Diana J. Wilkie

Measuring pain quality: validity and reliability of children's and adolescents' pain language

&NA; Although considerable research has been conducted to identify childrens and adolescents language of pain, research is lacking regarding a method to quantify the pain quality described by this language. Three descriptive studies involving 1223 children, aged 8–17 years, were conducted in school and hospital settings. The aims were to develop and examine the validity and reliability of a word list for measuring pain quality that was free of age, gender, and ethnic biases. A word list with 43 words was developed and resulted in sensory, affective, evaluative, and total scores that correlated with pain location and pain intensity scores (r = 0.19−0.44; P ⩽ 0.01). Pain quality scores decreased over time in a postoperative pain model. Test‐retest reliability of the word list scores was high (r = 0.78–0.95; P < 0.001). This world list was revised and resulted in a word list with 56 words relatively free of gender, ethnic, and developmental biases. Additional research is needed to assess the psychometric properties of this world list in pediatric populations experiencing different pain syndromes.

Nociceptive and Neuropathic Pain in Patients With Lung Cancer: A Comparison of Pain Quality Descriptors

Predictive validity of each word from the McGill Pain Questionnaire (MPQ) has not been investigated in relation to pain etiology. The purpose of this study was to explore differences in the words used to describe nociceptive and neuropathic pain. Patients with lung cancer (N = 123) selected words from the 78 MPQ pain quality descriptors and indicated the corresponding pain site for each word. Using only the MPQ pain location, and the cancer and treatment data abstracted from medical records, each pain site was classified as nociceptive or neuropathic (etiology). Pain etiology and quality descriptors were tested for proportional differences with sensitivity, specificity, and predictive value calculated for statistically significant descriptors. Of the 457 pain sites, 343 were classified as nociceptive (75%), 114 as neuropathic (25%). Lacerating, stinging, heavy, and suffocating were selected for a significantly larger proportion of nociceptive sites whereas throbbing, aching, numb, tender, punishing, pulling, tugging, pricking, penetrating, punishing, miserable, and nagging were selected for a larger proportion of neuropathic sites. Ten words correctly predicted 78% of the sites with 81% sensitivity to nociceptive pain and 59% sensitivity to neuropathic pain. Interestingly, several pain quality descriptors (burning, shooting, flashing, tingling, itching, and cold) previously associated with neuropathic pain did not distinguish between neuropathic and nociceptive pain. Infrequent selection of many MPQ words and lack of neurological exam data in the medical records are possible explanations for inconsistency with previous literature. Prospective studies are needed to validate pain quality descriptors for nociceptive and neuropathic types of lung cancer pain.

Postoperative analgesics for children and adolescents: Prescription and administration

Pain was measured and analgesic treatment examined in 131 children and adolescents, 8-17 years of age, for 5 days after surgery. Analgesic data were converted to 10 mg intramuscular morphine-equivalent doses (IMMSEQ) and were designated appropriate or inappropriate for body weight. Analgesic onset, peak, and duration were calculated in relation to administration routes and the time pain assessments were made. Children reported moderately severe pain in many body locations. Initially, all but two children were prescribed and ultimately all but one received analgesics. Prescribed and administered doses were frequently less than doses recommended for weight. Two-thirds of the children were beyond analgesic action when pain was assessed. Weak to moderately strong associations were noted between IMMSEQ doses and pain intensity scores on each of the 5 postoperative days. Unfortunately, findings indicate that children continue to be undertreated when they experience postoperative pain.

