Effects of training on Feline Grimace Scale scoring for acute pain assessment in cats.

OBJECTIVES: The aim of the study was to determine the effects of training on inter-rater reliability and agreement of Feline Grimace Scale (FGS) scoring by small animal practitioners. METHODS: Seven small animal veterinarians were asked to score a total of 50 images of cats in varying degrees of pain before and after training in FGS scoring. Participant scores were compared with those of an expert rater. Inter-rater reliability was analyzed using the intraclass correlation coefficient (ICC) before and after training (ICC <0.50 = poor reliability, 0.50-0.75 = moderate reliability, 0.76-0.90 = good reliability and >0.90 = excellent reliability). The Bland-Altman method was used to analyze the limits of agreement (LoAs) and bias between participants and the expert rater. RESULTS: After training, the ICC classification improved for each action unit (ear position, orbital tightening, muzzle tension, whiskers change and head position). The inter-rater reliability for the total FGS ratio scores before and after the FGS training session was moderate (ICC = 0.75; 95% confidence interval [CI] 0.66-0.83) and good (ICC = 0.80; 95% CI 0.73-0.87), respectively. Before training, LoAs were -0.277 to 0.310 with a bias of 0.016. After training, LoAs were -0.237 to 0.255 with a bias of 0.008. The bias was low (<0.1) both before and after training and LoAs did not span the FGS analgesic threshold (0.39). CONCLUSIONS AND RELEVANCE: Training in FGS scoring improved inter-rater reliability and agreement among seven small animal veterinarians and the veterinarians' skills in pain assessment.

Association between acute pain trajectory and patient-reported outcomes at 6-months following lumbar surgery for patients with lumbar degenerative disease.

PURPOSE: To investigate the association between acute pain trajectory over one week and patient-reported outcomes (PRO) at 6-months following lumbar surgery in patients with lumbar degenerative disease (LDD). METHODS: Two hundred and fifty-five subjects with LDD who received surgical treatment at our hospital between April 2019 and March 2022. Acute pain trajectory was measured using a pain trajectory calculator to determine an approximate line using the linear least squares method based on pain intensity on postoperative days 1, 3, 5, and 7. The pain trajectory-slope, which represents the change in postoperative pain intensity of the calculated approximation line, was evaluated as the main exposure for the present study. The PRO was assessed using the Oswestry Disability Index (ODI) measured at 6 ± 1 months postoperatively. Poor PRO scores in this study were defined using a threshold of an ODI of 22% or greater, which represents the patient acceptable symptomatic state after lumbar spine surgery. Multivariable logistic regression analysis including covariates was performed to investigate the association between pain trajectory-slope and PRO at 6-months following lumbar surgery. RESULTS: In this study, 101 (39.6%) had poor PRO scores. Multivariable logistic regression analysis adjusted for covariates showed that pain trajectory-slope was associated with the poor PRO scores (odd ratios; 1.203, 95% confidence intervals; 1.130-1.288). CONCLUSIONS: The results of this study show that acute pain trajectory is significantly associated with poor PRO scores 6-months after lumbar surgery. Patients with slower pain relief or worsening pain were associated with poor PRO scores.

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

AIMS AND OBJECTIVES: To translate and validate the Nonverbal Pain Assessment Tool. BACKGROUND: Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. DESIGN: A cross-sectional survey. METHODS: We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. RESULTS: The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. CONCLUSION: The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. RELEVANCE TO CLINICAL PRACTICE: The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. REPORTING METHOD: Our study followed the STROBE Checklists. PATIENT OR PUBLIC CONTRIBUTION: Patients actively cooperated and participated in data collection during the implementation of the study.

Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study.

BACKGROUND: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. OBJECTIVE: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children's Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. METHODS: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. RESULTS: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. CONCLUSIONS: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality.

Association Between Modifiable Structural and Process Factors and the Quality Indicator Pain in Nursing Home Residents: A MultiCentre Cross-Sectional Survey.

AIM(S): The aim of this study is to examine the association between modifiable structural and process factors and self-reported as well as observed pain in Swiss residential long-term care residents. DESIGN: Sub-study of a multicentre cross-sectional survey. METHODS: Institution, unit, and staff data were collected from September 2018 to October 2019 in 118 residential long-term care institutions in Switzerland's German- and French-speaking regions using paper questionnaires. Resident data were exported during the same period from routine data sets. RESULTS: In this study, 6213 residents from 86 residential long-term care institutions were included. Modifiable structural factors such as institutions having access to geriatricians, nursing experts and a palliative care team, the presence of a pain guideline on the unit and good teamwork among care workers were associated to less pain in residents. CONCLUSION: It is possible for residential long-term care institutions to improve pain in residents and to optimise the quality of care by providing access to geriatricians, nursing experts and a palliative care team, working with a pain guideline and fostering teamwork. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Residential long-term care institutions can modify and implement modifiable structural factors which can reduce pain in residents to optimise residents' quality of life and quality of care. IMPACT: Improved pain management in residential long-term care institutions can lead to optimised quality of care and quality of life for individual residents. REPORTING METHOD: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices.

