How much change in pain score does really matter to patients?

Bahreini, Maryam; Safaie, Arash; Mirfazaelian, Hadi; Jalili, Mohammad

doi:10.1016/j.ajem.2019.158489

Cited by 64 publications

(54 citation statements)

References 26 publications

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“…Fortunately, NRS reduction has been validated to correlate with VAS reduction, 21,22 so these scores were pragmatically included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…However, relying on the treating team to document pain scores resulted in NRS being used in place of VAS in 19 of 44 patients. Fortunately, NRS reduction has been validated to correlate with VAS reduction, 21,22 so these scores were pragmatically included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…NRS has been validated to correlate with VAS. 21,22 Opioid use was recorded pre-hospital, including by the ambulance service or at the referring hospital, and in the ED during the pre-block time period and until 12 hours post block or the patient entered the operating theatre. These data were available to the investigators via the electronic medical record and ambulance service patient records.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

Fahey

Cripps

et al. 2021

Preprint

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Background The pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB). Methods From October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse events over the duration of their admission. Results There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 FICB, 14 FNB) and 19 received a PENG block. There was no difference in maximum pain score reduction between the groups whether measured at rest or on movement. Clinicians providing the PENG block were less experienced in the technique than those providing FICB or FNB. There was no difference in adverse effects between groups. Although opioid use was similar between the groups, more patients were opioid free after a PENG block. Conclusions Although there was no difference in maximal pain score reduction, this study demonstrated that the PENG block was feasible and could be provided safely and effectively to patients with hip fracture in the ED. On this basis, a larger randomised controlled study should now be designed.

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“…Fortunately, NRS reduction has been validated to correlate with VAS reduction, 21,22 so these scores were pragmatically included in our study.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

See 1 more Smart Citation

Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

Fahey

Cripps

et al. 2021

Preprint

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“…The outcome was self-reported score on the numerical rating scale for pain (NRS pain) (0–10), 22 where a two-point reduction was considered clinically meaningful. 23 Also, the intervention and control groups were compared with respect to age, gender and the locations of pain reported. The study was exempt from full review by the WPAFBMC Institutional Review Board and met all ethical standards, as the treatments provided were administered as part of routine clinical care and the data collection was considered to fall into the remit of service evaluation.…”

Section: Methodsmentioning

confidence: 99%

Battlefield acupuncture appears to be an effective therapy for pain management

2021

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Introduction: The Department of Defense has been training primary care providers in battlefield acupuncture (BFA), a subtype of auricular acupuncture, as an adjunct therapy for pain management. Methods: The objective of this study was to evaluate the effectiveness and safety of BFA for pain management in an outpatient Internal Medicine clinic staffed by resident physicians. The target population for this single-center prospective cohort study were military beneficiaries at a medical treatment facility located at the Wright-Patterson Air Force Base. Participants who met inclusion criteria were treated with BFA in addition to routine standard care for pain (n = 69). The control group was composed of participants who received routine standard care only without BFA (n = 27). Pain was assessed by a self-reported pain scale (0–10) at the time of encounter, immediately after BFA (for the intervention group), then at 24 and 48 h afterwards. Results: Mean pain for the intervention group decreased from 5.45 before BFA to 3.29 immediately following BFA to 2.21 at 24 h and to 2.10 at 48 h (p < 0.001). Thus, at all three post-treatment time points, mean decrease in pain surpassed a two-point reduction, deemed to be a clinically important difference. The BFA group had a greater reduction in pain compared to the no intervention group at 24 h (3.14 vs 0.59, p < 0.001) and at 48 h (3.26 vs 0.96, p < 0.001). Four intervention group participants (6%) reported an adverse reaction (three with pain at the insertion site) or complication (one with superficial infection). Conclusion: BFA provided by Internal Medicine residents appears to be a safe and effective adjunct therapy for pain management in an outpatient setting, but requires further validation by randomized controlled trials.

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“…The NRS is a segmented numeric version of the visual analog scale in which a respondent selects a whole number (integers 0–10) that best reflects the intensity of their pain. A reduction of 1.65 points in pain had been reported to demonstrate a minimal clinically important difference (MCID) for the NRS scores [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Effect of Different Local Analgesia Administration Techniques in Total Hip Arthroplasty: A Retrospective Comparative Cohort Study

Hashimoto

Sonohata

Kawaguchi

et al. 2021

Pain Research and Management

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Objective. To improve postoperative pain management, several authors have described the use of periarticular injection (PAI) or intra-articular injection (IAI) following total hip arthroplasty (THA). However, no comparative studies examining the results between PAI and IAI following THA have been published. This study aimed to evaluate the analgesic and anti-inflammatory effects of PAI and IAI following THA. Methods. This single-center, retrospective cohort study enrolled patients who underwent unilateral primary THA. A total of 278 patients (281 hips) were included in the final analyses, with 112 patients (113 hips) in the control group, 85 patients (87 hips) in the PAI group, and 81 patients (81 hips) in the IAI group. Numeric rating scale (NRS) scores and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Results. NRS scores, creatine phosphokinase, and C-reactive protein levels in the PAI and IAI groups were significantly lower than those in the control group on POD 1 and 7. D-dimer levels were significantly lower in the PAI and IAI groups than in the control group on POD 7. The white blood cell count was significantly higher in the PAI and IAI groups than in the control group on POD 1 and 7. Aspartate transaminase, alanine aminotransferase, blood urea nitrogen, and creatinine levels were within the reference ranges in all three groups at all time points. NRS scores and laboratory data showed no significant differences between the PAI and IAI groups at all time points. Conclusion. PAI and IAI have equivalent analgesic and anti-inflammatory effects. Considering the technical challenges of PAI, IAI may be preferable because of its simplicity in the case of using a closed suction drain.

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How much change in pain score does really matter to patients?

Cited by 64 publications

References 26 publications

Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

Battlefield acupuncture appears to be an effective therapy for pain management

Comparison of the Effect of Different Local Analgesia Administration Techniques in Total Hip Arthroplasty: A Retrospective Comparative Cohort Study

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