Articles: pain-measurement.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialSeverity of baseline pain and degree of analgesia in the third molar post-extraction dental pain model.
The purpose of this study was to determine whether different levels of pain would respond similarly to analgesia. We compared the analgesic response to ibuprofen in subjects with moderate versus severe baseline pain in clinical trials using the third molar post-extraction dental pain model. We performed a pooled raw data analysis of 517 subjects included in the ibuprofen treatment arm of 11 similar studies submitted to the Food and Drug Administration. The inclusion and exclusion criteria were similar in all studies. All studies used the same metrics and recorded pain at the same times. As expected, the well established analgesic effect of ibuprofen was confirmed. More intense baseline pain was initially associated with a larger decrease and greater fractional decreasing in pain intensity after medication. A larger percentage of those with milder baseline pain obtained relief compared with those with severe baseline pain. Reduction in pain intensity occurred mainly in the first 2 h. At later time points, the association of baseline conditions with a reduction in pain level diminished. We conclude that the intensity of initial pain is not correlated with the need for larger doses of analgesic. ⋯ A person taking an analgesic wants to know when and how well it will work. People with moderate pain are more likely to get relief, whereas those with severe pain who get relief will get relatively more relief. Most relief of acute pain occurs within less than 2 h. These data indicate that most people with intense initial pain do not require larger doses of analgesics.
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Anesthesia and analgesia · Jun 2003
Randomized Controlled Trial Clinical TrialThe numeric rating scale and labor epidural analgesia.
A verbal numeric 0-10 rating scale (NRS) is widely used to evaluate pain in research studies, but its usefulness to the clinician is not well established. In this study, we define desire for additional analgesic medication as a clinically relevant outcome in research studies about pain and compare it with the results of the NRS. A post hoc analysis of three studies that we previously conducted concerning labor epidural analgesia was performed. In all three studies, a verbal NRS score was obtained before and 15 min after labor epidural analgesia. At 15 min, the woman was also asked if she wanted more pain medication. We found that very few patients (2%) with a NRS score of 0-1 wanted more medication. When the NRS score was 2 or 3, 51% of the patients wanted more medication, and when the NRS score was >3, almost all patients (93%) wanted more medication. Grouping the final NRS scores into 3 categories (0 or 1, 2 or 3, and >3) is more useful to the clinician than using individual NRS scores. ⋯ This study demonstrated that unless the score of the verbal numeric 0-10 rating scale (NRS) is 0 or 1, most women want more analgesic medication for labor epidural analgesia. Additionally, we found that grouping the NRS values into 3 categories for analysis (0 or 1, 2 or 3, and > 3) is more useful to the clinician than using the full spectrum of NRS scores.
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Randomized Controlled Trial Comparative Study Clinical Trial
Minimum clinically significant VAS differences for simultaneous (paired) interval serial pain assessments.
We conducted two studies to determine whether the minimum clinically significant difference in the visual analog scale (VAS) for nearly simultaneous and brief-interval serial assessments of pain is less than that for pain assessment at 20- to 30-minute intervals, using a 10-cm VAS. The first study was a blinded, randomized, placebo-controlled paired trial comparing the pain of intravenous cannulation in both hands (20-minute application of a eutectic mixture of local anesthetics v placebo) of study subjects. The second study was a non-blinded, randomized, paired trial of different treatments for jellyfish stings. ⋯ On the basis of these findings, the minimum clinically significant VAS difference for paired comparisons that are simultaneous or occur within 5 minutes of each other is about 0.5 cm or less. This value is less than the 1.3-cm value determined for serial 20- to 30-minute pain comparisons. It is likely that other types of pain comparisons may have different minimum clinically significant VAS differences.
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Clinical pediatrics · Apr 2003
Randomized Controlled Trial Clinical TrialPediatric pain measurement using a visual analogue scale: a comparison of two teaching methods.
The goals of this study were to evaluate the validity of the visual analogue scale (VAS) for young children and to compare a newly developed method of teaching children to use a VAS with one used in our previous studies. It was hypothesized that the new method would increase the number of children who understand the VAS and correctly mark their responses on the VAS line. The association between child's age and ability to understand the VAS was also evaluated. ⋯ Subjects who were able to understand the VAS were significantly older (mean = 9.8 years, SD = 2.8) than those who did not (mean = 8.2 years, SD = 2.5). Overall, only about one third of the subjects were able to correctly mark the VAS and understand the concept of the VAS. Other measures of pain that are better understood by young children may be more valid indicators of pain than the VAS.
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Complement Ther Med · Mar 2003
Randomized Controlled Trial Clinical TrialThe impact of site specificity and needle manipulation on changes to pain pressure threshold following manual acupuncture: a controlled study.
To investigate the contribution of two principal features that underlie traditional Chinese acupuncture: site specificity and application of needle manipulation. ⋯ Both manipulation and site of needling contributed significantly to the elevation of PPT following acupuncture. Distribution of effects on PPT did not support either neural segmental or Traditional Chinese Medicine channel theories. Psychological and physiological nonspecific effects appeared to play a minimal role in changes to PPT.