Fannie Gaston-Johansson

Remembrance of labor pain: how valid are retrospective pain measurements?

&NA; Recently, several authors have questioned the reliability and validity of relying on retrospective assessment of labor pain. Many studies designed to determine the relationships between psychosocial and demographic factors and pain intensity during labor have relied on such measurements. The purpose of this prospective study was to determine if primiparas and multiparas can accurately remember the pain of labor. Fifty primiparas and 88 multiparas participated in the study. Prospective assessment of in‐labor pain was performed using a Visual Analogue Scale (VAS) in 3 phases of labor. Retrospective assessment of labor pain was performed 2 days post partum using the VAS. Results showed that there were significant differences between the amount of actual pain reported and the amount of pain and discomfort remembered by both primiparas and multiparas. The mean rating for remembered discomfort was higher than for remembered pain. The subjects tended to deflate the intensity of their labor pain. The results suggest that previous studies that have relied on retrospective assessments of labor pain may be invalid.

Pain assessment: Differences in quality and intensity of the words pain, ache and hurt

&NA; A study was undertaken to investigate if the concepts pain, ache and hurt differ from each other in intensity and quality and to identify discriminating semantic correlates for each of these concepts. Forty‐one nurses with different backgrounds in nursing and 12 patients with chronic pain syndrome were included in the study. The methods used were a questionnaire, the visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ). There was a statistically significant difference in the intensity of the words pain, ache and hurt on both the VAS and the MPQ. Pain was shown to have the highest intensity, followed by ache with hurt having the lowest. Semantic correlates consisting of sensory and affective words which best discriminate between the concepts pain, ache and hurt were identified. Semantic correlates for pain were: cutting, crushing, tearing, sharp, dreadful, killing, torturing and suffocating: for ache were: aching, pulling, gnawing, irritating, annoying, troublesome, exhausting, unbearable and terrifying; for hurt were: pricking, pinching, stinging, sore, fearful, unhappy.

A comparative study of feelings, attitudes and behaviors of patients with fibromyalgia and rheumatoid arthritis

The purpose of this explorative study was to administer a battery of questionnaires related to a broad number of psychosocial factors in patients with fibromyalgia syndrome (FS). By doing this, psychological factors associated with the consequences of chronic pain in patients with FS could be identified and studied in more depth. Thirty-one patients with FS were compared to 30 patients with rheumatoid arthritis (RA) with regard to feelings about self, pain/ache preoccupation, support from significant others, psychosomatic symptoms, activities of daily living, job satisfaction, and future expectations. The results of the study showed that patients with FS had significantly more negative feelings toward themselves, were more preoccupied with thinking about their pain/ache, received more practical help from significant others, experienced more limitations with regard to activities of daily living, and experienced more negative feelings about employment than patients with RA. Patients with FS were also more pessimistic about future employment than RA patients.

Psychological variables and cancer pain.

Pain can cause both physical and psychological distress that has a negative impact on a patients quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. Psychological variables were measured using subscales of the Brief Symptom Inventory (BSI). Patients who reported pain completed the McGill Pain Questionnaire (MPQ) and Visual Analogue Scale. Significant positive correlations were found between total MPQ scores and all four subscales of the BSI (r = 0.60-0.78, p < 0.05). Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.

Progression of labor pain in primiparas and multiparas

The purpose of this study was to systematically describe the dimensions of pain during the progression of labor in primiparas and multiparas. Fifty primiparas and 88 multiparas were assessed for pain when the cervix was dilated 2–4 cm, 5–7 cm, and 8–10 cm. The sensory component of in-labor pain was more severe than the affective component for both primiparas and multiparas throughout labor and delivery except during Stage III when primiparas reported more intense affective pain. Primiparas reported more intense sensory pain in Stages I and III and more intense affective pain in all three stages of labor than the multiparas even though they consumed significantly more pain medications than the multiparas.

Similarities in pain descriptions of four different ethnic-culture groups

The purpose of this study was to identify pain terms commonly used by Hispanics, American Indians, blacks, and whites to describe painlike experiences. Subjects were asked to rate the intensity of the terms pain, ache, and hurt on a Visual Analogue Scale. Following this procedure, they were given three separate copies of the McGill Pain Questionnaire and asked to choose the words that represented pain, ache, and hurt, respectively. The results showed that all cultural groups rated pain as the most intense terms, followed by hurt; ache was rated least intense. There was a significant difference between the intensity level of the three terms (p less than 0.001). Word descriptors that distinguished pain from ache and hurt are presented. The importance of these findings for clinical practice is discussed.

Rheumatoid arthritis: determination of pain characteristics and comparison of RAI and VAS in its measurement

&NA; The purposes of this study were to determine pain characteristics in female patients with rheumatoid arthritis (RA) and to determine the relationship between the outcome of the Ritchie Articular Index (RAI) and pain intensity as measured by the visual analogue scale (VAS). The sample consisted of 30 female patients with a definite diagnosis of RA and a functional capacity of class II. The results indicated that the pain fluctuated during the day. The intensity level of present pain was lower than that of usual pain. Eight patients reported that their worse pain occurred several times/day. Ache was the word most frequently chosen by the subjects to denote their pain sensations. A high correlation r = 0.86 (P < 0.01) was found between the scores of RAI and present pain on the VAS. This finding suggests that the pain in RA is associated with the hyperalgesic state induced by the inflammatory condition associated with RA. There was no significant correlation between blood tests like ERS, WBC and VAS or RAI.

Pain description by nurses and physicians.

The purpose of this study was to determine if nurses and physicians selected similar words to describe painlike experiences and to determine how they rated terms commonly used to describe pain. Thirty-seven registered nurses and 21 physicians comprised the sample. The Visual Analogue Scale (VAS) was used to measure the terms ache, hurt, and pain. The McGill Pain Questionnaire (MPQ) provided a list of word descriptors from which the subjects selected words that best represented the terms ache, hurt, and pain. There was no significant differences between the nurses and physicians in the mean rating of any of the pain terms on the VAS. The nurses and physicians chose very similar word descriptors from the MPQ to discriminate one pain term from another. These findings suggest that nurses and physicians may have a common understanding of the language used to describe painlike experiences.