Articles: pain-measurement.
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J. Perianesth. Nurs. · Feb 2001
ReviewEvidence-based practice part 2: reliability and validity of selected acute pain instruments.
Pain management is an important aspect of perianesthesia patient care. PACU nurses need to be familiar with pain measurement to judge effectiveness of pain management. In fact, the 1999-2000 Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) guidelines have included the measurement of pain before and after pain treatment in their standards of practice. This article reviews selected pain instruments that could be used to measure pain in perianesthesia patients and the available reliability and validity of the instruments.
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Pain is an undertreated, understudied problem in the growing elder population. Clinicians need to consider the compelling evidence that a significant majority of this population experience pain that interferes with quality of life and normal functioning. The barriers to adequate pain management must be addressed and misconceptions corrected. ⋯ Pain assessment and reassessment need to be performed regularly and used in treatment selection. Consideration of physiologic changes that occur in the aged will guide choices of pharmacologic and non-pharmacologic therapies. Pain assessment and treatment must be recognized as fundamental care issues.
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Inadequate pain assessment in children may lead to an underestimation of pain, and consequently, undertreatment in this population. This article provides an overview of pain assessment and describes specific measurement tools that can be used with infants, children, and adolescents. Nationally published practice guidelines and standards recommend pain assessment at regular intervals with age-appropriate tools. Pain assessment must be integrated into perianesthesia nursing practice, and nurses must develop competency in the assessment and treatment of pain in children.
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Pain in children is frequently underrecognized or undertreated based on misconceptions and misjudgments about the experience of pain in this age group. The goal of pain assessment is to obtain sufficient and accurate data, depending on the developmental stage of the child. ⋯ Assessing the emotional state of the family and caregivers is also crucial. Health care providers need to be persistent and thorough when evaluating pain in children and use this information to formulate and modify an appropriate treatment plan.
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Many lines of evidence implicate the somatosensory areas near the lateral sulcus (Sylvian fissure) in the cortical representation of pain. Anatomical tracing studies in the monkey show nociceptive projection pathways to the vicinity of the secondary somatosensory cortex in the parietal operculum, and to anterior parts of insular cortex deep inside the Sylvian fissure. Clinical observations demonstrate alterations in pain sensation following lesions in these two areas in human parasylvian cortex. ⋯ This anatomical separation may be one of the reasons why single unit recordings of nociceptive neurons are scarce within regions comprising low-threshold mechanoreceptive neurons. The functional significance (sensory-discriminative, affective-motivational, cognitive-evaluative) of the closely spaced parasylvian cortical areas in acute and chronic pain is only poorly understood. It is likely that some of these areas are involved in sensory-limbic projection pathways that may subserve the recognition of potentially tissue damaging stimuli as well as pain memory.