Medical Evidence Influence on Inpatients and Nurses Pain Ratings Agreement

Derry

et al. 2018

Pain

Pain assessment by patients is the rule in clinical trials but may not be in clinical practice. We examined studies comparing assessment of pain by patients and professionals in clinical practice using published studies (1990-2016; ≥20 patients), in English, in an institutional setting, comparing pain assessment within 24 hours by patients and health care professionals. A difference of at least 10% of the maximum score was considered significant. We judged quality on sampling method, blinding, and study size. Eighty studies (20,496 patients) provided data from a range of settings and locations; most (51%) used unbiased sampling, and most (68%) were blind or probably blind. Nine studies with ≥500 patients involved 58% of patients; 60 with <200 patients involved 25%. Large studies were more likely to use comprehensive or random sampling and blinding of patients and professionals. Underestimation of pain by professionals compared with patients was reported by 62/80 studies (78%); there was no difference in 17 (21%) and overestimation in 1 (1%). Underestimation was reported in 75% of large studies (>500 patients), 91% of mid-sized studies (200-400), and 78% of small studies (<200). High-quality studies (blind, comprehensive, or random sampling, >200 patients) consistently reported underestimation (10/11; 91%). The extent of underestimation tended to increase with pain severity. Professionals consistently tend to underestimate pain compared with assessment by patients. This tendency is more pronounced with more severe pain, and the extent of underestimation can be large. It is likely that this contributes to undertreatment of pain.

Section: Discussionsupporting

confidence: 92%

Professionals underestimate patients' pain: a comprehensive review

Derry

et al. 2018

Pain

“…Among all contextual cues that may influence pain care, patient distress -i.e., signs of emotional/psychological suffering brought on by pain (17) -and diagnostic evidence of pathology -i.e., confirmation, through complementary diagnostic tests, of a pathology or lesion that induces pain (18) -are ones most studied; pain is often under-assessed/treated in the presence (vs. absence) of patient distress (17,18) or in the absence (vs. presence) of evidence of pathology 17,18). The detrimental effects of these variables on nurses' pain assessments have been found in experimental vignette-based studies (e.g., 3,4) and studies conducted in real clinical contexts (e.g., 19,20). However, it is yet unknown whether the effects of those clinical cues are identical for high versus low SES patients.…”

Section: Introductionmentioning

confidence: 99%

Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices

et al. 2019

Objective Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses’ pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices. Design Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design. Subjects Female nurses participated in two experimental studies (N = 150/N = 158). Methods Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices. Results The low-SES patient’s pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient’s pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices. Conclusions Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.

Human Behavior and Emerging Technologies

“…Some studies have tried to overcome these barriers by incorporating an automated facial analysis tool, i.e., ePAT [28], showing promising results in elderly with advanced dementia. Also, in the clinical setting, selfassessment methods are subject to presentation bias [29], and there are a series of other limitations such as the nature of the scales [30], the need to provide continuous monitoring, especially in intensive care; or idiosyncratic factors of the observer [31,32]; cultural background [31,33,34]; and gender [35]. These limitations have led to researching new methodologies to evaluate pain based on nonverbal indicators [36], which is also the effort of this paper.…”

Section: Introductionmentioning

confidence: 99%

ASAD: A Novel Audification Console for Assessment and Communication of Pain and Discomfort

Sheward

Romano

Marquardt

2022

Pain and discomfort are subjective perceptions that are difficult to quantify. Various methods and scales have been developed to find an optimal manner to describe them; however, these are difficult to use with some categories of patients. Audification of pain has been utilized as feedback in rehabilitation settings to enhance motor perception and motor control, but not in assessment and communication settings. We present a novel tool, the Audification-console for Self-Assessment of Discomfort (ASAD), for assessing and communicating pain and discomfort through sound. The console is a sequence of increasing pitch and frequencies triggered at the press of buttons and displayed as a matrix that can be associated with the subjective perception of pain and discomfort. The ASAD has been evaluated in its ability to capture and communicate discomfort, following a fatigue test in the lower limbs with thirty healthy volunteers, and compared to the most common self-reported methods used in the NHS. (The National Health Service (NHS) is the publicly funded healthcare system in England and one of the four National Health Service systems in the United Kingdom.) This was a qualitative, within subjects and across groups experiment study. The console provides a more accurate assessment than other scales and clearly recognizable patterns of sounds, indicating increased discomfort, significantly localized in specific frequency ranges, thus easily recognizable across subjects and in different instances of the same subject. The results suggest a possible use of the ASAD for a more precise and automatic assessment of pain and discomfort in health settings. Future studies might assess if this is easier to use for patients with communication or interpretation difficulties with the traditional tools.