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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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Tonsil surgery is one of the most painful operations in childhood. The Children’s and Infants' Postoperative Pain Scale (CHIPPS), the Faces Pain Scale-Revised (FPS-R) and the little-known German version of the parents' postoperative pain measure (PPPM-D) are age-appropriate measures. Children undergoing intracapsular tonsillectomy (TO) or extracapsular tonsillectomy (TE) received the non-opioids ibuprofen (IBU) and paracetamol (PCM) on a “as needed”-basis requested by parents. A pain service checked pain scales and applied piritramide as rescue medication (RM) if required. Objective was evalution of sufficient analgesia. Endpoints were number of patients (PAT) needing the RM, doses of requested non-opioids, consistency of indications in different pain scales and correlation between pain and efficacy of the premedication or duration of the intervention.

Concepts: Opioid, Pain, Paracetamol, Ibuprofen, Aspirin, Analgesic, McGill Pain Questionnaire, Codeine

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Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of three self-reported pain scales commonly used in the pediatric Emergency Department (ED). The inclusion criteria were children aged 6-17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥ 30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R) and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson’s correlations and the Bland-Altman method; responsiveness to change assessed using paired-sample t-tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants was included, with a mean age of 11.9 years ± 2.7 and a majority of boys (252/456, 55.3%). Correlations between each pair of scales was 0.78 (VAS/FPS-R), 0.92 (VAS/CAS) and 0.79 (CAS/FPS-R). Limits of agreement (95%CI) were -3.77 to 2.33 (VAS/FPS-R), -1.74 to 1.75 (VAS/CAS) and -2.21 to 3.62 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores among the scales (p<0.0001). ICC and CR estimates suggested acceptable reliability for the three scales at respectively 0.79 and ± 2.29 (VAS), 0.82 and ± 2.07 (CAS), and 0.76 and ± 2.82 (FPS-R). The scales demonstrated good psychometric properties for children with acute pain in the ED. The VAS and CAS showed a strong convergent validity, while FPS-R was not in agreement with the other scales.

Concepts: Statistics, Psychometrics, Pain, Validity, Reliability, McGill Pain Questionnaire, Pain scale, Scales

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The Modified Behavioral Pain Scale (MBPS) was designed to assess procedural pain in infants and is considered valid for assessing immunisation pain. The aim of this study was to assess the practical and psychometric properties of the MBPS when applied to other commonly performed procedures. Twenty-six clinicians independently applied the MBPS scale to segments of video collected from 100 children aged six to 42 months undergoing one of four procedures in the emergency department. Positive correlation between MBPS and VASobs pain (r = 0.74) was shown and inter- and intra-rater reliability coefficients were high (0.87 and 0.89, respectively). Construct validity was demonstrated by scale responsiveness to painful stimuli (4.6 times increase in scores across phases) and the capacity of the scale to distinguish between painful versus non-painful procedures, p < 0.001. However, mean baseline scores for procedures were not zero (likely a function of item descriptors for a 'zero' score) and the mean difference increased across phases for children with baseline scores greater than 3 was much lower than for children with scores less than 3, p = 0.0001. Finally, 28% of scores changed following the second viewing of a video segment. The MBPS appears reliable and sensitive to procedural pain when applied by clinicians. Results question the capacity of the scale to differentiate between pain- and non-pain related distress, the feasibility of this scale and the appropriateness of item descriptors for medical procedures.

Concepts: Psychometrics, Pain, Validity, Construct validity, Reliability, McGill Pain Questionnaire, Segment, Item response theory

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Pain assessment can benefit from observation of pain behaviors, such as guarding or facial expression, and observational pain scales are widely used in clinical practice with nonverbal patients. However, little is known about head movements and postures in the context of pain. In this regard, we analyze videos of three publically available datasets. The BioVid dataset was recorded with healthy participants subjected to painful heat stimuli. In the BP4D dataset, healthy participants performed a cold-pressor test and several other tasks (meant to elicit emotion). The UNBC dataset videos show shoulder pain patients during range-of-motion tests to their affected and unaffected limbs. In all videos, participants were sitting in an upright position. We studied head movements and postures that occurred during the painful and control trials by measuring head orientation from video over time, followed by analyzing posture and movement summary statistics and occurrence frequencies of typical postures and movements. We found significant differences between pain and control trials with analyses of variance and binomial tests. In BioVid and BP4D, pain was accompanied by head movements and postures that tend to be oriented downwards or towards the pain site. We also found differences in movement range and speed in all three datasets. The results suggest that head movements and postures should be considered for pain assessment and research. As additional pain indicators, they possibly might improve pain management whenever behavior is assessed, especially in nonverbal individuals such as infants or patients with dementia. However, in advance more research is needed to identify specific head movements and postures in pain patients.

Concepts: Scientific method, Psychology, Assessment, Observation, Pain, Suffering, Pain management, McGill Pain Questionnaire

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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