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.

Effects of photobiomodulation and an aerobic exercise on the level of pain and quality of life in women with fibromyalgia.

To evaluate the effectiveness of photobiomodulation (PBM) in conjunction with an aerobic exercise program (AEP) on the level of pain and quality of life of women with fibromyalgia (FM). METHODS: A double-blinded randomized controlled trial in which 51 participants with FM were allocated into 4 groups: control group (CG) (n = 12); active PBM group (APG) (n = 12); AEP and placebo PBM group (EPPG) (n = 13); AEP and active PBM group (EAPG) (n = 14). AEP was performed on an ergometric bicycle; and a PBM (with an increase dosage regime) [20 J, 32 J and 40 J] was applied using a cluster device. Both interventions were performed twice a week for 12 weeks. A mixed generalized model analysis was performed, evaluating the time (initial and final) and group (EAPG, EPPG, APG and CG) interaction. All analyses were based on intent-to-treat for a significance level of p ≤ 0.05. RESULTS: The intra-group analysis demonstrated that all treated groups presented a significant improvement in the level of pain and quality of life comparing the initial and final evaluation (p < 0.05). Values for SF-36 and 6-minute walk test increased significant in intragroup analysis for EPPG comparing the initial and final evaluation. No intergroup differences were observed. CONCLUSIONS: Both exercised and PBM irradiated volunteers present improvements in the variables analyzed. However, further studies should be performed, with other PBM parameters to determine the best regime of irradiation to optimize the positive effects of physical exercises in FM patients.

Acute post-orchiectomy pain does not reduce alpha rams' interest in feed resources.

Sheep pain is an animal welfare issue monitored based on behavioral responses, including appetite. Dominant (alpha) males have priority for accessing limited feed resources, however, the effects of pain on feed interest in members of a group with defined social hierarchy are unknown. Our objective was to investigate effects of acute post-orchiectomy pain on alpha rams' interest in accessing a limited feed resource. Eighteen rams were randomly housed in pens of 3 rams. After acclimation, the first 5-d (consecutive) battery of a behavior test was performed. In this test, 180 g of the regular diet concentrate was placed in a portable trough in the center of the pen; this feed was supplemental to the diet and represented a limited, albeit strongly preferable feed resource. Rams were filmed for 5 min after the feed introduction. Hierarchical levels (alpha, beta, and gamma) were defined based on the social hierarchical index according to higher initiator and lower receptor agonistic behaviors from the social network analyses. After 15 d, a second 5-d behavioral test battery was repeated. On the following day, alpha rams were castrated. Flunixin meglumine was given immediately before surgery and a final behavioral test was performed 8 h post-orchiectomy, concurrent with an expected peak in postoperative pain. For all recordings, the latency, frequency, and duration of time that each ram had its mouth inside the feed trough were recorded, and the Unesp-Botucatu sheep acute pain scale pain scale (USAPS) was applied. The social hierarchical index was highest in alpha rams, followed by beta and gamma. The pain scores were statistically equivalent across the 11 evaluation days for beta and gamma rams, whereas there was an increase in the final evaluation for alpha. There was no difference in latency, frequency, and duration between alpha, beta, and gamma rams across evaluations. We concluded that acute post-orchiectomy pain did not decrease alpha rams' interest in accessing limited feed. Routine feeding offers a valuable chance to detect pain-related behavior using the USAPS in rams. However, dominance may confound appetite-related behaviors in assessing acute pain, as alpha rams' interest in limited feed remained unaffected by the pain.

Effects of adding electro-massage to manual therapy for the treatment of individuals with myofascial temporomandibular pain: a randomized controlled trial

