activity, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. There are several instruments validated for assessing pain and other common symptoms and functional disabilities in palliative care:
Memorial Pain Assessment Card; Memorial Symptom Assessment Scale (MSAS) and a Short Form (MSAS-SF); M.D. Anderson Symptom Inventory (MDASI); the Rotterdam Symptom Checklist; and the Symptom Distress Scale. validity had previously been verified and compared with the SF-36 health-related quality of life questionnaire for patients with chronic noncancer pain. Both groups of patients had substantially lower quality of life compared with a normal population. But most impressive was the finding that patients with chronic noncancer pain reported even worse quality of life than dying cancer patients, a dramatic illustration of the major impact of chronic pain conditions on the global situation of persons with long-lasting pain. absolute self-reported pain scores may be seen in patients with high scores in situations in which the healthcare worker believes there should be little pain. Motivational reasons (e.g., a patient believing they will be treated more promptly), as well as emotional reasons (e.g., fear of serious illness or of losing a job), often account for these apparent discrepancies. The initial rating assigned by the patient is therefore less meaningful than changes in that rating in response to interventions. Another popular unidimensional tool under this category is the Numeric Rating Scale used for the assessment of acute pain. The patient is asked to choose one number from a numeric range that best reflects the intensity of pain. A frequently used range in the assessment of ischemic cardiac pain is 0 to 10 (NRS-11). Another customary range is 0 to 100 (NRS-101). This scale appears to yield better results than the VAS for patients with chronic pain 11 and illiterate patients. A variation on the NRS is the 11-point box scale. The patient is asked to circle one of the 11 boxes arranged horizontally on a straight line, each containing a number from 0 to 10. The VRS comprises carefully chosen phrases, arranged in an order to describe increasing perception of the intensity of pain. The patient is asked to choose the phrase that best describes their pain. Pain drawings have also been advocated as an informative tool. Instead of assessing the overall intensity of pain, this method identifies the distribution of pain and the characteristics of the pain syndromes experienced. On a line drawing of a person, the patient is asked to mark the areas where they feel pain. The patient is then asked to use different shadings to indicate the quality of pain (e.g., stabbing, pins and needles, cramps, numbness). give a value from 0 to 5 at the time of the questionnaire to represent the overall pain intensity; this number is termed the present pain intensity (PPI). Finally, the number of words chosen to describe the pain is also counted. Over time, the MPQ has shown good consistency and reliability in the evaluation of acute and chronic pain and has been translated to and validated in many other languages. Some other examples of assessment tools used to measure the multidimensional aspects of pain include the Minnesota Multiphasic Personality Inventory (MMPI), the West Haven–Yale Multidimensional Pain Inventory, the Checklist for Interpersonal Pain Behavior, and the Pain Beliefs Questionnaire.
Assessment of health-related quality of life of patients in chronic pain The importance of assessing the quality of life in chronic pain patients was illustratively documented by Fredheim and colleagues. Health-related quality of life was assessed in 288 patients admitted to the multidisciplinary pain center and in 434 patients with advanced cancer admitted to the palliative care program of the same medical center at the University Hospital in Trondheim, Norway. They used the European Organization for Research and Treatment of Cancer EORTC- QLQ C30-quality-of-life questionnaire. Its reliability and Unidimensional tools for pain assessment based on self-report Unidimensional pain scales are frequently used when a single, clearly defined question is to be answered. They are easy to understand and use and place a minimal burden on the patient. Scales with a wide range of possible scores
ensure sensitivity to intervention and permit statistical evaluation. The pain-assessment tools in this category measure the intensity of pain based on the patient’s self-report. The Visual Analog Scale is perhaps the most commonly used and validated tool for pain assessment based on self-report. The scale comprises a 10-cm line with descriptive phrases at either end. In most pain studies the range is from “no pain” to “severe pain” or “worst pain ever.” Selected phrases should be easily understood and not so extreme as to not be chosen. Patients estimate their level of pain by placing a mark on the line; the distance from the ”no pain” point is then measured. No intermediate marks should be placed along the length of the line; this leads to the clustering of responses. A 10-cm horizontal line is the most widely used version of the VAS, and the most widely validated. Once a length has been chosen, it should remain constant throughout the study. Variation in responses has been seen in individuals who are asked to mark lines of different lengths. Many variations on this theme exist, including slide rules, numeric markings on top of the line, vertical lines, and labeling of the line with descriptive words. None of these variations has a clear advantage, although the version chosen should be used for the duration of a study. Data obtained are commonly analyzed with a 100-point scale corresponding to the 10-cm line. There is no mechanism for validating individual scores because they are a subjective interpretation of a sensation. Apparent discrepancies in Multidimensional tools for general pain assessment Unlike the unidimensional tools for pain assessment, the multidimensional tools take into account multiple factors that influence the perception of pain. These factors include the quality and the temporal sequence of pain, the affective contributions, and the patient’s belief system. Although this comprehensive approach is important, the use and interpretation of these tools are difficult because of their complexity. In addition, the length of time required to complete the evaluations usually make them impractical in the emergency setting. In this category, the McGill Pain Questionnaire is a popular mention. It identifies keywords that describe the different qualities of pain and classes them into four major groups: sensory, affective, evaluative, and miscellaneous. Each word is assigned a rank value, and the sum of the rank values of the words chosen becomes the pain rating index (PRI), The patient is also asked to
Book Code: PYCA2725
Page 148
EliteLearning.com/Psychology
Powered by FlippingBook