The primary aims of this review were to provide an overview of general pain tools and instruments and to evaluate their validity, reliability, responsiveness and interpretability in order to reduce methodological concerns in COPD and pain studies. The primary aims of this review were to identify general pain measurement tools and instruments used in an adult population and assess their psychometric properties. The review objectives were to provide an overview of the psychometric quality and to compare the assessment of each psychometric property in terms of validity, reliability, responsiveness and interpretability of general pain instruments or tools.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used to underpin the development of the review protocol. The search was not restricted to any publication time-frame although it was restricted to publications in English.
The reference lists of selected relevant articles were screened for potential publications. The review protocol outlined the process where abstracts were identified and reviewed for inclusion.
For all included abstracts, full-text articles were retrieved. All included full-text publications were further searched to identify the original psychometric studies of the pain tool or instrument. The protocol restricted the search to psychometric studies that included adult participants and the measurement was pain. The collecting, collating and evaluation of the published data were predetermined by the reviewers before the commencement of the study.
The review of abstracts that met the inclusion criteria was performed by two independent reviewers AMJ, SMSS and was aided by a predesigned data extraction spreadsheet. Disagreements over inclusion of full-text articles were settled through discussion and consensus reached. All included articles were assessed for methodological quality using the consensus-based standards for the selection of health measurement instruments COSMIN checklists of domains and properties in each domain.
Each of these domains had prescribed and defined measurement properties Table 1. For example, validity has the properties of content validity, construct validity and criterion validity. The first analysis was a quality assessment which employed a specific COSMIN checklist incorporating a dichotomous scale comprising of yes and no with numerical value assignment of 1 and 0, respectively. The second analysis of general pain instruments and tools utilized the COSMIN 4-point rating scale, 17 which calculates a summary of methodological quality for each domain.
Each component was assessed using a rating of excellent, good, fair or poor 17 Table 2. As per COSMIN guidance an overall score of the general pain instrument or tool was subsequently calculated using a predeveloped assessment scale by Terwee et al 17 to rate the level of quality.
To examine the overall quality of statistical methods used in the development of each general pain instrument or scale, a rating system was adapted from prescribed criteria in accordance with COSMIN recommendations. The database search initially yielded 1, potentially relevant studies. Duplicate papers were removed and abstracts screened with full-text versions of the published articles retrieved.
Additionally, five pain measurement instrument or tools studies were identified through further searching of reference lists. Eligibility criteria were applied and eight general pain measurement instrument development and validation studies were included for methodological quality assessment Figure 1. Figure 1 illustrates the selection of general pain measurement studies reported in this review.
PLoS Med. Detailed results for content validity, criterion validity, reliability, internal consistency, responsiveness and interpretability show several general pain instruments were highly rated in one domain but were found to be poor in other aspects of the psychological properties.
The first analysis employed a dichotomous scale and the Pain Sensitivity Questionnaire PSQ 18 scored high in four of the six domains including content validity, internal consistency, responsiveness without a gold standard comparison and interpretability.
The Geriatric Pain Measure GPM 19 also scored highly in four of the six domains including content validity, criterion validity, internal consistency and responsiveness without a gold standard comparison. The second analysis using the COSMIN 4-point rating scale Table 5 , found that the PSQ scored highly in three of the five assessed domains including content validity, internal consistency and responsiveness.
The GPM scored highest in two of the five assessable domains including criterion validity and internal consistency. The PainMatcher 20 scored highest in reliability and the PCP:S 21 scored highest in responsiveness using this assessment. The third analysis in the examination of overall quality of statistical methods used Table 6 in the development and validation studies of pain tools and instruments, the GPM scored highest in the content validity, criterion validity, reliability and internal consistency domains.
Our review of validation studies revealed a wide variety of pain measurement instruments and tools have been studied and included general pain and disease-specific pain measurement. This review utilized three approaches to assess selected general pain instruments or tools and found that several pain measurement instruments scored significantly higher on the COSMIN criteria in validity, reliability, responsiveness and interpretability.
From this review, the findings suggest that there is wide variability in quality of pain measurement instruments and tools across all domains.
This variability may be due to increased rigor and changing expectations in validation studies across time resulting in the potential for varying methodologies and quality of publication.
These findings were consistent in each separate analysis. Table 2. Also evaluates analgesic use, patient-related barriers to effective pain management, and items to asses the following 9 concepts: amount of time that pain is greater than the tolerable level; patient satisfaction with pain level; expectations about the pain; effectiveness of previous pain treatments; pain medication treatment pattern; nondrug treatments used for pain; tendency to tell or not tell others about the pain; onset of pain; and belief about the cause of the pain.
Diagnosis of medical and psychological comorbidities Patients with SCD can experience pain caused by complications of the disease such as avascular necrosis of joints, gallstones, and leg ulcers. Assessment of pain at home The biologic differences between acute and chronic pain will not be discussed in this paper. Investigational pain-measurement tools that assess pain biology There are a variety of tools currently under investigation that address pain measurement in SCD.