Abstract Objective To evaluate the effect of the addition of dynamic cervical electrical stimulation (electro-massage, ES) to manual therapy (MT), compared to MT by itself, in individuals with myofascial temporomandibular pain. Methodology A total of 46 participants with bilateral myofascial temporomandibular pain for at least three months were distributed into two groups. Group 1 (n=21) received local MT consisting of soft tissue mobilization and release techniques over the neck and temporomandibular regions. Group 2 (n=25) received an ES procedure in the cervical region combined with the same intervention as group 1. All participants underwent a 2-week protocol. The primary outcomes were pain intensity (Visual Analogue Scale), pressure pain threshold (PPT) at the masseter and upper trapezius muscles (algometer), and pain-free vertical mouth opening (manual gauge). The secondary outcome was active cervical range-of-movement. Measurements were taken at baseline, immediately after intervention, and at a 4-week follow-up. Results The ANOVA revealed significant changes over group*time, with better results for group 2 (large effect sizes) regarding pain intensity (p< 0.001; η2>0.14), pressure pain sensitivity and mouth opening (p<0.001; η2>0.14). Similar findings were observed for active cervical range-of-movement in all directions (p<0.001; η2>0.14), except rotation (p≥0.05). Conclusion Electrical stimulation therapy over the cervical region combined with a MT protocol over the neck and temporomandibular joint shows better clinical benefits than MT by itself in subjects with myofascial temporomandibular pain. Registration code: NCT04098952

Analysis of agreement in the evaluation of pain in newborns during hepatitis B vaccination / Análise de concordância na avaliação da dor de recém-nascidos durante a vacinação contra hepatite B

ABSTRACT BACKGROUND AND OBJECTIVES: Healthy newborns inevitably undergo painful procedures from the first hours of life and pain assessment is essential for choosing the right treatment. The objective of this study was to evaluate the agreement between evaluators of the Neonatal Facial Coding System (NFCS) pain scale in healthy newborns before, during and after hepatitis B vaccination performed in the first 48 hours of life. METHODS: This is an analysis of agreement between two evaluators, carried out as part of a quasi-experimental intervention study, developed in a maternity hospital in Belo Horizonte. Two researchers carried out an independent evaluation based on filming 2 minutes before, during and 2 minutes after the procedure. RESULTS: The study included 129 newborns between August and December 2022, 60 (46.51%) in the control group (facilitated restraint) and 69 (53.49%) in the intervention group (breastfeeding). There was substantial agreement between the researchers before (0.69) and after (0.70) vaccination. When the agreement between the groups was analyzed, it was substantial for the evaluations of newborns submitted to facilitated restraint before and after the procedure. In the breastfeeding group, agreement was almost perfect before and substantial after the procedure. CONCLUSION: There was substantial agreement between the researchers who used the NFCS scale before, during and after vaccination. This data validates the use of the scales when assessing the pain of newborns undergoing easy restraint and breastfeeding, even though it is an indirect method of assessment. It is important to highlight the importance of periodic staff training programs for the use of pain assessment scales at bedside.

RESUMO JUSTIFICATIVA E OBJETIVOS: Recém-nascidos saudáveis são submetidos a procedimentos dolorosos desde as primeiras horas de vida e a avaliação da dor é essencial para escolha do tratamento adequado. O objetivo deste estudo foi avaliar a concordância entre pesquisadores da escala Neonatal Facial Coding System (NFCS) antes, durante e após a vacinação contra hepatite B nas primeiras 48 horas de vida de recém-nascidos saudáveis. MÉTODOS: Trata-se de uma análise de concordância entre pesquisadores, realizada como um estudo de intervenção quase-experimental, desenvolvido em uma maternidade pública de Belo Horizonte. Dois pesquisadores procederam a avaliação independente a partir de filmagens 2 minutos antes, durante e 2 minutos após o procedimento. RESULTADOS: Foram incluídos 129 recém-nascidos entre agosto e dezembro de 2022, sendo 60 (46,51%) no grupo controle (contenção facilitada) e 69 (53,49%) no grupo intervenção (amamentação). Observou-se concordância substancial entre os pesquisadores antes (0,69) e após (0,70) a vacinação. Quando analisada concordância entre os grupos, ela foi substancial para as avaliações de recém-nascidos submetidos à contenção facilitada antes e após o procedimento. No grupo submetido à amamentação, a concordância foi quase perfeita antes e substancial depois do procedimento. CONCLUSÃO: Há concordância substancial entre os pesquisadores que utilizaram a escala NFCS antes, durante e após a vacinação. Este dado valida a utilização das escalas durante a avaliação da dor de recém-nascidos submetidos à contenção facilitada e amamentação, mesmo tratando-se de um método indireto de avaliação. É importante destacar a importância de programas periódicos de capacitação da equipe para utilização de escalas de avaliação da dor à beira leito.

