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Concept: McGill Pain Questionnaire

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We developed the Michigan Body Map (MBM) as a self-report measure to assess body areas where chronic pain is experienced and to specifically quantify the degree of widespread body pain when assessing for centralized pain features (e.g., fibromyalgia-like presentation). A total of 402 patients completed the measure in five distinct studies to support the validation of the original and a revised version of the MBM. Administration is rapid 39-44 sec and errors for the original MBM were detected in only 7.2% of the possible body areas. Most errors underestimated the number of painful areas or represented confusion in determining the right versus left side. The MBM was preferred (p=0.013) and felt to better depict pain location (p=0.001) when compared to the Widespread Pain Index checklist of the 2011 Fibromyalgia Survey Criteria, but participants did not express any preference between the MBM and Brief Pain Inventory body map. Based on the data from the first three studies, a revised version of the MBM was created including a front and back body image and improved guidance on right-sidedness versus left. The revised MBM was preferred when compared to the original and more accurate in depicting painful body areas (p=0.004). Furthermore, the revised MBM showed convergent and discriminant validity with other self-report measures of pain, mood and function. In conclusion, the MBM demonstrated utility, reliability and construct validity. This new measure can be used to accurately assess for the distribution or widespreadedness of bodily pain as an element of the fibromyalgia survey score.

Concepts: Vitamin D, Psychometrics, Pain, Nociception, Validity, Utility, Chronic pain, McGill Pain Questionnaire

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Abstract Background. The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. Objective. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children’s research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Results. Four strong and three weak recommendations emerged from the process; two of the strong recommendations were linked to high- and moderate-quality evidence, respectively. The panel recommended that all patients be considered candidates for analgesia, regardless of transport interval, and that opioid medications should be considered for patients in moderate to severe pain. The panel also recommended that all patients should be reassessed at frequent intervals using a standardized pain scale and that patients should be re-dosed if pain persists. The panel suggested the use of specific age-appropriate pain scales. Conclusion. GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding patient assessment and narcotic medication dosing. Future research should define optimal approaches for implementation of the guideline as well as the impact of the protocol on safety and effectiveness metrics.

Concepts: Opioid, Pain, Emergency medical services, Suffering, McGill Pain Questionnaire, Emergency medicine, Paramedic, Emergency medical technician

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OBJECTIVE: Painful HIV distal sensory polyneuropathy (HIV-DSP) is the most common nervous system disorder in HIV patients. The symptoms adversely affect patients' quality of life and often diminish their capacity for independent self-care. No interventions have been shown to be consistently effective in treating the disorder. The purpose of the present study was to determine whether hypnosis could be a useful intervention in the management of painful HIV-DSP. METHOD: Participants were 36 volunteers with HIV-DSP who received three weekly training sessions in self-hypnosis. Participants were followed for pain and its sequelae for 7 weeks prior to the intervention, and for 7 weeks postintervention. Participants remained on the same standard-of-care pain regimen for the entire 17 weeks of the protocol. The primary outcome measure was the Short Form McGill Pain Questionnaire cale (SFMPQ) total pain score. Other outcome measures assessed changes in affective state and quality of life. RESULTS: Mean SFMPQ total pain scores were reduced from 17.8 to 13.2 (F[1, 35] = 16.06, P < 0.001). The reductions were stable throughout the 7-week postintervention period. At exit, 26 out of 36 (72%) had improved pain scores. Of the 26 who improved, mean pain reduction was 44%. Improvement was found irrespective of whether or not participants were taking pain medications. There was also evidence for positive changes in measures of affect and quality of life. CONCLUSION: Brief hypnosis interventions have promise as a useful and well-tolerated tool for managing painful HIV-DSP meriting further investigation.

Concepts: Nervous system, Life, Neuroscience, Pain, Sensory system, McGill Pain Questionnaire, Peripheral neuropathy, Polyneuropathy

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Pain scales employing faces are commonly used tools for assessing pain in children capable of communicating. However, some children require other types of pain scales since they have difficulties in understanding faces pain scales. The goal of this study was to develop and validate the “Pain Block” concrete ordinal scale for 4-7-year-old children. This was a multicenter prospective observational study in the Emergency Department. Psychometric properties (convergent validity, discriminative validity, responsivity, and reliability) were compared between the “Pain Block” pain scale and the Faces Pain Scale-Revised (FPS-R) to assess the validity of the “Pain Block” scale. A total of 163 children (mean age, 5.5 years) were included in this study. The correlation coefficient between the FPS-R and the Pain Block scale was 0.82 for all participants which increased with age. Agreement between the two pain scales was acceptable, with 95.0% of the values within the predetermined limit. The differences in mean scores between the painful group and non-painful group were 3.3 (95% confidence interval (CI), 2.6-4.1) and 3.8 (95% CI, 3.1-4.6) for FPR-S and Pain Block, respectively. The pain scores for both pain scales were significantly decreased when analgesics or pain-relieving procedures were administered (difference in Pain Block, 2.4 (1.4-3.3); difference in FPS-R, 2.3 (1.3-3.3)). The Pain Block pain scale could be used to assess pain in 4-7-year-old children capable of understanding and counting up to the number 5, even if they do not understand the FPS-R pain scale.