Quantitative sensory testing A pain-assessment tool currently used in investigational studies is QST. Neuroimaging Brain-imaging methodologies such as functional magnetic resonance imaging fMRI , positron emission tomography PET , and scalp electroencephalography EEG are noninvasive and useful in understanding the neural basis of pain in a living human being. Patient-reported measurement tools that assess pain biology Questionnaires focused on the phenotypic characterization of pain are currently under investigation in patients with SCD.
Table 3. Patient-reported screening tools to phenotype pain in patients with SCD. No cutoff score established to differentiate neuropathic from nonneuropathic pain. Generally, higher T-scores indicate more neuropathic pain. Generally, higher T-scores indicate more nociceptive pain.
Plasma biomarkers for pain measurement Currently, there are no plasma biomarkers that can be used in isolation to measure pain in patients with SCD. Conclusions The assessment and measurement of pain is a complex phenomenon that relies on patient report. Figure 1. References 1. The cost of health care for children and adults with sickle cell disease. Am J Hematol. Health-related quality of life in children with sickle cell disease: a report from the Comprehensive Sickle Cell Centers Clinical Trial Consortium.
Pediatr Blood Cancer. Severe painful vaso-occlusive crises and mortality in a contemporary adult sickle cell anemia cohort study. PLoS One. AAPT diagnostic criteria for chronic sickle cell disease pain. J Pain. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. Somatic symptom burden in adults with sickle cell disease predicts pain, depression, anxiety, health care utilization, and quality of life: the PiSCES project.
Thinking beyond sickling to better understand pain in sickle cell disease. Eur J Haematol. International Association for the Study of Pain. IASP taxonomy: pain. Available at: www. Accessed 22 April The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties.
Arthritis Care Res Hoboken. Pain Res Manag. ASCQ-Me short forms. Accessed 20 April PedsQLTM sickle cell disease module: feasibility, reliability, and validity. Qual Life Res. The impact of childhood chronic disease on child patient reported outcomes. Project information: 1U19AR Accessed 1 May Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain. Vaso-occlusive painful events in sickle cell disease: impact on child well-being.
A multicenter randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children. Impact of emergency department care on outcomes of acute pain events in children with sickle cell disease. Panepinto JA. Health-related quality of life in patients with hemoglobinopathies. Dobrozsi S, Panepinto J.
Patient-reported outcomes in clinical practice. Basch E. N Engl J Med. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. It is rated by a healthcare professional, such as a nurse or physician. Two points are assigned to each parameter.
A rating of 0 means there are no signs of pain. A rating of 2 means there are signs of extreme pain. Some of the common populations this scale might be used with include:. Each is rated from 1 to The McGill Pain Questionnaire consists of 78 words that describe pain. A person rates their own pain by marking the words that most closely match up to their feelings. Some examples of the words used are:. Once a person has made their selections, a numerical score with a maximum rating of 78 is assigned based on how many words were marked.
This scale is helpful for adults and children who can read. The color analog pain scale uses colors:. The colors are usually positioned in a line with corresponding numbers or words that describe your pain. The color analog scale is often used for children and is considered reliable. The Mankoski pain scale uses numbers and corresponding, specific descriptions of pain so you can be sure that you and your healthcare provider understand one another.
Descriptions are detailed. They include phrases such as "very minor annoyance, occasional minor twinges" or "cannot be ignored for more than 30 minutes. The brief pain inventory is a worksheet made up of 15 questions.
You are asked to numerically rate the effect of your pain on categories such as how you relate with other people, how well you can walk walk, and how you've sleep over the last 24 hours. This scale has 12 lines, each of which has a descriptor—such as faint, strong, intense, and very intense—placed in the middle of it.
There is a plus sign at the end of each line. There is a minus sign at the start of each line. You are asked to mark each line in the middle if your pain matches what the descriptor implies. If your pain is less intense, you place your mark on the minus side of the line instead. Likewise, if your pain is more intense, your mark should be placed on the plus side of the line.
Pain scales can help doctors determine how much pain you are experiencing and the impact it is having on you. They can also help define your pain in mutually understood terms. There are several kinds of pain scales. Some uses pictures or colors, while others use numbers or words. A healthcare provider may choose to use one scale over another depending on what they want to learn, the capacity of their patient e.
Regardless, pain scales help ensure better communication between a healthcare provider and a patient so a proper diagnosis and treatment plan can be established. Some doctors regularly use a pain scale with patients. Some hospital rooms even have them posted on their walls, prompting staff to have a discussion about pain each time they pay a patient a visit.
If you are not asked to use a pain scale but are having a hard time clearly communicating your pain to a healthcare provider, ask for one.
Many people find that it helps them more easily measure their pain and explain it to their doctor. FLACC stands for face, legs, activity, crying, and consolability. Face 4 hurts a little more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you don't have to be crying to feel this bad. Ask the person to choose the face that best describes how he is feeling.
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates physical, behavioural and self report is preferred when possible. These include:. Further information on pain management principles and assessing pain in children can be found here:. The evidence table for this guideline can be viewed by clicking here. Please remember to read the disclaimer. Updated February The Royal Children's Hospital Melbourne.
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