Pain management: education of the adult Intensive Care Unit nursing staff / Gerenciamento da dor: educação da equipe de enfermagem da Unidade de Terapia Intensiva adulta

ABSTRACT BACKGROUND AND OBJECTIVES: Taking into account the complexity and subjectivity of pain for the patient and the need for constant updating of the healthcare team, the objective was to verify the knowledge and care practices of the nursing team regarding pain management in hospitalized adult patients in the Intensive Care Unit (ICU) before and after carrying out an educational activity. METHODS: 32 nurses and nursing technicians who had been working in the ICU for more than six months participated. The stages included the application of the pre-test, educational activity and post-test, addressing assessment scales and pharmacological and non-pharmacological management methods. RESULTS: Regarding the concepts of chronic pain and acute pain, 68% responded that they knew the differences, however 15% answered questions related to acute pain correctly and 3% answered questions related to chronic pain correctly in the pre-test. Regarding prior knowledge about pain assessment scales, 84% knew the Numerical Verbal Scale, 15% knew the Behavioral Pain Scale, and 6% knew the Advanced Dementia Pain Scale; 62% said they had difficulty assessing pain in patients with advanced dementia and/or on mechanical ventilation. In questions related to pharmacological management, 44% got the questions right in the pre-test and 71% got them right in the post-test. Regarding non-pharmacological management, 31% always perform it, and 96% use adequate positioning in bed as a measure. CONCLUSION: After the educational activity, there was an increase in the number of correct answers regarding questions related to assessment scales, pharmacological and non-pharmacological management.

RESUMO JUSTIFICATIVA E OBJETIVOS: Levando em consideração a complexidade e subjetividade da dor para o paciente e a necessidade de atualização constante da equipe de saúde, objetivou-se verificar o conhecimento e as práticas assistenciais da equipe de enfermagem acerca do manejo da dor de pacientes adultos internados na Unidade de Terapia Intensiva (UTI) antes e após a realização de uma atividade educativa. MÉTODOS: Participaram do estudo 32 enfermeiros e técnicos de enfermagem alocados em UTI há mais de seis meses. As etapas compreenderam a aplicação do pré-teste, atividade educativa e pós-teste, abordando escalas de avaliação e métodos de manejo farmacológico e não farmacológico. RESULTADOS: Quanto aos conceitos de dor crônica e dor aguda, 68% responderam que conheciam as diferenças, porém 15% acertaram questões relacionadas à dor aguda e 3% acertaram questões relacionadas à dor crônica no pré-teste. Quanto ao conhecimento prévio sobre as escalas de avaliação da dor, 84% conheciam a Escala Verbal Numérica, 15% conheciam a Behavioral Pain Scale, e 6% conheciam a Escala de dor na Demência Avançada; 62% afirmaram sentirem dificuldade em avaliar a dor em pacientes com demência avançada e/ou em ventilação mecânica. Nas questões relacionadas ao manejo farmacológico, 44% acertaram as questões no pré-teste e 71% acertaram no pós-teste. Em relação ao manejo não farmacológico, 31% realizam sempre, e 96% utilizam como medida o posicionamento adequado no leito. CONCLUSÃO: Após a atividade educativa, houve aumento no número de acertos referente às questões relacionadas às escalas de avaliação, manejo farmacológico e não farmacológico.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD) / Dor em idosos com demência: validação da versão brasileira do instrumento Pain Intensity Measure for Persons with Dementia (PIMD)

Abstract Background Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. Objective To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. Methods Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. Results A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). Conclusion The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