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

Assessing the Association of Pain Intensity Scales on Quality of Life in Elderly Patients with Chronic Pain: A Nursing Approach.

BACKGROUND: Chronic pain is prevalent among the elderly and significantly affects their quality of life (QoL). Pain intensity scales are crucial tools in evaluating the severity of pain and tailoring management strategies. This study investigates the relationship between various pain intensity scales and QoL among elderly patients with chronic pain, highlighting the implications for nursing practice. METHODS: A cross-sectional study was conducted with 150 elderly patients (aged 65 and above) in Riyadh, Saudi Arabia. Participants were assessed using the Numeric Rating Scale (NRS), Visual Analog Scale (VAS), and McGill Pain Questionnaire (MPQ) alongside the 36-Item Short-Form Health Survey (SF-36) to evaluate QoL. Data analysis involved Pearson correlation and multiple regression to explore the association of pain intensity on QoL. RESULTS: All pain scales showed significant negative correlations with QoL. The MPQ exhibited a significant association, suggesting its comprehensive nature captures the multidimensional association of pain more effectively. Regression analysis identified pain intensity, age, and duration of chronic pain as significant predictors of reduced QoL. CONCLUSIONS: The findings emphasize the importance of selecting appropriate pain assessment tools that reflect the complex nature of pain in elderly patients. Implementing comprehensive pain assessments like the MPQ can enhance individualized care strategies and potentially improve the QoL in this population. This study underscores the role of nurses in optimizing pain management approaches tailored to the elderly.

A Comparative Analysis of Pain Assessment Methods in the Initial Postoperative Phase Following Different Pilonidal Cyst Surgeries.

Background and Objectives: In this study, we aimed to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale and to explore potential correlations between these methods. Materials and Methods: A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study. The patients were divided into two groups based on the type of surgery assigned to each patient at the pre-hospital consultation: pit-picking surgery (n = 39) and radical excision (n = 39). The pain levels at the surgical site were assessed and compared using the visual analog scale (VAS) and pressure algometry the morning before surgery and the day after the operation. Results: There was no statistically significant difference (p > 0.05) in VAS measurement results between surgical groups when comparing pain intensity experienced by patients before, during, and after surgery. Notably, specific pressure algometry variables (pressure pain tolerance left 2.05 ± 1.46 compared to 1.42 ± 0.73 kg/cm2, p = 0.02; maximum pressure pain tolerance left 2.91 ± 1.33 compared to 2.32 ± 1.14 kg/cm2, p = 0.04; maximum pressure pain tolerance center 2.51 ± 1.07 compared to 1.91 ± 0.91 kg/cm2, p = 0.01; interval of pressure pain tolerance center 0.98 ± 0.62 compared to 0.59 ± 0.39 kg/cm2, p = 0.00) on the first postoperative day were significantly lower in the "pit-picking" group compared to the excision group. Furthermore, no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day. Conclusions: In the early postoperative period following pilonidal disease surgery of varying extents, pain measured with the VAS does not differ. In contrast, the pressure algometry method showed greater pain in the minimally invasive surgery cohort on the first postoperative day. However, further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement.

Digital versus Speculum-Based Balloon Catheter Insertion for Labor Induction: A Systematic Review and Meta-Analysis: Digital vs speculum-based balloon IOL.

