Postoperative pain assessment and management among nurses in selected hospitals in Benin City,Edo State,Nigeria

Objective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals,Benin City,Edo State,Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted.The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities.The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2%of nurses had a poor level of knowledge on postoperative pain assessment.The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90.“Providing clean,calm,and well-ventilated ward environment”(3.69±0.61)was the most used nonpharmacological method for postoperative pain management,followed by“distraction,relaxation,and guided imagery”(3.52±0.50),“dressing,bandage,splint,and reinforce wound sites postoperatively”(3.39±0.54),and“early ambulation/exercise”(3.20±0.62).The most used pharmacological interventions were“acetaminophen”(3.63±0.55),“topical anesthetic”(2.92±0.62),“nonselective nonsteroidal anti-inflammatory drugs”(2.87±0.43),and“mixed opioid agonist-antagonist”(2.56±0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting.It is,therefore,pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management,especially on nonpharmacological approaches among nurses.

Effect of Verbal Instructions in Pain Assessment during a Passive Straight Leg Raise Test in People with Chronic Low Back Pain

The most prevalent issue in physical therapy is pain. Due to the subjective nature of pain, assessment tools are essential in understanding it as objective data. However, assessment of pain may result in distress for the patient. A physical therapist (PT) should conduct these tests as quickly and accurately as possible. Straightforward instructions are vital in such cases. This study aimed to clarify the effect of verbal instructions for pain assessment during a passive straight leg raise (PSLR) test for participants with chronic low back pain (CLBP). This study included 22 participants who provided informed consent and received three consecutive PSLR tests with measurement of the hip flexion range of motion (HFROM) and were instructed to cease the test at submaximal pain before the first test. Following the second and third tests, participants were given specific verbal instructions to remember pain intensity, quality, and location. After each test, participants were to circle the pain location on the body chart and rate their pain intensity on a numeric rating scale (NRS) and pain quality. All participants were then interviewed about the differences between having and not having specific verbal instructions. The results of HFROM, NRS, and pain extent were not significantly different between the first and second tests or between the second and third tests using a paired t-test. Eleven changes in pain location were found in the second test compared to those in the first test. In the third test, only three participants circled a different area than in the second test. Ten participants showed similar changes with pain location in pain quality in the three PSLR tests. This study revealed the effect of specific verbal instructions prior to PSLR tests. Particularly, participants could notice exact pain location. Our findings may help PT to understand pain cause and reduce patients’ stress during pain assessment in clinical settings.

Assessment of neonatal pain:uni-and multidimensional evaluation scales

Neonatal pain is a problem that is easily overlooked.According to the status quo of neonatal pain management,commonly 9 scales are used for evaluation of neonatal pain;details of the specific indicators,such as the applicable neonatal gestational age range,score,and the type of pain,for the domestic references are provided so as to provide reference for the proper evaluation and standardized management of neonatal pain,as well as to promote the management level of neonatal pain.

Usefulness of PQRST pain assessment method for non-traumatic chest pain

Background The symptom of chest pain is one of the most common presenting complaints seen in primary and secondary care and is the leading cause of emergency department visits. PQRST pain assessment method might be useful, but contemporary researches of its feasibility for chest pain patients are limited. Methods Between March 2017 and August 2017, 533 consecutive patients as control group and 657 cases as treatment group were retrospectively recruited in the Emergency Department of our center. We compared the time took for the first cardiogram, the time spent in the emergency department, triage accuracy and patient stratification rate between two groups. Results In treatment group, statistically less time was spent to take the first cardiogram（5.3±1.2 vs. 11.2±2.5, P 〈 0.001）. This group had higher triage accuracy（92.34% vs. 86.91%, P = 0.003）and patient stratification（95.51% vs. 91.48%, P = 0.006）. Conclusions PQRST pain assessment method is useful and feasible for increasing triage accuracy and patient stratification rate of non-Traumatic chest pain patients in emergency department.

Distress Assessment and Response Systems in Patients With Cancer Pain

Objective This study used the Distress Assessment and Response Tool(DART)to screen,evaluate,and explore physical symptoms,psychological problems,and social support in patients with cancer pain,with an aim to provide data for the comprehensive care of these patients to improve their quality of life.Methods The DART was used to survey 497 patients with cancer pain who were admitted to the Cancer Center of the First Hospital of Jilin University from June 2014 to March 2017.All patients were diagnosed with malignant tumors by clinical,radiological and/or cytological examinations,and were experiencing tumor-related pain.This study recorded the patient’s somatic symptoms,psychological problems and social support in detail.After the data were collected,the SPSS 21.0 software was used to perform the statistical analysis,with the significance level set at P<0.05.Results In total,82.7%of patients were experiencing mild pain(NRS≤3);of these,29.7%and 15.8%reported depression and anxiety,respectively.In addition,17.3%of patients were experiencing moderate or severe pain(NRS≥4);of these,53.5%and 40.7%reported depression and anxiety,respectively.There was a statistically significant difference in the incidence of anxiety and depression between the two groups.Conclusion Patients with cancer pain,particularly those with moderate-to-severe pain,showed a high incidence of distress.In addition,they were likely to report physical symptoms,were conscious of poor health conditions,and were prone to have anxiety and depression.In terms of social support,patients with moderate-to-severe cancer pain should receive substantial support,as they experience work-related and economic concerns and report difficulties in family life and social activities.