Resumo Antecedentes Embora existam várias formas de estimar a dor na demência ainda há necessidade de ferramentas com melhores itens para avaliação da presença e intensidade da dor nesses indivíduos. Objetivo Analisar as propriedades psicométricas de uma ferramenta de avaliação da dor em idosos dementados, a "Pain Intensity Measure for Persons with Dementia Portuguese - PIMD-p". Métodos Idosos expostos a situações potencialmente dolorosas, sendo esses dementados e com prejuízo na comunicação verbal, foram selecionados em uma unidade ambulatorial e uma instituição de longa permanência, em São Paulo. A PIMD-p foi aplicada por 2 pesquisadores (E1 e E2), de forma separada, num mesmo dia, e, com intervalo de no máximo 14 dias, essa foi reaplicada por apenas um deles (E3), e ainda, foi obtida a intensidade álgica inferida pelos cuidadores dos idosos participantes. Na análise estatística foram utilizados o Alfa de Cronbach, o Coeficiente de Spearman e o Índice de Correlação Intraclasses. Resultados Selecionada uma amostra de 50 idosos com média de idade de 86 anos, a maioria portadora de demência moderada e de dor de origem musculoesquelética. Apuradas para a PIMD-p uma boa consistência interna, segundo o alfa Cronbach (0,838); excelentes reprodutibilidades intra e interobservador (0,927 e 0,970, respectivamente; p < 0,001); e uma validade convergente, essa última obtida com as fortes e significativas correlações entre as intensidades dolorosas inferidas e os indicadores de dor do instrumento em estudo (exceto para o indicador "olhar expressivo"; corr = 0,106 e p = 0,462). Conclusão A PIMD-p se mostrou ser uma ferramenta com propriedades de medida adequadas para avaliar a presença e intensidade álgicas em idosos com demência e com prejuízo na comunicação verbal.

Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy.

Pain assessment guides decision-making in pain management and improves animal welfare. We aimed to investigate the reliability and validity of the UNESP-Botucatu cattle pain scale (UCAPS) and the cow pain scale (CPS) for postoperative pain assessment in Bos taurus (Angus) and Bos indicus (Nelore) bulls after castration. METHODS: Ten Nelore and nine Angus bulls were anaesthetised with xylazine-ketamine-diazepam-isoflurane-flunixin meglumine. Three-minute videos were recorded at -48 h, preoperative, after surgery, after rescue analgesia and at 24 h. Two evaluators assessed 95 randomised videos twice one month apart. RESULTS: There were no significant differences in the pain scores between breeds. Intra and inter-rater reliability varied from good (>0.70) to very good (>0.81) for all scales. The criterion validity showed a strong correlation (0.76-0.78) between the numerical rating scale and VAS versus UCAPS and CPS, and between UCAPS and CPS (0.76). The UCAPS and CPS were responsive; all items and total scores increased after surgery. Both scales were specific (81-85%) and sensitive (82-87%). The cut-off point for rescue analgesia was >4 for UCAPS and >3 for CPS. CONCLUSIONS: The UCAPS and CPS are valid and reliable to assess postoperative pain in Bos taurus and Bos indicus bulls.

Improving Ovine Behavioral Pain Diagnosis by Implementing Statistical Weightings Based on Logistic Regression and Random Forest Algorithms.

Recently, the Unesp-Botucatu sheep acute pain scale (USAPS) was created, refined, and psychometrically validated as a tool that offers fast, robust, and simple application. Evidence points to an improvement in pain diagnosis when the importance of the behavioral items of an instrument is statistically weighted; however, this has not yet been investigated in animals. The objective was to investigate whether the implementation of statistical weightings using machine learning algorithms improves the USAPS discriminatory capacity. A behavioral database, previously collected for USAPS validation, of 48 sheep in the perioperative period of laparoscopy was used. A multilevel binomial logistic regression algorithm and a random forest algorithm were used to determine the statistical weights and classify the sheep as to whether they needed analgesia or not. The quality of the classification, estimated by the area under the curve (AUC) and its 95% confidence interval (CI), was compared between the USAPS versions. The USAPS AUCs weighted by multilevel binomial logistic regression (96.59 CI: [95.02-98.15]; p = 0.0004) and random forest algorithms (96.28 CI: [94.17-97.85]; p = 0.0067) were higher than the original USAPS AUC (94.87 CI: [92.94-96.80]). We conclude that the implementation of statistical weights by the two machine learning algorithms improved the USAPS discriminatory ability.