OBJECTIVES: Induction of labor is commonly undertaken when ongoing pregnancy poses risk to either mother or fetus. Often cervical preparation is required with mechanical methods increasingly popular due to their improved safety. This study evaluates the efficacy, safety, and acceptability of digital versus speculum-based balloon insertion for cervical preparation, aiming to identify gaps and inform future research. DATA SOURCE: PubMed, Ovid MEDLINE, EMBASE, and Scopus were searched from database inception until 30 June 2023. STUDY ELIGIBILITY CRITERIA: Included studies were randomized controlled trials comparing digital versus speculum-based insertion of catheter-related balloons for labor induction in individuals with viable singleton pregnancies, in both inpatient and outpatient settings, written in English. Exclusions included studies not using cervical balloons, comparisons to non-balloon methods, non-human studies, and non-primary literature like guidelines, reviews, commentaries, and opinion pieces. METHODS: Title and abstract screening were performed by four authors. Full-text articles were assessed against inclusion criteria. Selection was agreed upon by consensus among three authors, with a fourth consulted for disputes. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for randomized trials. A meta-analysis was also performed. RESULTS: Out of 3397 studies, four met the inclusion criteria, all being randomized controlled trials with some concerns in at least one domain but no high risk of bias. Two studies found digital insertion significantly less painful than speculum-based insertion (p<0.001), while one reported no difference (p=0.72). Maternal satisfaction was comparable, with one study favouring digital insertion (p=0.011). Meta-analysis findings for other outcome measures suggest no difference between speculum or digital insertion. However, due to substantial heterogeneity, findings for procedural time, time from induction-to-delivery, and epidural rate should be cautiously interpreted. CONCLUSIONS: Digital insertion for cervical preparation appears associated with reduced pain and higher patient acceptability compared to speculum-based insertion. Additionally, efficacy and safety were comparable, indicating it is a preferable option for clinical use. There was no difference in other procedural, obstetric, or neonatal outcomes, however, more rigorous research employing standardised outcome measures is needed to facilitate a clinically meaningful interpretation.

Psychotherapy and chronic pain management: a quantitative study evaluating the contribution of psychotherapy to quality of life and treatment compliance in chronic disease patients.

BACKGROUND: The psychology of pain is an important field of study that focuses on understanding the psychological factors associated with pain and developing effective approaches to its management. Pain is a complex sensation that affects a person's physical and mental well-being, and psychological factors can have a significant impact on the perception, response and coping with pain. This research study examines the contribution of psychotherapy in managing chronic pain and improving quality of life and treatment adherence. PARTICIPANTS AND PROCEDURE: The sample consisted of 87 participants who completed the McGill Pain Assessment Questionnaire, SF-36 Quality of Life questionnaire, and the Morisky Medication Adherence Scale (MMAS-8) questionnaire. Two groups were created: one group received psychotherapy to manage pain and illness, while the other group either did not receive psychotherapy or had no contact with this therapeutic method. RESULTS: The results showed that patients who received psychotherapy had higher scores in the dimensions of mental health, vitality, general health, physical pain, physical functioning, and social functioning compared to patients who did not receive psychotherapy. Statistical analysis confirmed significant differences between the two groups. Additionally, psychotherapy was associated with higher treatment adherence, as indicated by the mean scores of patients receiving psychotherapy compared to those who did not. CONCLUSIONS: This suggests that psychotherapy can contribute to increased treatment adherence. The results clearly show that patients who received psychotherapy have significantly higher levels of mental health, vitality, general health and functioning compared to patients who did not receive psychotherapy.

Improving Pain Management in the Intensive Care Unit by Assessment.

PURPOSE: Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation. DESIGN: Quantitative pre-post design. METHODS: The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT). RESULTS: After implementation, a 38% adherence rate was found. The frequency of nurses' pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01. CONCLUSIONS: Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses' adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps. CLINICAL IMPLICATIONS: Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.

Pain Assessment and Analgesic Requirements after Sleeve Gastrectomy: A Comparison Study of Robotic versus Laparoscopic Approaches.

Background: Sleeve gastrectomy is the most common bariatric procedure worldwide, yet postoperative pain management remains a concern. This study aimed to compare pain medication usage and pain scores between laparoscopic sleeve gastrectomy (LSG) and robotic sleeve gastrectomy (RSG) patients, addressing the potential benefits of RSG in postoperative pain control. Methods: A retrospective review of our institutional bariatric surgery registry included 484 patients (435 LSG, 49 RSG) who underwent surgery between September 2015 and November 2020. Pain management medications, including opioid use converted to morphine milligram equivalents (MMEs), and Numerical Rating Scale (NRS) scores were analyzed postoperatively using mixed-effects models. Results: RSG patients reported lower pain scores in the initial 24 h post-surgery and received significantly lower doses of morphine equivalents compared to LSG patients (median 7.5 mg vs. 12.5 mg, p < 0.001). RSG procedures had longer operative times (122.5 ± 27.1 vs. 89.9 ± 30.5 min, p < 0.001) but a shorter average length of stay (2.24 ± 0.60 vs. 2.65 ± 1.49 days) compared to LSG. Conclusions: These findings suggest that RSG may lead to reduced immediate postoperative pain and lower opioid requirements compared to the laparoscopic approach, despite longer operative times. Further randomized controlled trials are needed to confirm these observations and evaluate long-term outcomes.

