Mary D. Tesler

Use of the Mcgill Pain Questionnaire To Measure Pain: A Meta-analysis

A meta-analysis of 51 studies was done to estimate normative mean McGill Pain Questionnaire (MPQ) scores and to assess pain quality and pain intensity as measured by the MPQ in 3,624 subjects with seven painful conditions. Across the painful conditions, all of the estimated normative mean scores were no more than 50% of the maximum score, suggesting that scores may be skewed to the left. Although the estimated normative mean scores were similar among the seven painful conditions, higher affective scores appeared to differentiate chronic painful conditions from acute painful conditions. Of the 78 MPQ words that describe pain quality, only 19 were selected by more than 20% of the subjects. Data reported in the majority of these studies were inadequate to test for differences in scores or word selection pattern by the seven painful conditions.

How do children describe pain? A tentative assessment

Abstract In a study to determine how children describe the experience of pain, we queried a convenience sample of 100 children in hospitals and 114 children in church and private schools who were between 9 and 12 years old. The questions were designed to seek correlations by age among boys and girls and between hospitalized and non‐hospitalized children that would aid health professionals in strategies that will identify and assist the child who is in pain. The preliminary results show that children clearly describe pain, that there are no appreciable differences by age groups, but that children who are hospitalized describe pain differently from children who are not.

Cancer pain intensity measurement: concurrent validity of three tools--finger dynamometer, pain intensity number scale, visual analogue scale.

Although the visual analogue scale (VAS) and number scales are known to be valid and sensitive measures of pain intensity, some older individuals are unable to use them. For individuals who lack the ability to use these scales, valid alternative measures of pain intensity would be useful for research and clinical practice. The purpose of this study was to examine the concurrent validity of a new measure of pain intensity, the Finger Dynamometer (FD), in a sample of 15 adults with advanced stage cancer pain. In a repeated measures correlational design each patient rated present pain intensity using the FD, a Pain Intensity Number Scale (PINS), and a VAS at four separate times. Data analyses using Kendall Correlational Coefficients indicated weak to moderate correlation between the FD and PINS (gamma = .47 to .68; p less than .01) and between the FD and VAS (gamma = .38 to .46; p less than .05) at each measurement time. Strong correlation was found between the VAS and the PINS (gamma = .77 to .89; p less than .001). Findings support the concurrent validity of the VAS and the PINS but indicate that further research is necessary to establish the psychometric properties of the FD as a measure of pain intensity in chronic pain models, such as cancer pain. Recommendations are made regarding important variables to be considered in further research with the FD.

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.

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.

Description of the Pain Experience: A Study of School-Age Children

Analysis of childrens responses describing the pain experience revealed that 9- to 12-year-olds can identify causes of pain, can select words that describe pain, and can express how they feel when in pain. Hospitalized children described painful experiences related to surgery and medical procedures and used words related to tension, fear, and overall pain intensity significantly more often than nonhos-pitalized children.Funded by the Committee on Research of the Academic Senate of the University of California, San Francisco.

Pain behaviors: Postsurgical responses of children and adolescents

There is scant data identifying the range and variety of pain behaviors associated with ongoing, short-term acute pain of older children and adolescents. The purposes of this study were to identify and record pain behaviors manifested by children and adolescents during the first 3 days after surgery and examine the relationship between behaviors and self-report of pain intensity. Data were collected from 37 multi-ethnic children and adolescents using the Word Graphic Rating Scale for self-report of pain intensity and the Pediatric Pain Behavior List to record pain behaviors. The five most frequently observed behaviors were calm, maintaining one position, flexing limbs, eyes shut, and knees drawn up. All children reported pain on the first 2 days postsurgery. Many children who were lying in one position with a calm expression, at the same time, reported moderate to severe pain.

Coping Strategies of Hospitalized School-Age Children

To effectively plan and implement care nurses need to know the variety of coping behaviors used by hospitalized children. Little research has documented the strategies used by the hospitalized school-age child to deal with the stresses of the experience. This study sought to answer two questions: 1) what strategies does the six to 12 year old child hospitalized for surgery use to cope with the experience; and 2) can parents provide the information on admission that will predict the strategies the child will use?

Coping Strategies of Children in Pain

A total of 214 children, 9–12 years of age, 100 hospitalized and 114 in school, participated in a study to describe their experience with pain. The children were asked to report what made them feel better when they had pain; 182 were able to identify at least one approach they used to cope with pain. Findings indicated that children could identify a variety of strategies for coping with pain. Girls more than boys and the school more than the hospitalized children reported a larger number and variety. There were also marked differences in the categories of coping strategies between the hospitalized and non-hospitalized and between boys and girls.

A strategy to assess the temporal dimension of pain in children and adolescents.

Two formats to enable children and adolescents to report the changing intensity, duration, and pattern of their pain were developed and tested: (a) a dot matrix with intensity markers on the y-axis and time markers on the x-axis and (b) a list of words or word phrases describing the temporal dimension of pain. Analyses of the dot matrix markings revealed six patterns of pain: steady decrease, steady increase, ongoing sharp increases and decreases, stair-step increase and decrease, steady increase and decrease, and constant. The 12 words and phrases described how pain began as well as how the pattern of pain changed over time.