A Cross-Cultural Adaptation and Content Validity of COMFORTneo Scale into Brazilian Portuguese.

CONTEXT: The instrument used to assess neonatal pain must be adequate regarding the type of pain, population, country, and language to provide the best evidence-based clinical strategies; however, few neonatal pain instruments have been translated and validated for the Brazilian population. OBJECTIVE: The aim was to perform a cross-cultural adaptation of the COMFORTneo scale into Brazilian Portuguese and to evaluate the content validity of the adapted scale. METHODS: The cross-cultural adaptation process followed six main steps: translation, synthesis of the translations, back-translation, submission to the expert committee, final version pretest, being that 65 individuals participated in this stage, including both healthcare professionals and students, and submission to the committee for process appraisal. Additionally, an equivalence form composed of a four-point Likert scale was sent to each committee participant to calculate the content validity index (CVI). The CVI was obtained as the sum of the items ranked as three or four by the experts divided by the total number of experts. RESULTS: No difficulties were reported in the production of translated versions. The CVI for the final version of the translated instrument was 0.99. The final version was reviewed to correct any possible grammatical errors. The layout was modified as necessary, and instructions on scale scoring were added to facilitate the application, resulting in the COMFORTneo Brazil scale. CONCLUSION: The COMFORTneo scale was properly and cross-culturally adapted into Brazilian Portuguese, reaching semantic, idiomatic, experimental, and conceptual equivalence with the original instrument, and a good CVI.

Using EmPalPed-An Educational Toolkit on Essential Messages in Palliative Care and Pain Management in Children-As a Strategy to Promote Pediatric Palliative Care.

Background: Most children needing palliative care (PC) live in low- and middle-income countries. In Colombia, pediatric palliative care (PPC) knowledge among healthcare professionals (HCPs) is lacking as PPC is not included in the educational curricula of healthcare programs. Therefore, specific training that improves knowledge of HCPs and access to PC for children and their families is needed. To address this gap, we organized and conducted the Essential Messages in Palliative Care and Pain Management in Children (EmPalPed), an educational toolkit to increase awareness and promote essential knowledge in PPC for low- and middle-income countries. Methodology: The EmPalPed toolkit consisted of a 5-h virtual workshop with small working groups of HCPs caring for children with life-threatening conditions such as cancer. The toolkit was organized along five key domains: (1) PC as it relates to the concept of quality of life (QoL), (2) effective communication, (3) addressing pain management as a top priority, (4) providing end-of-life care, and (5) access to high-quality PC as a fundamental human right. The workshop activities included different educational strategies and tools (e.g., a pocket guide for pain assessment and management, a PPC booklet, a quick guide for communicating bad news, role playing, and discussions of clinical cases). Results: A total of 145 HCPs from 22 centers were trained. The post-test analysis for HCPs showed that attitude and knowledge about communication (p < 0.001), pain assessment (p < 0.001), first-line opioid of choice in children (p < 0.001), and palliative sedation (p < 0.001) had positive and statistically significant changes from the pre-test analysis. Discussion: This study supported the notion that the EmPalPed educational toolkit is an effective mechanism for raising awareness regarding PPC as well as providing training in many of the key aspects of PPC. The EmPalPed training approach should be studied beyond this setting, and the impact should be measured longitudinally.

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction.

Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions. Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n = 12) - 20 mL of saline solution (control); Group II (n = 12) - 20 mL of 0.5% bupivacaine; Group III (n = 12) - 20 mL of 0.5% bupivacaine + 0.1 mg of epinephrine; and Group IV (n = 12) - 20 mL of saline solution + 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure. Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain ( p = 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions. Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II ( p = 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects ( p > 0.05).