Artificial Intelligence-Driven Diagnostic Processes and Comprehensive Multimodal Models in Pain Medicine.

Pain diagnosis remains a challenging task due to its subjective nature, the variability in pain expression among individuals, and the difficult assessment of the underlying biopsychosocial factors. In this complex scenario, artificial intelligence (AI) can offer the potential to enhance diagnostic accuracy, predict treatment outcomes, and personalize pain management strategies. This review aims to dissect the current literature on computer-aided diagnosis methods. It also discusses how AI-driven diagnostic strategies can be integrated into multimodal models that combine various data sources, such as facial expression analysis, neuroimaging, and physiological signals, with advanced AI techniques. Despite the significant advancements in AI technology, its widespread adoption in clinical settings faces crucial challenges. The main issues are ethical considerations related to patient privacy, biases, and the lack of reliability and generalizability. Furthermore, there is a need for high-quality real-world validation and the development of standardized protocols and policies to guide the implementation of these technologies in diverse clinical settings.

Video-based compilation of acute pain behaviours in cats.

OBJECTIVES: The aim of this work was to create a video-based compilation of acute pain behaviours in cats as an open-access online resource for training of veterinary health professionals. METHODS: A database comprising 60 h of video recordings of cats was used. Videos were previously recorded after ethical approval and written client consent forms, and involved cats with different types (eg, medical, surgical, trauma, orofacial) and degrees (eg, from no pain to severe pain) of acute pain, before and after surgery or the administration of analgesia. The database included videos of cats of different coat colours, ages, sex and breeds. Video selection was based on a published ethogram of acute pain behaviours in cats. Videos were selected by one observer (SM) according to their definition and quality, followed by a second round of screening by two observers (SM and PVS). Video editing included a standardised template (ie, watermark and titles). RESULTS: A total of 24 videos (mean length 33 ± 17 s) with each acute pain-related behaviour described in the ethogram were uploaded to an open-access online video-sharing platform (http://www.youtube.com/@Steagalllaboratory) with an individual hyperlink. Videos were provided with a short description of the behaviour for the public. CONCLUSIONS AND RELEVANCE: This video-based compilation may promote better training of veterinary health professionals on acute pain assessment while improving feline health and welfare and the understanding of cat behaviours.

Validation of the Spanish Version of the Breakthrough Pain Assessment Tool in Patients With Cancer.

INTRODUCTION AND BACKGROUND: Assessment of breakthrough pain is essential for adequate management of cancer pain. The Breakthrough Pain Assessment Tool (BAT) has been proven to be a brief, multidimensional, and reliable questionnaire for the assessment of breakthrough cancer pain (BTCP). Currently, there are no validated instruments in Spanish that allow assessing BTCP. OBJECTIVES: The objective of this study was to validate the Breakthrough Pain Assessment Tool - Spanish (BAT-S) version of the BAT in adult patients with cancer. METHODS: The BAT-S was tested in a prospective observational study conducted in adult patients with cancer-related pain and treated in a comprehensive cancer center in Mexico. We conducted a forward-backward translation and cross-cultural equivalence test in the Spanish language. The psychometric properties in patients with cancer were assessed using factor analysis, reliability, and validity. To assess reliability, the Kappa test and the intra-class correlation coefficient were used. For consistency, Cronbach's alpha test was used. RESULTS: Seventy patients participated in the study; 140 questionnaires were analyzed. The Spanish translation was well accepted by participants. Reliability was comprised between 0.746 for "use of analgesics" and 1.00 for "pain location." Thirteen of the 14 items had values above 0.8, and 12 above 0.9. Cronbach´s alpha coefficient was 0.7. CONCLUSION: This study confirms that BAT-S is a valid and reliable questionnaire to assess breakthrough pain in Mexican patients with cancer. This newly validated tool may be used to facilitate clinical management of primarily Spanish-speaking patients with breakthrough cancer pain. KEY MESSAGE: This study describes a prospective observational study to assess the validity and reliability of the Breakthrough Pain Assessment Tool in its Spanish version. The results support the use of this newly validated tool to facilitate clinical management of primarily Spanish-speaking patients with breakthrough cancer pain.

Nurses' Beliefs About Pain Assessment in Dementia: A Qualitative Study Informed by the Theory of Planned Behaviour.

