Articles: pain-measurement.
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Int. J. Pediatr. Otorhinolaryngol. · Aug 2019
Children and their parents' assessment of postoperative surgical pain: Agree or disagree?
The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. ⋯ Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.
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Preverbal children are at increased risk for underassessment of pain. Pain is a social transaction involving the child in pain and the nurse assessor. However, our understanding of the nurse's part in this transaction is limited. ⋯ Nurses preferred pain assessment based on clinical judgment and tailored to the individual child. Implementation strategies that aim to integrate structured pain scales with clinical judgment to assess pain may be more likely to succed. Further examination of this approach is warranted.
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Comparative Study
Assessing pain in the postoperative period: Analgesia Nociception IndexTMvs pupillometry.
Potential methods for objective assessment of postoperative pain include the Analgesia Nociception Index™ (ANI), a real-time index of the parasympathetic tone, the pupillary light reflex (PLR), and the variation coefficient of pupillary diameter (VCPD), a measure of pupillary diameter (PD) fluctuations. Until now, the literature is divided as to their respective accuracy magnitudes for assessing a patient's pain. The VCPD has been demonstrated to strongly correlate with pain in an obstetrical population. However, the pain induced by obstetrical labour is different, given its intermittent nature, than the pain observed during the postoperative period. The aim of the current study was to compare the respective values of these variables at VAS scores ≥4. ⋯ NCT03267979.
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Measuring pain in infants is important but challenging, as there is no "gold standard." The measurement of skin conductance (SC) is considered to be a measure of stress and as a surrogate indicator of pain. The objectives of this study were to identify the extent of research conducted and to synthesize the validity evidence of SC for assessing acute pain in infants. ⋯ Inconsistent findings on validity of SC exist. Future research should aim to identify the diagnostic test accuracy of SC compared with well-accepted referent pain measures in infants, study the validity evidence of SC in critically ill infants, and utilize rigorous research design and transparent reporting.
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Pain undertreatment, or oligoanalgesia, is frequent in the emergency department (ED), with major medical, ethical, and financial implications. Across different hospitals, healthcare providers have been reported to differ considerably in the ways in which they recognise and manage pain, with some prescribing analgesics far less frequently than others. However, factors that could explain this variability remain poorly understood. Here, we used neuroscience approaches for neural signal modelling to investigate whether individual decisions in the ED could be explained in terms of brain patterns related to empathy, risk-taking, and error monitoring. ⋯ These results highlight the multiple processes underlying pain management, and suggest that the neural representations of others' states and one's errors play a key role in individual treatment decisions. Neuroscience models of social cognition and decision-making are a powerful tool to explain clinical behaviour and might be used to guide future educational programs to improve pain management in ED.