A avaliação e registo da dor no serviço de urgência: um estudo transversal

Resumo: Introdução: A dor constitui-se como o principal motivo de procura de cuidados de saúde no serviço de urgência. Os enfermeiros têm um papel essencial na promoção e intervenção no controlo da dor dado serem profissionais com uma relação privilegiada com as pessoas. Objetivo: Descrever como foi avaliada e registada a dor na área de ambulatório de um serviço de urgência geral pela equipa de enfermagem. Metodologia: Estudo quantitativo, descritivo e transversal. Foram analisados os registos de avaliação da dor de 105 pessoas. Procedeu-se à análise dos dados utilizando estatística descritiva. Resultados: A dor foi avaliada em 53 episódios (50,48 %). A Escala de Avaliação Numérica foi o instrumento mais utilizado (43,81 %). As características da dor foram descritas em 39,05 % dos episódios. Em 1,90 % dos episódios houve registo de reavaliação da dor após implementação de medidas farmacológicas. Conclusão: A avaliação da dor foi subnotificada nas diferentes dimensões descritas no estudo. Neste sentido, torna-se essencial a definição de estratégias para a formação e treino dos enfermeiros sobre avaliação da dor.

Resumen: Introducción: El dolor es el principal motivo de búsqueda de atención sanitaria en un servicio de urgencias. Las enfermeras tienen un papel crucial en la promoción e intervención en el control del dolor, ya que son profesionales con una relación privilegiada con las personas. Objetivo: Describir cómo el equipo de enfermería valoró y registró el dolor en el área de menores de un servicio de Urgencias. Metodología: Estudio cuantitativo, descriptivo y transversal. Se analizaron los registros de valoración del dolor de 105 personas. El análisis de los datos se realizó mediante estadística descriptiva. Resultados: El dolor fue evaluado en 53 episodios (50,48 %). La Escala Numérica fue el instrumento más utilizado (43,81 %). Las características del dolor se describieron en el 39,05 % de los episodios. En el 1,90 % de las crisis se registró una reevaluación del dolor tras la aplicación de medidas farmacológicas. Conclusiones: La evaluación del dolor fue subestimada en las dimensiones presentadas en el estudio. Por ello, es imprescindible definir estrategias para la educación y formación de las enfermeras en la valoración del dolor.

Abstract: Introduction: Pain is the main reason for seeking healthcare in an emergency service. Nurses have a crucial role in promoting and intervening in pain control as they are professionals with a privileged relationship with people. Objective: Describe how the nursing team assessed and recorded pain in the minor's area of an Accident and Emergency service. Methodology: Quantitative, descriptive, and cross-sectional study. The pain assessment records of 105 people were analyzed. Data analysis was conducted using descriptive statistics. Results: Pain was assessed in 53 episodes (50.48 %). The Numerical Rating Scale was the most used instrument (43.81 %). The characteristics of pain were described in 39.05 % of the episodes. In 1.90 % of the attacks, there was a record of pain reassessment after implementing pharmacological measures. Conclusion: Pain assessment was underreported in the different dimensions described in the study. Thus, it is essential to define strategies for the education and training of nurses on pain assessment.

Assessment of The Addition of Epinephrine to Intra-articular Bupivacaine for the Control of Acute Pain in Patients underwent to Anterior Cruciate Ligament Reconstruction / Avaliação da adição da epinefrina à bupivacaína intra-articular no controle da dor aguda em pacientes submetidos a reconstrução do ligamento cruzado anterior

Abstract Objective To evaluate postoperative pain, using the visual analog scale (VAS), in patients undergoing anterior cruciate ligament reconstruction (ACLR) and receiving intra-articular anesthetic solutions. Methods The present is a randomized clinical trial with a sample of 48 patients divided into 4 groups: Group I (n » 12) - 20 mL of saline solution (control); Group II (n » 12) - 20 mL of 0.5% bupivacaine; Group III (n » 12) - 20 mL of 0.5% bupivacaine þ 0.1 mg of epinephrine; and Group IV (n » 12) - 20 mL of saline solution þ 0.1 mg of epinephrine. These solutions were injected into the knee at the end of the surgery. Pain was assessed using the VAS immediately and 6, 12, 24 and 48 hours after the procedure. Results The VAS scores were highly variable among the groups. A Kruskal-Wallis analysis of variance (ANOVA), considering a level of significance of 5%, revealed that all intra-articular anesthetic solutions influenced the assessment of pain (p » 0.003), and that Group-III subjects presented less postoperative pain. There was no evidence of a higher or lower use of supplemental analgesic agents, or of adverse effects resulting from these anesthetic solutions. Conclusion Bupivacaine combined with epinephrine was the most effective solution for pain control in patients undergoing ACLR, but with no statistically significant differences when compared to Group II (p » 0.547). There was no decrease or increase in the use of supplemental analgesics or in the occurrence of adverse systemic effects (p > 0.05).

