cancer and is currently being used to assess the effectiveness of pain management in pediatric palliative care. Behavioral assessment secondary to pain intensity is also recommended in children. Few behavioral measurement tools have been evaluated for their response to medication, and insufficient attention has been paid to the significance of behaviors in terms of the level of pain. In younger children or children with handicaps and communication problems, these are, nonetheless, the preferred tools. Various scales have been developed for postoperative pain, but pain behavior can be different in advanced diseases. Scales that have been validated for use in chronic pain conditions include the DEGR scale for cancer pain and San Salvadour Scales for cognitively delayed children. The Brief Pain Inventory (BPI) was developed from the Wisconsin Brief Pain Questionnaire. The BPI assesses pain severity and the degree of interference with function, using 0–10 NRS. It can be self-administered, given in a clinical interview, or even administered over the telephone. Most patients can complete the condensed version of the BPI in 2 or 3 minutes. Chronic pain usually varies throughout the day and night, and therefore the BPI asks the patient to rate their present pain intensity, ‘pain now, pain at its worst, ‘least’, and ‘average’ over the last 24 h. The location of pain on a body chart and the characteristics of the pain are documented. The BPI also asks the patient to rate how much pain interferes with seven aspects of life—general Tools for chronic pain assessment in adults The Brief Pain Inventory activity, walking, normal work, relations with other people, mood, sleep, and enjoyment of life. The BPI asks the patient to rate the relief they feel from the current pain treatment (Song et al., 2022). The McGill Pain Questionnaire The McGill Pain Questionnaire (MPQ) and the short-form MPQ (SF-MPQ) evaluate sensory, affective–emotional, evaluative, and temporal aspects of the patient’s pain condition. The SF-MPQ consists of 11 sensory (sharp, shooting, etc.) and four affective (sickening, fearful, etc.) verbal descriptors. The patient is asked to rate the intensity of each descriptor on a scale from 0 to 3 (= severe). Three pain scores are calculated: the sensory, the affective, and the total pain index. Patients also rate their present pain intensity on a 0–5 scale and a VAS (Alharbi et al., 2020). The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommended six core outcome 2. Physical functioning. 3. Emotional functioning. 4. Patient ratings of improvement and satisfaction with treatment. 5. Other symptoms and adverse events during treatment. 6. Patient’s disposition and characteristics data. domains: 1. Pain. The recommended outcome measures and instruments for these six domains, and what the IMMPACT group considers meaningful changes in the measured variables are the following: 1. Pain intensity rated on a 0–10 NRS and the amount of any rescue analgesics used: a 10–20% decrease in pain intensity is considered minimally important, at least a 30% decrease is moderately important, and more than 50% decrease is a substantial improvement. 2. Physical functioning assessed by the BPI pain interference items: a one-point improvement is minimally important. 3. Emotional functioning assessed by Beck Depression Inventory: more than a five-point decrease is clinically important. The Profile of Mood States: total mood disturbance is clinically important with a 10–15-point decrease. 4. Patient ratings of improvement, or worsening, of the pain condition by the patient’s global impression of change scale:
The San Salvadour Scales have 22 items. Many of them depend on the child’s response to manipulation during physical examination, basal state, and sleep. It is correlated with the level of autonomy. It has never been used in palliative care, but the relevance of palliative care in neurologically disabled children can suggest its use in special populations. On the other hand, the DEGR scale consists of 10 indicators divided into three subgroups: voluntary expression of pain, direct signs of pain, and psychomotor alterations. Observation of the child is carried out at rest, on movement, and during social interaction and play. It has been validated in French for children with cancer aged 2 to 6 years. Translations in English and Spanish are available. At the moment, it is the only available measurement tool for prolonged pain in young children. It is appropriate for younger children in palliative care but lacks the benefit of self-report. a minimally important change to the better is the patient’s report of ‘minimally improved’ moderately important is ‘much improved,” and a substantial change is ‘very much improved.” 5. Other symptoms and any adverse events are documented by using passive capture of spontaneously reported events and open-ended prompts. 6. Patient’s dispositions and characteristics data were assessed following the CONSORT recommendations. Quantitative Sensory Testing (QST) QST refers to a set of methods in which patients’ perceptual responses to quantifiable sensory stimuli are assessed to characterize somatosensory function or dysfunction. Multiple stimulus modalities can be used to elicit both painful and nonpainful percepts, most commonly including thermal (heat, cold) and mechanical (tactile, pressure, vibration) stimuli, but electrical, ischemic, and chemical stimuli are also used. Stimulus modalities and parameters can be selected to preferentially engage different nerve endings, nerve fibers, and central nervous system pathways to systematically evaluate somatosensory transmission and pain processing. Moreover, dynamic QST approaches can provide valuable information regarding pain inhibitory and pain facilitatory functions. Multiple authors have discussed the use of QST in the assessment and classification of pain in recent years. Subsequently, we will briefly review the application of QST in the assessment of neuropathic pain and the use of QST for determining pain modulatory function. The clinical application of QST has been most well-developed in the characterization of neuropathic pain. The most systematic approach has been developed by the German Neuropathic Pain Network (DFNS). The DFNS approach obtains 13 different measures in response to thermal and mechanical stimuli, which reflect both gain of function (e.g., allodynia, hyperalgesia) and loss of function (e.g., insensitivity to cold or vibration) changes. The DFNS protocol has been shown to have excellent inter-rater and test-retest reliability, and they have reported reference values from a group of pain-free controls (Terkelsen& Birklein, 2022). Using this QST protocol, these investigators have identified multiple somatosensory profiles within major neuropathic pain diagnostic groups, suggesting that different mechanisms may be at play for patients with the same neuropathic pain diagnoses and that these subgroups respond differently to a treatment. Using the DFNS QST methodology, a previous double-blind randomized clinical trial in patients with peripheral neuropathic pain found that the sodium channel blocker oxcarbazepine showed substantially greater efficacy in patients who showed sensory gain (i.e., hyperalgesia) compared to those who showed a sensory loss. Importantly, these phenotype groups did not differ in their responses to placebo. QST has been increasingly studied in non-neuropathic pain conditions. In this context, the general goal is to characterize pain modulatory function more globally in contrast to the greater focus on peripheral afferent function in assessing neuropathic
Book Code: PYFL4024
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