Effect of Specific Verbal Instructions on the Identification of Pain Location during a Passive Straight Leg Raise Test

Musculoskeletal pain is common. Because pain is subjective, objectively describing it is crucial. However, pain assessment may cause distress in patients;therefore, physical therapists (PTs) should conduct these tests quickly and accurately. Simple and clear instructions are recommended for pain assessment. However, few studies have provided evidence to support this hypothesis. Correspondingly, this study aimed to confirm the effectiveness of specific verbal instructions for pain location during five consecutive Passive Straight Leg Raise (PSLR) tests. The 28 asymptomatic participants (age 27.4 ± 9.6 years) who provided informed consent received five consecutive PSLR tests: three without and two with specific verbal instructions to ascertain pain intensity, quality, and location. The participants drew pain locations on a body chart and described the pain intensity and quality after each test. All participants were interviewed regarding the differences they noted in the presence and absence of specific verbal instructions. Each pain location was classified into one of ten areas for statistical analysis. The proportion of participants who changed the pain location was compared between the tests using McNemar’s test, and the kappa coefficient was confirmed for consistency of pain location. There was a significant difference in the proportion of participants who changed their pain location between the second and third tests and from the third to the fourth test (McNemar’s test: p = 0.003). Kappa coefficients had low consistency (κ = 0.28) just after receiving the specific verbal instructions in the fourth test compared to the third test. Consistency improved in the fifth test (κ = 0.57);93% of the participants answered that the pain location had become clearer. This study revealed the effects of specific verbal instructions in identifying pain locations. This detailed information may help PTs provide appropriate treatment and contribute to reducing pain in clinical settings.

Effect of cryotherapy on pain management at the puncture site of arteriovenous fistula among children undergoing hemodialysis

Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%;p < 0.001).Conclusions: Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

A Modified CNN Network for Automatic Pain Identification Using Facial Expressions

Pain is a strong symptom of diseases. Being an involuntary unpleasant feeling, it can be considered a reliable indicator of health issues. Pain has always been expressed verbally, but in some cases, traditional patient self-reporting is not efficient. On one side, there are patients who have neurological disorders and cannot express themselves accurately, as well as patients who suddenly lose consciousness due to an abrupt faintness. On another side, medical staff working in crowded hospitals need to focus on emergencies and would opt for the automation of the task of looking after hospitalized patients during their entire stay, in order to notice any pain-related emergency. These issues can be tackled with deep learning. Knowing that pain is generally followed by spontaneous facial behaviors, facial expressions can be used as a substitute to verbal reporting, to express pain. In this paper, a convolutional neural network (CNN) model was built and trained to detect pain through patients’ facial expressions, using the UNBC-McMaster Shoulder Pain dataset. First, faces were detected from images using the Haarcascade Frontal Face Detector provided by OpenCV, and preprocessed through gray scaling, histogram equalization, face detection, image cropping, mean filtering, and normalization. Next, preprocessed images were fed into a CNN model which was built based on a modified version of the VGG16 architecture. The model was finally evaluated and fine-tuned in a continuous way based on its accuracy, which reached 92.5%.

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

Introduction: Pain assessment is an essential step towards pain relief. In our context, however, it is insufficient in emergency departments. The aim was to assess the nature and effectiveness of the analgesia used in the emergency department of the CHU-Donka. Method: This was a single-centre prospective observational study conducted over one month (November 2020) in the medical-surgical emergency department of CHU-Donka. All patients aged 18 or over admitted to the emergency department with moderate to severe acute pain were included. Results: We enrolled 880 patients, 615 of whom (69.88%) were in pain. Males predominated (65.2%), with a sex ratio of 1.87. The average age was 44.78 ± 16.41 years, with extremes ranging from 18 to 85 years. The most represented age group was 18 - 34 years, with 66.18%. Initial assessment of pain by nursing staff in 3 cases. Initial assessment of pain by the investigator was 100%, 74% moderate and 26% severe. No reassessment of pain by nursing staff. Reassessment by the interviewer was 100% and found 5% no pain, 61% mild pain, 24% moderate pain and 10% severe pain. With an average numerical scale of 3.77 ± 2.61 and extremes from 0 to 10. Average length of stay was 2.85 ± 1.48 hours, with extremes ranging from 45 minutes to 8 hours. Analgesia was administered with paracetamol alone (43.58%), combined with tramadol or nefopam. No patient received morphine. Conclusion: This study revealed a lack of pain assessment in our department.

