scholarly journals Multicenter survey on emergency nurses’ perception of Numerical Rating Scale reliability at triage time in adult Emergency Department patients

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Gianfranco Cervellin ◽  
Ivan Comelli ◽  
Andrea Bellone ◽  
Fabrizio Giostra ◽  
Nicoletta Acierno ◽  
...  
Keyword(s):  
Pain Measurement ◽  
Pain Perception ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Central Italy ◽  
Reliability And Validity ◽  
Emergency Nurses ◽  
Multicenter Survey ◽  
Numerical Rating ◽  
Triage Time

Since pain perception is highly subjective and culturally mediated, its objective evaluation remains difficult. Nevertheless, pain measurement should ideally be a part of the assessment of patients in order to plan adequate pain relief. Several scales have been proposed for pain measurement, being the numerical rating scale (NRS) the most widely used, often at triage time. NRS have demonstrated acceptable reliability and validity, in post-operative medicine and in oncologic pain, but data in the Emergency Departments (EDs) are poor. The aim of this study is to evaluate the Emergency Nurses’ (ENs) perception about the reliability of NRS in the triage process. A questionnaire based on 11 items was designed and subsequently administered to a large number of ENs in several EDs in Northern and Central Italy. 301 questionnaires were filled out and returned. The majority declares using NRS scale to measure pain (item 2, mode = 4, mean = 3.8), and attributing priority code based on NRS value (item 3, mode = 4, mean = 3.4). In general, triage nurses believe that NRS is only indicative and that their judgement matters (item 4, mode = 4, mean = 3.2). The vast majority of triage nurses do believe that the patients will indicate a fake higher NRS value with the aim to get a more urgent code (item 5, mode = 5, mean = 4), while only a small minority expects that patients would underestimate their NRS for fear of penalizing more urgent patients. Very few believe that such scale underestimates the patients’ condition, while the majority is ambivalent about whether such scale overestimates it. In conclusion, NRS confirms to be a potentially valuable tool for pain evaluation at triage time, but many nurses express some doubts on its reliability, and will attribute the triage code mainly basing on their own judgement.

scholarly journals Observer trait anxiety is associated with response bias to patient facial pain expression independent of pain catastrophizing

2015 ◽  
Vol 20 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Joshua A Rash ◽  
Kenneth M Prkachin ◽  
Tavis S Campbell
Keyword(s):  
Response Bias ◽  
Trait Anxiety ◽  
Pain Perception ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Detection Methods ◽  
Top Down ◽  
Helping Behaviours ◽  
Numerical Rating

Nonverbal communication, such as facial expression, is an important component of the communication of pain to an observer. One factor that influences pain perception by an observer is characteristics specific to the observer themselves (ie, ‘top-down’ characteristics). The authors of this article aimed to assess how anxiety in the observer affects their ability to rate a sufferer’s pain, controlling for pain catastrophizing.BACKGROUND: Top-down characteristics of an observer influence the detection and estimation of a sufferer’s pain. A comprehensive understanding of these characteristics is important because they influence observer helping behaviours and the sufferer’s experience of pain.OBJECTIVES: To examine the hypothesis that individuals who score high in trait anxiety would perceive more intense pain in others, as indicated by a larger negative response bias, and that this association would persist after adjusting for pain catastrophizing.METHODS: Healthy young adult participants (n=99; 50 male) watched videos containing excerpts of facial expressions taken from patients with shoulder pain and were asked to rate how much pain the patient was experiencing using an 11-point numerical rating scale. Sensitivity and response bias were calculated using signal detection methods.RESULTS: Trait anxiety was a predictor of response bias after statistically adjusting for pain catastrophizing and observer sex. More anxious individuals had a proclivity toward imputing greater pain to a sufferer.CONCLUSIONS: Individuals scoring higher on trait anxiety were more likely to impute pain to a sufferer. Anxious caregivers may be better able to respond with appropriate intervention once pain behaviour is detected, or they may exacerbate symptoms by engaging in excessive palliative care and solicitous behaviour.

scholarly journals Measuring Pain Intensity in Elderly Patients

2021 ◽  
Vol 1 (2) ◽  
pp. 77-81
Author(s):  
Sasikaan Nimmaanrat
Keyword(s):  
Pain Intensity ◽  
Vital Sign ◽  
Pain Measurement ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Scale ◽  
Measurement Tool ◽  
Measurement Tools ◽  
Aging Populations ◽  
Numerical Rating

Pain intensity is considered as the fifth vital sign. However, it is the only vital sign which is subjective, with there being many pain measurement tools for adults to rate their level of pain. Additionally, there is an increasing number of aging populations throughout the world, and pain measurement in this group of people is challenging as geriatrics have both physical and cognitive impairment. The most frequently utilized pain measurement tools are; the Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS); and faces scales [Faces Pain Scale (FPS) and Faces Pain Scale-Revised (FPS-R) are the faces scales studied most often] tend to be valid for measuring pain severity in cognitively intact elderly. When problems arise, the VAS is the pain measurement tool found to have more difficulties (including higher rates of failure) than the other tools. In elderly with cognitive deficits, fewer difficulties tend to occur as the tools become simpler, with the most valid and useful tools in the following order: the FPS/FPS-R, the VRS, the 0-10 NRS, and the VAS. Furthermore, simpler pain measurement tools tend to be favored over more complicated tools. Keywords: aging; elderly; geriatrics; older; pain measurement; pain measurement tools

17-Italian Foot Function Index with numerical rating scale: Development, reliability, and validity of a modified version of the original Foot Function Index

