A verbal descriptor incremental pain scale developed by South African Tswana-speaking patients with low back pain

Background: Measuring pain in patients whose home language is not English can be difficult as there may not be a scale available in their home language. Scales devised in other countries may also not be accurate after translation.Objectives: The aim of this study was to develop and test a new verbal pain descriptor scale in a Tswana-speaking population in South Africa with low back pain.Method: Two separate Tswana-speaking groups (20 males and 20 females) of patients with low back pain were asked to describe each of four categories of pain: mild, moderate, severe and worst. They then voted and descriptions obtaining more than 70% of the vote were taken to the next round of voting with both groups together. A final scale of one description for each category of pain (Tswana Verbal Pain Descriptor Scale – TVPDS) for both males and females was tested on a sample of 250 patients with low back pain and against three other non-verbal pain scales.Results: All items on the final scale were approved by at least 70% of both male and female participants. The scores for the TVPDS correlated well with present pain perception (r = 0.729, p < 0.0001) measured on the numerical visual analogue scale. The TVPDS correlated well with the Wong–Baker FACES Pain Rating Scale (r = 0.695, p < 0.0001) and the Pakistani Coin Pain Scale (r = 0.717, p < 0.0001).Conclusion: The TVPDS has the potential to be a useful clinical scale but more testing in other languages is still required.Clinical implications: This pain scale has the potential to be a useful scale to use for Tswana-speaking persons with low back pain and could also be useful for persons of other languages, if translated.

Use of Analgesia in an Emergency Department

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Keywords: analgesia; emergency; Nepal.

Adapted version of the mcgill pain questionnaire to Brazilian Portuguese

The purpose of this study was to the present a translated version of the McGill Pain Questionnaire to Brazilian Portuguese that adapted the original pain descriptors according to the Brazilian culture, aiming at its scientific validation. Initially, the original questionnaire was translated by 3 legally recognized translators fluent in English and in Brazilian Portuguese. The translations were meticulously assessed by 5 health professionals (3 dentists, 1 physician and 1 medical student) who were asked to choose the best translation for each pain descriptor of the original questionnaire in English. The resulting questionnaire was applied to 80 subjects (20 professors, 20 dental students, 20 employees and 20 patients, all related to the School of Dentistry of Ribeirão Preto, University of São Paulo). After some adjustments to improve the understanding of the pain descriptors, an adaptation of the intensity values of each pain descriptor was done by 20 postgraduate dental students and 20 undergraduate dental students, who were asked to record, for each word, the pain intensity value based on their personal opinion. In addition, they were asked to fill out the final version of the questionnaire to identify any doubts. The McGill Pain Questionnaire proved to be a very useful tool for measuring pain, and its version in Brazilian Portuguese was validated to be used as an important diagnostic resource.

Practice of analgesia in an emergency department of eastern Nepal

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.Key Words: Analgesia, Emergency, Nepal