Resumo Objetivo Avaliar primariamente a dor pós-operatória, por meio da escala visual analógica (EVA), nos pacientes submetidos a reconstrução do ligamento cruzado anterior (RLCA) que receberam soluções anestésicas intra-articulares (IAs). Métodos Ensaio clínico randomizado com uma amostra de 48 pacientes, divididos em 4 grupos: Grupo I (n » 12) - 20 ml de solução fisiológica (controle); Grupo II (n » 12) - 20 ml de bupivacaína a 0,5%; Grupo III (n » 12) - 20 ml de bupivacaína a 0,5% þ 0,1 mg de epinefrina; e Grupo IV (n » 12) - 20 ml de solução fisiológica þ 0,1 mg de epinefrina, injetados no joelho ao término da cirurgia. A dor foi avaliada pela EVA imediatamente e 6, 12, 24 e 48 horas após o procedimento. Resultados Observou-se grande variabilidade nos resultados da EVA entre os pacientes avaliados em cada grupo. Verificou-se, pela análise de variância (analysis of variance, ANOVA) de Kruskal-Wallis, considerando um nível de 5% de significância, que as soluções anestésicas IAs de cada grupo influenciaram na avaliação da dor desses pacientes (p » 0,003), sendo os do Grupo III os que apresentaram menor dor pósoperatória. Não se evidenciou um maior ou menor consumo de drogas analgésicas suplementares, ou efeitos adversos das decorrentes das soluções empregadas. Conclusão A solução combinada de bupivacaína e epinefrina foi a mais eficaz no controle da dor nos pacientes submetidos a RLCA, mas sem diferenças estatisticamente significativas com relação ao grupo II (p » 0,547). Não se observou diminuição ou aumento no consumo de analgésicos suplementares, ou o aparecimento de efeitos sistêmicos adversos (p > 0,05).

Quality Assessment of Neonatal Pain Scales Translated and Validated to Brazilian Portuguese: A Systematic Review of Psychometric Properties.

OBJECTIVES: The objective of this systematic review was to identify and describe the psychometric properties of neonatal pain scales that were translated into Brazilian Portuguese and to verify the methodological quality of these translation, transcultural adaptations and validation. DESIGN: The present study is a systematic review. A systematic search in the literature included studies of development, validation, and transcultural adaptation of neonatal pain scales to Brazilian Portuguese. The instruments must have been developed for health care professionals to evaluate neonatal pain and stress in full-term and preterm newborns. DATA SOURCES: The search strategy was conducted in PubMed, Web of Science, Scopus, and Scielo databases following The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). REVIEW /ANALYSIS METHODS: A total of 1,479 publications were identified and 5 fulfilled the inclusion criteria, with 4 instruments evaluated. For the methodological quality analysis of the measurement properties of the instruments the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist was used. The psychometric properties verified were internal consistency, content validity, reliability, and construct validity. RESULTS: Three instruments reviewed were inadequate and one was doubtful. CONCLUSIONS: The neonatal pain scales wich were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality based on COSMIM checklist. Caution should be considered for clinical decisions about pain management judgment coming from these instruments.

Exploring the Abilities of Peripheral Autonomic Parameters to Describe Pain: Another Dead End?