Concepts: Statistics, Observational study, Psychometrics, Pain, Validity, Reliability, Normal distribution, McGill Pain Questionnaire

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Acute pain and peripheral sensitization development after cautery disbudding was investigated in 33 calves administered preventive multimodal analgesia. The animals were assigned randomly to three groups: 1) Group SH (Control), undergoing sham disbudding at 1 and 4weeks of age; 2) Group ED (Early Disbudding), undergoing disbudding at 1week of age and sham disbudding at 4weeks of age; 3) Group LD (Late Disbudding), undergoing sham disbudding at 1week of age and disbudding at 4weeks of age. Physiological parameters (heart rate, respiratory rate, rectal temperature, invasive blood pressure, cortisol, β-endorphin, interleukin-1β, interleukin-6, tumor necrosis factor-α and haptoglobin plasmatic concentration), local variables (tactile sensitivity score, pressure pain thresholds and horn temperature), behavior and pain scores [multidimensional pain scale and visual analogue scale (VAS)] were assessed at baseline and at several pre-determined time points until 24h after disbudding. Tactile sensitivity score significantly and equally increased in both groups ED and LD and pressure pain thresholds significantly decreased in group LD until 24h after disbudding compared to group SH. Pain and VAS scores significantly and equally increased in both groups ED and LD until 24h after disbudding compared to group SH. No significant differences in physiological parameters, behavior and horn temperature were detected among groups. The present study suggests that acute pain and peripheral sensitization develop and do not differ in calves disbudded at 1week and 4weeks of age. Moreover, the use of physiological and behavioral parameters as sole indicators of acute pain might lead to improper conclusions and should be reassessed.

Concepts: Psychology, Pulse, Medical signs, Pain, Sensory system, Aortic dissection, Behaviorism, McGill Pain Questionnaire

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Pain in children is underestimated and undertreated because of lack of pain assessment tools. Pain assessment depends on the cognitive development of the child being tested, clinical context, and pain typology. For children older than age 6 years, pain assessment is based on a self-report. For children younger than age 6 years, behavioral pain scales are needed to assess pain. Numerous pain scales exist. Many are reliable and some are recommended, but all have specific conditions for their use. In this article, we review the available pain scales for children from birth to adolescence. We provide the validity criteria of each pain scale to help caregivers use the adapted tools. We then propose a synthesis of the reliable tools to use based on the pain context. [Pediatr Ann. 2017;46(10):e387-e395.].

Concepts: Psychology, Childbirth, Educational psychology, Psychometrics, Pain, Childhood, Developmental psychology, McGill Pain Questionnaire

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To evaluate the efficacy of 2%, 4% Lignocaine, EMLA mixture and Precaine topical anaesthetic agents (with 1:1, 00,000 epinephrine) during the extraction of deciduous anterior tooth. Eighty patients with pre-shedding mobility of deciduous anterior tooth were divided randomly into four groups. Lignocaine, in amount of 2% and 4%, Precaine and EMLA topical anaesthetic agents were applied and the tooth was extracted. VAS has been used to assess the subjective pain while Wong-Baker faces scale and SEM pain scale have been used to record the objective pain to check the efficacy of these topical anaesthetic agents. SPSS ver.17 was used for statistical analysis. Group comparison was done by ANOVA (Fishers F test) and inter comparison was done by Tukeys t test. Based on the scoring criteria of VAS, SEM and Wong Bakers facial pain scales, Precaine had best scores followed by EMLA mixture, 4% Lignocaine, and then 2 % Lignocaine during extraction of primary anterior teeth with pre-shedding mobility. The efficacy of Precaine was superior compared to EMLA mixture followed by 4% lignocaine and 2% Lignocaine respectively.

Concepts: Statistics, Anesthesia, Topical, Topical anesthetic, McGill Pain Questionnaire, Local anesthetic, Lidocaine, Local anesthetics

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Infants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal or postoperative pain. What is not well understood is how well these scales perform when used to assess procedural pain in infants and children.

Concepts: Evaluation, Assessment, Educational psychology, Psychometrics, Pain, McGill Pain Questionnaire, Educational evaluation, Psychological testing

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The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery.

Concepts: Comparison, Symptoms, Psychometrics, Pain, McGill Pain Questionnaire, Pain scale, Tool

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The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates.

Concepts: Pregnancy, Fetus, Observational study, Pain, Gas, Gestational age, German language, McGill Pain Questionnaire