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Measurement of pain

Measurement of pain . Dr. S. Parthasarathy MD., DA., DNB, MD ( Acu ), Dip. Diab . DCA, Dip. Software statistics PhD ( physio ) Mahatma Gandhi medical college and research institute , puducherry – India . Why this topic ? . Pain is not simple Subjective Multi dimensional

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Measurement of pain

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  1. Measurement of pain Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio) Mahatma Gandhi medical college and research institute , puducherry – India

  2. Why this topic ? • Pain is not simple • Subjective • Multi dimensional • Sensory, emotional etc…etc… • Day , age , drugs etc, etc ….

  3. The first man • So simple • Keele , Lancet , 1948 • Measured pain as • Mild, moderate, severe • Unfortunately or fortunately , it still remains

  4. Rotter scale and locus of control • The Locus of Control is a 13 item questionnaire • People with an internal locus of control believe that their own actions determine the rewards • those with an external locus of control believe that their own behavior doesn't matter much •    Scores range from 0 to 13.  A low score indicates an internal control while a high score indicates external control. • But why we need it ??

  5. Nurse or PCA • Internal ------ • External --------

  6. In the post op ward Pulse BP Temperature Respiration And pain as the fifth vital sign

  7. So how do we measure pain ?? • Pain is a separate language • Subjective • Multidimensional • So very difficult

  8. Visual analog scale 3.5

  9. Advantages • Extremely simple • Sensitive • Reproducible • Quick • Cheap • Can also use for nausea, patient satisfaction • Both vertical and horizontal scales are available

  10. Disadvantages • Patient understanding • Resting and movement • Unidimensional

  11. Numerical rating scale similar to VAS 0- 10 numbers 0 = least pain 10 = maximum pain

  12. Simple, VAS and NRS

  13. Mcgill pain questionnaire • Melzack- Torgerson (1971) • Sensory • Affective • and emotional components of pain addressed

  14. Mcgill pain questionairre • Crushing • Throbbing • Cramping • Splitting • Cutting • Shooting • Etc etc

  15. Mcgill pain questionnaire

  16. Mcgill pain questionairre • 102 word descriptors into 20 subclasses • For each subclass – patient has to tell the description • To tell the score

  17. Three things in MPQ • PRI • Summation of Scores of each class • NWC number of words chosen • PPI • 1 to 5 (mild to very severe

  18. Advantages - Disadvantages • Wholesome • Data analysis • All components • Assessment of therapy • Very lengthy • Frustrated • Repetition not possible • Knowledge of patients

  19. Short form MPQ • Instead of 20 – 15 • Instead of 102 - 15 * 4 = 60 • VAS • PPI is there. • Less vast and less frustrating

  20. Short form

  21. MPQ and all painful conditions • 50 • Causalgia 40 amputation • LBA,cancer, PHN primi • Arthritis 30 multi • toothache 20 fracture, bruise, cut 10 sprain 0

  22. Nonverbal adults

  23. Paediatric pain assessment

  24. Problems in children • Pain can be measured by self-report (what children say), • biological markers (how their bodies react), and behavior (what children do). • Because pain is a subjective event, self-report is best if it is available. • behavioral or biological measures • Cry, vocalization HR,BP,autonomic NS • Faces

  25. It may vary • Stranger • Fearing child • Injection

  26. Regular techniques • VAS • NRS • Acceptable over 8 years • Faces Pain Scales • Faces pain scales comprise a series of line diagrams of faces with expressions of increasing distress

  27. OUCHER • The OUCHER is a poster developed for children to help them communicate how much pain or hurt they feel.  • There are two scales on the OUCHER:  a number scale for older children and a picture scale for younger children.

  28. Wong baker faces rating scale

  29. Wong baker faces rating scale

  30. CHEOPS Children’s Hospital Eastern Ontario Pain Scale

  31. Body outlines and colouring

  32. So many scales • Manchester scale • Pieces of hurt scale • The Bieri Faces Pain Scale • Face, Legs, Activity, Cry, Consolability Scale (FLACC)

  33. Poker chips

  34. Neonate • The Neonatal Facial Action Coding System consists of 10 facial actions that coders identify from videotapes. • Facial movements observed in response to heel lance were: brow bulge, • eye squeeze, • nasolabial furrow and lip part, taut tongue, mouth stretch, and chin quive

  35. AGE and pain assessment • coding hurt Faces VAS NRS 0 2 4 6 8 1 0 12

  36. Special Considerations for the CognitivelyImpaired Child • What are the Barriers to effective pain management in the cognitively impaired ? • the complexity of pain assessment in those who cannot verbalize their pain • outdated beliefs that these children have altered or • blunted pain perception • limited evidence for the safety and efficacy of analgesic regimens • an exaggerated concern regarding opioid side effects

  37. The University of Wisconsin Pain Scale for Preverbal andNonverbal Children • Cry, • Faces • Behaviour • Posture • Sleep • And the FLACC scale

  38. Summary • Pain measurement – multidimensional • SDS, VAS, NRS • Mcgill - long and short forms Paediatric pain Codes, hurt, faces , VAS , NRS

  39. The pain ends - Thank you all

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