BACKGROUND: Pain is essential for survival, but it is also a major clinical, social, and economic problem that demands adequate management. The latter involves timely and accurate assessment, so several efforts have been made to develop accurate and reliable pain assessment tools. Advances in objective pain assessment include a large body of work focused on determining whether autonomic-mediated peripheral responses can be used to predict pain intensity. However, there is still no clinically validated autonomic marker for objective pain assessment. OBJECTIVES: In order to identify possible causes of this situation, the present study reviews the most recent advances examining peripheral autonomic markers' ability to describe pain intensity. STUDY DESIGN: Systematic literature review. METHODS: We conducted an online search on PubMed using terms such as "pain assessment," "experimental pain," "autonomic arousal," "heart rate," "heart rate variability," "electrodermal activity," "pupillary diameter," and "blood pressure." Articles published from 2010 through 2020 examining the abilities of peripheral autonomic markers to describe experimental pain intensity were collected and reviewed. From each of the included studies, we extracted information regarding autonomic parameters and stimulation modalities used by experimenters, as well as the sample size, gender, and health condition of the patients. RESULTS: Twenty-six articles were included for analysis, from which only 2 studies reported the use of multiple modalities. Half of the documents reported sample sizes ranging from 20 to 50 patients, and only 3 studies used formal power calculation to determine the sample size. Most of the articles included only healthy patients, so the influence of age, gender, and pre-existing health conditions on the autonomic peripheral parameters' capabilities to reflect the experience of pain remains unexplored. LIMITATIONS: It is possible that several documents were not retrieved due to a potential search engine bias or the use of very specific terms. Furthermore, only studies reporting pain intensity as a unique measure of its severity were included. CONCLUSION: The measurement of autonomic responses elicited by experimentally induced pain is one crucial step toward the development of reliable pain assessment tools. Still, several issues need to be addressed before continuing to explore the use of autonomic parameters for the assessment of pain. It is also recommended that future research endeavors in capturing the singularity of the pain experience involve the measurement of both peripheral (end organs) and central (brain) autonomic responses to pain.

Clinical Assessment of Chronic Musculoskeletal Pain-A Framework Proposal Based on a Narrative Review of the Literature.

The assessment of chronic musculoskeletal pain (CMP) is a challenge shared by several health professionals. Fragmented or incomplete assessment can cause deleterious consequences for the patient's function. The objective of this paper was to propose a framework for clinical assessment of CMP based on the current literature and following the conceptual model of the International Classification of Functioning and Health (ICF). We propose that the ICF rationale may help to guide the processes, acting as a moderator of the clinical assessment, since it changes the perspective used to obtain and interpret findings during anamnesis and physical examination. Additionally, updated specific knowledge about pain, including that of pain domains and mechanisms, along with effective patient-clinician communication may act as a mediator of CMP assessment. We conduct the readers through the steps of the clinical assessment of CMP using both the proposed moderator and mediators and present a clinical example of application. We suggest that the proposed framework may help clinicians to implement a CMP assessment based on the biopsychosocial model using a critical and updated rationale, potentially improving assessment outcomes, i.e., clinical diagnosis.

Can parental pain catastrophizing influence the relationship between dental caries and pain in early childhood?

OBJECTIVE: Knowledge on the parents' catastrophizing of the children's dental pain is lacking. This study aimed to verify whether parental pain catastrophizing influences the relationship between caries and dental pain in early childhood and if the child's age interacts with this relationship. STUDY DESIGN: A cross-sectional study was carried out with 83 dyads of children and their parents/primary caregivers. The parents answered the Brazilian version of the Pain Catastrophizing Scale-Parents and the Dental Discomfort Questionnaire. The children were examined to measure their caries experience. Correlations, simple mediation, and conditional process analyses were performed. RESULTS: The research participants were mostly male children (50.6%) with a mean age of 38 months (Q1 33.0, Q3 48.0). Most of the parents were mothers (n = 73; 88.0%) and had catastrophic thoughts (80.7%). Perceived dental pain in the child was positively correlated with the child's caries experience and parental pain catastrophizing. The parents' catastrophizing did not mediate the relationship between the caries experience and the pain intensity (a * b = 0.05; the lowest level of the confidence interval: -0.01; upper level of the confidence interval: 0.14). The child's age did not moderate the direct or indirect effect of the caries experience on the pain intensity of the children. CONCLUSION: In early childhood, parental catastrophizing of the children's pain and children's age does not influence the direct relationship between children's caries experience reported by the dentist and children's dental pain reported by parents.

Clinical Interpretation of Self-Reported Pain Scores in Children with Acute Pain.

OBJECTIVE: To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic. STUDY DESIGN: Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication. RESULTS: We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10). CONCLUSIONS: We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.