AIM: To explore registered nurses' beliefs regarding pain assessment in people living with dementia. DESIGN: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour. METHODS: Online semi-structured in-depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis. FINDINGS: Registered nurses believe pain assessment improves the well-being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments. CONCLUSION: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices. IMPACT: Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices. REPORTING METHOD: This study adhered to the COREQ criteria. PATIENT OR PUBLIC CONTRIBUTION: Registered nurses caring for people living with dementia participated as interview respondents.

Pain intensity scales: A cross-sectional study on the preferences and knowledge of physiotherapists and participants with musculoskeletal pain.

BACKGROUND: Subjective pain intensity can be measured using instruments like the Faces Pain Scale-Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Pain Rating Scale (NPRS), and Visual Analogue Scale (VAS). However, information on physiotherapists' and patients' knowledge and preference for these tools is scarce. OBJECTIVE: We investigated the knowledge and preference of physiotherapists and participants with musculoskeletal pain (MP) regarding the pain intensity measurement scales. METHODS: This cross-sectional study consisted of physiotherapists and participants with MP. Physiotherapists were recruited via social media for an online open survey, gathering sociodemographic, professional data, and their knowledge and preferences for pain intensity scales. Participants over 18 with MP, participated in interviews focusing on their familiarity and preferences for pain intensity scales. Data was analyzed descriptively, and Chi-squared test evaluated scale preferences. RESULTS: We included 352 physiotherapists (mean experience = 10.5 years) and 94 participants with MP. Of the physiotherapists, 94.3% were familiar with pain scales, but 30.4% struggled to differentiate them. The NPRS was the most used (56.3%) and preferred scale (52.4%). Among participants with MP, unfamiliarity was noted with all scales. After instruction, 46% preferred FPS-R, with preference varying by income and education levels (p < 0.001). CONCLUSION: We found a knowledge gap among physiotherapists in identifying pain intensity scales, with a preference for the NPRS among those familiar with the scales. Participants with MP had limited familiarity with these scales. After instructions, these participants preferred the FPS-R, particularly those with lower income and education levels.

Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis.

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

Advancing the integration of biosignal-based automated pain assessment methods into a comprehensive model for addressing cancer pain.

BACKGROUND: Tailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address the potential correlations between subjective and APA-derived objectives variables in a cohort of cancer patients. METHODS: A multidimensional statistical approach was employed. Demographic, clinical, and pain-related variables were examined. Objective measures included electrodermal activity (EDA) and electrocardiogram (ECG) signals. Sensitivity analysis, multiple factorial analysis (MFA), hierarchical clustering on principal components (HCPC), and multivariable regression were used for data analysis. RESULTS: The study analyzed data from 64 cancer patients. MFA revealed correlations between pain intensity, type, Eastern Cooperative Oncology Group Performance status (ECOG), opioids, and metastases. Clustering identified three distinct patient groups based on pain characteristics, treatments, and ECOG. Multivariable regression analysis showed associations between pain intensity, ECOG, type of breakthrough cancer pain, and opioid dosages. The analyses failed to find a correlation between subjective and objective pain variables. CONCLUSIONS: The reported pain perception is unrelated to the objective variables of APA. An in-depth investigation of APA is required to understand the variables to be studied, the operational modalities, and above all, strategies for appropriate integration with data obtained from self-reporting. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number (NCT04726228), registered 27 January 2021, https://classic. CLINICALTRIALS: gov/ct2/show/NCT04726228?term=nct04726228&draw=2&rank=1.

Evidence for central sensitization as classified by the central sensitization inventory in patients with pain and hypermobility.

INTRODUCTION: Pain is a very common complaint among patients with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSDs). Often challenging to treat, insights into the underpinnings of pain in this population have been fleeting. Central sensitization (CS) has been postulated as a potential etiological factor. METHODS: In this retrospective study, 82 consecutive patients with hEDS/HSDs were reviewed. Demographic information and Central Sensitization Inventory (CSI) results were collected. RESULTS: 71 of 82 (86.5%) patients demonstrated CS. Scores ranged from 12 to 94 with a median of 56. Pain scores as measured on the numerical rating scale (NRS) ranged from 2 to 10 with a mean and median of 6. CONCLUSION: A large percentage of patients with pain and a diagnosis of hEDS/HSDs demonstrated evidence of central sensitization as measured using the CSI. The CSI is simple to administer. The CSI may provide clinical insights that are key to successfully managing patients with hEDS/HSDs. Further research is needed to explore the ability to classify pain phenotypes in this patient population and the impact on precision medicine.