its administration simplicity and reliability. VAS is considered the ‘gold standard technique and is used particularly in pain-related research. It consists of a 100 mm unmarked line with standardized wording: ‘no pain’ on the left of the line, and ‘worst pain imaginable’ on the right—the patient then places a mark on the line corresponding to their level of pain. A disadvantage of this scale is that it does not give an instant rating as a measurement is needed and application of the scale requires Pain intensity With limited time to assess pain, unidimensional self-report measures are often administered that ask patients to quantify their pain intensity by providing a single, general rating. Among the most commonly used are numerical rating scales (NRS) that ask patients to ‘Rate your typical pain on a scale from 0 to 10 where 0 equals no pain and 10 is the worst pain you can imagine” and verbal rating scales (VRS) that instead use verbal descriptors and ask the patient to report ‘Is your usual level of pain mild, moderate, or severe?”‘ Both the NRS and VRS appear sufficiently reliable and valid; no one method consistently demonstrates greater responsiveness in detecting improvements associated with pain treatment (Atisook et al., 2021). However, there are significant differences between NRS and VRS measures of pain intensity concerning missing data, including failure to complete the measure, patient preference, ease of data recording, and ability to administer the measure by telephone or with electronic diaries. Patients who are unable to complete NRS ratings may be able to complete VRS pain ratings more easily, but VRS measures are difficult for language-impaired individuals to complete. Pain location and quality In addition to intensity, pain is known to have different sensory and affective qualities. Understanding the quality of a patient’s pain through assessment can identify treatments that are effective for certain types of pain independent of pain severity. Characteristics of pain (e.g., aching and stabbing) are also important as they may assist in the selection of treatment. In addition, assessment can be enhanced through the use of simple pain diagrams that ask patients to indicate in a drawing of the Pain history General medical history is an important part of the pain history, often revealing important aspects of co-morbidities contributing to a complex pain condition. The specific pain history must clarify location, intensity, pain descriptors, temporal aspects, and possible pathophysiological and etiological issues. 1. Where is the pain? 2. How intense is the pain? 3. Description of the pain (e.g., burning, aching, stabbing, shooting, throbbing, etc). 4. How did the pain start? 5. What is the time course of the pain? 6. What relieves the pain? Subjective expression of pain Patients may express pain verbally through self-report and nonverbally by displaying pain behaviors, which are the controllable and uncontrollable actions and facial expressions that convey the experience of pain, distress, and suffering. These behaviors are important as they have a communicative function and are capable of eliciting responses from significant others (including healthcare providers). Also, they can contribute to the maintenance of behaviors when they receive attention and are reinforced in other ways (e.g., cues to take medication and avoid activity). Much like standardized self-report assessments, 7. What aggravates the pain? 8. How does your pain affect:
explanation to the patient when the level of understanding may be decreased in the early post-anesthetic period. A categorical verbal rating scale (VRS) uses words to describe the magnitude of pain, for example, none, mild, moderate, and severe. VRS is a quick, simple tool with a high validity as an indicator of pain intensity; however, it may be less precise and sensitive than VAS. Regardless of the selected tool, the primary modality of a pain assessment tool is centered on obtaining a comprehensive description of the pain—its nature, duration, intensity, origin, etc. A complicating factor for unidimensional ratings of pain intensity is that the type of information obtained can vary greatly depending on the contextual details of the question. Specifically, consideration should be given to the level of pain severity patients are asked to rate (e.g., least pain, pain on average, and most severe pain), the area of pain (e.g., pain in a specific location vs. whole body pain), circumstances (pain at rest vs. movement), and the time frame that patients are asked recall upon to report their pain (e.g., current pain vs. pain over the past week vs. pain over the past month). The use of daily diaries is believed to be more accurate as they are based on real-time rather than recall. Patients may be asked to maintain regular diaries of pain intensity with ratings recorded several times each day (e.g., meals and bedtime) for several days or weeks and multiple pain ratings can be averaged across time. One problem noted with the use of paper-and-pencil diaries is that patients may not follow the instruction to provide ratings at specified intervals. Rather, patients may complete diaries in advance (‘fill forward’) or shortly before seeing a clinician (‘fill backward’), undermining the putative validity of diaries. Electronic diaries have gained acceptance in some research studies to avoid these problems. human body the location of their pain. For example, the McGill Pain Questionnaire (MPQ) assesses three categories of word descriptors of pain qualities (sensory, affective, and evaluative) and includes a body diagram for patients to identify the area of their pain. A revised and extended version of this scale [Short-Form McGill Pain Questionnaire revised (SF-MPQ-2)] has also been developed and is one of the most frequently used measures to assess pain characteristics (Takei & Tagami, 2022). f. Your family life? g. Your social life? h. Your sex life? 9. What treatments have you received? Effects of treatments? Any adverse effects? 10. Are you depressed? 11. Are you worried about the outcome of your pain condition and your health? 12. Are you involved in a litigation or compensation process? standardized observational procedures have been developed to quantify pain behaviors [e.g., Pain Behavior Checklist (PBC)] but are most often utilized in clinical research settings (Knox et al., 2021). General observation of pain behaviors, and how they are responded to by significant others, can be made in many settings such as the waiting room or while being interviewed; however, the context in which the patient is observed must be considered as it may influence behavior (e.g., pain behaviors may differ if a significant other is present). In addition, investigation of the patient’s healthcare and medication a. Your sleep? b. Your physical functions? c. Your ability to work? d. Your economy? e. Your mood?
Book Code: PYFL4024
Page 138
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