Observation on the Therapeutic Effect of Shangjinbitong Powder(伤筋痹痛散)on Improving Acupoint Plaster

Objective:To study the therapeutic effect of Shangjinbitong Powder(伤筋痹痛散)on improving acupoint plaster,in order to provide some scientific basis for clinical use.Methods:This project was carried out from June 2020 to January 2021,30 patients with low back pain in the outpatient department of orthopedics and traumatology in our hospital and 30 patients with low back pain in the rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine were selected as the research objects.Patients with low back pain in our hospital were treated with Shangjinbitong Powder as the control group,and patients in rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine as the research group were treated with acupoint plaster improved by Shangjinbitong Powder.After one week of treatment,the effective rates of the two groups were compared.Results:The effective rate of treatment in the study group was significantly higher than that in the control group(P<0.05).There were no adverse reactions such as infection,scald and bleeding in the study group and the control group during the treatment.Conclusion:Shangjinbitong Powder improved acupoint plaster has good curative effect,convenient use,certain safety and clinical popularization value.

Major Clinical Features and Epidemic Characteristics of Erosive Vulvar Lichen Planus:A Retrospective Analysis

Objective:Vulvar lichen planus(VLP),especially erosive VLP(EVLP),seriously affects women’s physiological function and quality of life.A retrospective analysis of erosive vulvar lichen planus(EVLP)was performed to raise awareness on this chronic,deforming,and painful vulvar disease.Methods:This observational retrospective study involved 40 patients with EVLP among 1,368 patients with vulvar disease from 2017 to 2020.The patients’vulvar clinical features and extravulvar mucosal involvement were investigated.The patients’pain and quality of life were evaluated with the numeric rating scale and the Dermatology Life Quality Index(DLQI),respectively.Clinical characteristics were reported using frequencies and proportions for categorical variables.Continuous variables are expressed as mean±standard deviation.The association between NRS score for pain and DLQI score was analyzed by Pearson’s correlation test.Results:EVLP accounted for 2.9%(40/1,368)of all cases of vulvar disease,and the median age at onset was 42 years.Erosion mostly occurred on the labia minora and introitus.Half(20/40)of the patients had extravulvar mucosal involvement.Seventeen(42.5%)patients had oral lichen planus,and seven(17.5%)patients were diagnosed with vulvovaginal-gingival syndrome.The numeric rating scale score showed that 47.5%(19/40)of patients experienced mild pain,whereas 12.5%(5/40)described the pain as severe.Thirty-one patients(77.5%,31/40)had dyspareunia,and nine patients had aggravated pain after sexual intercourse.The mean DLQI score was 9.1±6.0,with 37.5%(15/40)of patients indicating that EVLP had severely affected their lives.The numeric rating scale score for pain was significantly correlated with the DLQI score(P=0.007).Conclusion:EVLP can affect the quality of women’s lives and cause severe deformations and painful architectural changes.The description of the characteristics of EVLP in this report will benefit the diagnosis and early treatment of this disease.

Post-Marketing Surveillance of Qishe Pill(芪麝丸)Use for Management of Neck Pain in a Chinese Patient Cohort to Determine Its Safety,Tolerability and Effectiveness

Objective:To evaluate the safety and effectiveness of Qishe Pill(芪麝丸)on neck pain in realworld clinical practice.Methods:A multi-center,prospective,observational surveillance in 8 hospitals across Shanghai was conducted.During patients receiving 4-week Qishe Pill medication,Visual Analogue Scale(VAS)and Neck Disability Index(NDI)assessments have been used to assess their pain and function,while safety monitoring have been observed after 2 and 4 weeks.Results:Results from 2,023 patients(mean age 54.5 years)suggest that the drug exposure per unit of body mass was estimated at 3.41±0.62 g/kg.About 8.5%(172/2,023)of all participants experienced adverse events(AEs),while 3.8%(78/2,023)of all participants experienced adverse reaction.The most common AEs were gastrointestinal events and respiratory events.The VAS score(pain)and NDI score(function)significantly decreased after 4-week treatment.An effect-quantitative analysis was also conducted to show that the normal clinical dosage may be consider as 3–4 g/kg,at which dosage the satisfactory pain-relief effect may achieve by 40-mm reduction in VAS.Conclusion:These findings showed that patients with cervical radiculopathy who received Qishe Pill experienced significant improvement on pain and function.(Registration No.NCT01875562).