The Foot ◽  
2015 ◽  
Vol 25 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Teresa Venditto ◽  
Lucrezia Tognolo ◽  
Rosaria Sabrina Rizzo ◽  
Cristina Iannuccelli ◽  
Luca Di Sante ◽  
...  
Keyword(s):  
Scale Development ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Reliability And Validity ◽  
Foot Function Index ◽  
Function Index ◽  
Numerical Rating ◽  
Foot Function

scholarly journals Conversion From Chronic to Episodic Migraine in Patients Treated With Erenumab: Real-life Data From an Italian Region

2020 ◽  
Author(s):  
Raffaele Ornello ◽  
Alfonsina Casalena ◽  
Ilaria Frattale ◽  
Valeria Caponnetto ◽  
Amleto Gabriele ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Central Italy ◽  
Real Life ◽  
Episodic Migraine ◽  
Headache Intensity ◽  
Acute Medication ◽  
Numerical Rating ◽  
Definition Of

Abstract BackgroundMost patients treated with erenumab in clinical practice have chronic migraine (CM). We assessed the rate and possible predictors of conversion from CM to episodic migraine (EM) in a real-life study.Main bodyWe performed a subgroup analysis of patients treated with erenumab from January 2019 to February 2020 in the Abruzzo region, central Italy. Treatment was provided according to current clinical practice. For the purpose of the present study, we included patients fulfilling the definition of CM for the three months preceding erenumab treatment and with at least 6 months of follow-up after treatment. We assessed the rate of conversion to EM from baseline to Months 4–6 of treatment and during each month of treatment. To test the clinical validity of conversion to EM, we also assessed the decrease in monthly headache days (MHDs), acute medication days, and median headache intensity on a Numerical Rating Scale (NRS). We included in our study 91 patients with CM. At Months 4–6, 62 patients (68.1%) converted from CM to EM; the proportion of converters increased from Month 1 to Month 5. In the overall group of patients, median MHDs decreased from 26.5 (IQR 20–30) to 7.5 (IQR 5–16; P < 0.001) compared with baseline, while median acute medication days decreased from 21 (IQR 16–30) to 6 (IQR 3–10; P < 0.001) and median NRS scores decreased from 8 (IQR 7–9) to 6 (IQR 4–7; P < 0.001). Significant decreases were found both in converters and in non-converters. We found no significant predictors of conversion to EM among the patients’ baseline characteristics.ConclusionsIn our study, two thirds of patients with CM converted to EM during 6 months of treatment with erenumab. MHDs, acute medication use, and headache intensity decreased regardless of conversion from CM to EM.

scholarly journals The measurement of pain - A brief review

1982 ◽  
Vol 38 (2) ◽  
pp. 34-37
Author(s):  
C. A. Liggins
Keyword(s):  
Pain Relief ◽  
Signal Detection ◽  
Pain Measurement ◽  
Signal Detection Theory ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Detection Theory ◽  
Subjective Measurement ◽  
Subjective Scale ◽  
Numerical Rating

Physiotherapists are now measuring pain when they assess their patients. Pain has been considered to be unmeasurable by some, but a number of subjective and objective methods have been devised. Subjective methods appear to be more satisfactory than objective methods. Several methods of subjective measurement are reviewed. Studies suggest that the Numerical Rating Scale (N.R.S.) may be an appropriate subjective scale for general use. Several methods of measuring pain relief are also reviewed. Patients tend to express themselves more in terms of pain relief than in terms of pain measurement. The principles of the Signal Detection Theory for quantification of pain are outlined.

scholarly journals Analgesic and Antihyperalgesic Properties of Propofol in a Human Pain Model

2010 ◽  
Vol 113 (2) ◽  
pp. 421-428 ◽  
Author(s):  
Oliver Bandschapp ◽  
Joerg Filitz ◽  
Harald Ihmsen ◽  
Andreas Berset ◽  
Albert Urwyler ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Scale Score ◽  
Pain Perception ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pharmacodynamic Modeling ◽  
Maximum Effect ◽  
Significant Group ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Background Propofol (Disoprivan, AstraZeneca AG, Zug, Switzerland) has long been considered to be nonanalgesic. However, accumulating evidence shows that propofol possesses modulatory action on pain processing and perception. In this study, the authors investigated the modulatory effects of propofol and a formulation similar to the solvent of propofol (10% Intralipid; Fresenius Kabi, Stans, Switzerland) on pain perception and central sensitization in healthy volunteers. Methods Fourteen healthy volunteers were included in this randomized, double-blind, placebo-controlled, crossover study. Intracutaneous electrical stimulation (48.8 +/- 25.8 mA) induced spontaneous acute pain (Numeric Rating Scale, 6 of 10) and stable areas of hyperalgesia and allodynia. Pain intensities and areas of hyperalgesia were assessed regularly before, during, and after a 45-min target-controlled infusion (2 microg/ml) of propofol, the solvent 10% Intralipid, and saline. Results During administration, propofol significantly decreased pain scores and areas of hyperalgesia and allodynia compared with both 10% Intralipid and saline (placebo-corrected mean Numerical Rating Scale score reduction by propofol: 38 +/- 28%). This difference disappeared shortly after cessation of the infusion. Thereafter, no significant group differences were observed in the Numerical Rating Scale score and the areas of hyperalgesia or allodynia. However, there was a trend to reduced hyperalgesia and allodynia after propofol treatment. Pharmacodynamic modeling regarding the analgesic effect of propofol showed an EC50 (half-maximum effect site concentration) of 3.19 +/- 0.37 microg/ml. Ten percent Intralipid was free of pain-modulatory effects in the authors' experiments. Conclusions Propofol showed short-lasting analgesic properties during its administration, whereas the solvent-like formulation 10% Intralipid had no effect on pain perception.

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

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