Behavior of patients with lung cancer: Description and associations with oncologic and pain variables

&NA; Although reflexes are recognized as protective responses to noxious stimuli, less is known about voluntary behavioral responses to cancer pain, which could provide clinicians with important diagnostic and therapeutic information. Forty‐five patients with lung cancer were studied in their homes on 2 occasions to identify pain behaviors and to examine relationships between behaviors and selected variables. Patients completed the McGill Pain Questionnaire (MPQ) and Visual Analogue scale (VAS). Using a videotape observation method, patients sat, stood, walked, and reclined for 10 min. Videotapes were scored using 5 position‐related and 31 pain‐related behavior definitions. Within 3 days scored behaviors were described to patients who reported whether each scored behavior was performed: to express pain; because pain prevented usual behavior; to control pain; or as a habit. Patients reported that pain was controlled by 42 different behaviors; the number of different pain‐reduction behaviors was correlated with pain intensity (r = 0.44) and pain quality (r = 0.64). Simultaneous multiple regression indicated that length of time pain was experienced, number of pain sites, pain quality, and pain intensity accounted for 41% of the variance in the number of pain control behaviors. None of the taped behaviors was reported as performed to express pain, and few of the patients reported that pain prevented behavior during the video session. Results clarify the pain‐behavior construct, provide insight about the multidimensional nature of lung cancer pain, and suggest directions for behavioral interventions to augment pharmacological therapy for lung cancer pain.

Pain Trajectory of Taiwanese with Nasopharyngeal Carcinoma Over the Course of Radiation Therapy

The purpose of this study was to describe the characteristics and management of pain among patients with nasopharyngeal carcinoma (NPC) prior to and during the 7-week course of radiation therapy (RT) in Taiwan. Twenty-nine men and 11 women with NPC participated in this prospective, longitudinal study. A modified Brief Pain Inventory was used to assess pain and its interference with daily activities weekly. Medical records were reviewed to abstract pain management and disease data. Findings showed that the pain intensity and pain interference scores escalated prominently at Week 3 and peaked at Week 5, representing the time course of RT complications. Pain prior to RT exacerbated the RT-induced mucositis pain. The pain related to RT for NPC was often severe and undertreated, and affected swallowing and talking more than sleeping or other general activities. We recommend interventions to control pain be instituted prior to Week 3 to minimize the potentiation of subsequent pain.

Children's language of pain

Electrical Engineering , McGill University; INRSTelecommunications , Montreal, Quebec, Canada. Aim of Investigation: Various acoustical features have been associated with infant pain cries: fundamental frequency and total time crying being most often reported as discriminating pain from hunger or pleasure cries. The purpose of this study was to determine which acoustical features distinguished responses to three negative situations: 1) pain (routine immunization), 2) anger (head restraint), and 3) fear (jack-in-the-box). Formant structure, not previously reported in infant literature, was also examined. Methods: Thirty-nine cry episodes from 2 to 6 month-old infants resulting from the above stimuli were visualized as spectrographs via fast Fourier analysis. Fundamental frequency (maximum, minimum, shift), total time crying, cry duration, melody, phonai;ion (harmonic structure), jitter and formant structure were compared across stimulus situations. Results: Pain cries were significantly different from anger and fear cries in their falling melody, high percentage of dysphonation, and the greater intensity of high frequency formants (second formants). They were similar to fear cries in fundamental frequency and total time crying, and to anger cries in occurence of jitter. Conclusion: Acute pain cries cannot be distinguished on the basis of fundamental frequency or total time crying from fear/startle cries. However, phonation or harmonic structure, formant structure, and melody appear to be better discriminators. These features may reflect changes in musculature or excitation in response to acute pain stimuli.

Technology survey of nursing programs: implications for electronic end-of-life teaching tool development.

From an online survey of current technological capabilities of US undergraduate nursing programs, we found almost universal use of Microsoft Windows-based computers and Microsoft Office Suite software. Netscape and Microsoft Internet Explorer were the most popular browsers for Internet access. The survey also assessed faculty preferences for end-of-life care teaching materials and found that nurse educators preferred simple easy-to-use tools provided on CD-ROM or the Internet, with instructions provided via CD-ROM, the Internet, and demonstration workshops. Our findings have numerous implications for the development of electronic teaching materials for nursing.