postsurgical pain in neonates. Multiple pain assessment tools, including CRIES, are available for use in neonatal patients and in patient populations who are otherwise unable to verbalize discomfort.

scholarly journals MP42: Validation of the Stoplight Pain Scale tool in the Canadian emergency setting

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S55-S56
Author(s):  
S. Shwetz ◽  
E. Morrison ◽  
A. Drendel ◽  
M. Yaskina ◽  
M. Rajagopal ◽  
...  
Keyword(s):  
Family Involvement ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Pain Treatment ◽  
Pain Scale ◽  
Assessment Tools ◽  
Future Research ◽  
Kappa Statistics ◽  
Emergency Setting ◽  
Direct Guidance

Introduction: Introduction: A variety of pain assessment tools exist for children, however none of the current scales were created specifically for family use. Further, none provide direct guidance with regards to pain treatment threshold. This study aimed to validate a novel, three faced, coloured coded (red, yellow, green), family-friendly pain tool, the Stoplight Pain Scale, by comparing it to the widely accepted and validated Faces Pain Scale-Revised (FPS-R). This novel tool has the capability to guide families with regards to treatment, as well as measure pain. Methods: Methods: A prospective observational cohort study was conducted at the Stollery Childrens Hospital emergency department (ED) (Edmonton, Alberta) from November, 2014 to February, 2017. Demographic information was collected, and patients (3-12 years) and their caregivers were asked to rate their pain using the novel Stoplight Pain Scale as well as the FPS-R. Pain was measured at presentation to the ED, immediately following painful procedures, and thirty minutes after analgesia administration. Patients and their caregivers also indicated their preferred scale for assessing pain. Results: Results: A purposeful random sample of 227 patients were included for analyses; 61/227 (26.9%) of patients were 3-5 years old and 166/227 (73.1%)were 6-12 years old. 53/227 (23.3%) of patients had been previously hospitalized. Correlation between the two pain scales was consistently fair to moderate; using Kappa Statistics, a baseline correlation for Stoplight and FPS-R was fair for both caregivers (0.38, 95% CI 0.28 0.48) and patients (0.36 95% CI 0.27-0.45). The Stoplight Pain Scale had fair to moderate correlation between caregiver and patient scores, (0.37, 95% CI 0.27-0.47), compared to FPS-R which showed poor to fair agreement between caregiver and child scores (0.20, 95% CI 0.12-0.29). Regardless of age or hospitalization status, 64% of patients (139/218) and 54% caregivers (118/220) preferred the Stoplight Pain scale (p=0.001). Conclusion: Conclusions: The Stoplight Pain Scale correlates moderately well with FPS-R, a validated pain assessment tool for children and shows good correlation between patients and caregivers assessment of reported pain. The Stoplight Pain Scale is a simple, easy to administer tool that may have a role in empowering family involvement in ED pain management. Future research should focus on at-home study of the tool.

scholarly journals Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Liam Rooney
Keyword(s):  
Pain Assessment ◽  
Rating Scale ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Reliability And Validity ◽  
Pain Scale ◽  
Assessment Tools ◽  
Self Report ◽  
Good Reliability ◽  
Dementia Patients

<p><span style="text-decoration: underline;"><strong>Background</strong></span></p><p>Dementia is a disease affecting 55,000 Irish people. (1)  It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent.  These people are at risk of having their pain underassessed and undermanaged. (2)  A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed.  Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.</p><p><span style="text-decoration: underline;"><strong>Introduction</strong></span></p><p>Adults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3)  It is estimated between 40% and 80% of dementia patients regularly experience pain. (4)  Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients &gt;8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants.  There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.</p><p><span style="text-decoration: underline;"><strong>Objective</strong></span></p><p>This research aimed to identify observational pain assessment tools used in this cohort.  The most consistently recommended tools were identified.  The suitability of these tools for use in the pre-hospital setting assessed.</p><p><span style="text-decoration: underline;"><strong>Findings</strong></span></p><p>Literature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting.  The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language.  These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:</p><p><em>Abbey Pain Scale</em></p><p>6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)</p><p><em>Doloplus 2</em></p><p>15 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)</p><p><em>PAINAD</em></p><p>5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6)</p><p> </p><p><span style="text-decoration: underline;"><strong>Conclusion</strong></span></p><p>The ability to self report pain is deemed “gold standard”.  Patients with mild to moderate disease, and indeed, some with severe disease, may retain the ability to self report.  An observational tool is required when dementia has progressed to the point where the patient becomes unable to self report or becomes non-verbal.  It is in these patients where undetected, misinterpreted or inaccurate assessment of pain becomes frequent. (7)  The aim of any tool is to gain a good assessment of pain, however, the pain scale used should be suitable to the clinical setting.  The feasibility of an assessment tool is an important factor along with reliability and validity.  No one assessment tool could be recommended over another.  Abbey and PAINAD have potential for use pre-hospital, however, further research, clinical evaluation and trial in an ambulance service is required.</p>

scholarly journals Patients' perspectives on methods of assessing pain

2020 ◽  
Vol 46 (2) ◽  
Author(s):  
Allison Catherine Verge ◽  
Karim Mukhida
Keyword(s):  
Pain Assessment ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Assessment Method ◽  
Assessment Tools ◽  
Tertiary Care Centre ◽  
Pain Evaluation ◽  
Art And Technology ◽  
Pain Clinics ◽  
Active Research

Pain questionnaires often serve as an assessment tool for initial  consultations in chronic pain clinics. The Pain Management Unit (PMU) is a tertiary care centre in Halifax, Nova Scotia. A number of clinicians in the PMU have noted that some patients express that questionnaires are time consuming to complete and believe they are not used in a manner that is helpful to their health care. The effectiveness of questionnaire-based pain evaluation is an area of active research. Text-heavy questionnaires have been criticized for their reliance on literacy and for the format’s inability to facilitate patient self-expression. Other methods of assessing pain have been suggested, including those that use pictograms, photographs and technology. This study was designed to gauge patients’ opinions on the current pain assessment method used in the PMU. In addition, it aimed to evaluate if incorporating art and technology appealed to current patients. The ultimate goal of this study was to evaluate if improvements could be made to patients’ pain assessment experience. Thirty patients were interviewed following their initial consultation appointments at the PMU. Interviews were transcribed verbatim and analyzed using NVivo Software to look for themes expressed by research participants. The study yielded a total of 20 different themes, such as repetition within the questionnaires, and the patient’s desire to incorporate different technologies such as an iPad or computer. Recommendations are proposed based on these themes to help guide the creation or modification of pain assessment tools. 

Sign in / Sign up

Export Citation Format

Share Document