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(102) Development of a multidimensional postoperative pain scale (MPOPS) for the hospital setting
The Journal of Pain, Vol 15, No 4 (April), Suppl. 1, 2014: pp S1-S119 Available online at www.jpain.org and www.sciencedirect.com
Abstracts for Poster Presentations, American Pain Society 33rd Annual Meeting, April 30-May 3, 2014, Tampa, FL A. Diagnosis, Assessment, and Reviews
(102) Development of a multidimensional postoperative pain scale (MPOPS) for the hospital setting
A01 Acute Pain
K Archer, R Castillo, C Abraham, S Heins, W Obremskey, and S Wegener; Vanderbilt University Medical Center, Nashville, TN
(100) Hispanic inpatient pain intensity D McDonald, M Ambrose, and B Morey; Saint Francis Hospital and Medical Center, Hartford, CT Hispanic adults continue to experience significant pain from chronic conditions such as arthritis. Insufficient research exists regarding inpatient pain management for Hispanic patients and the impact from co-morbid conditions such as arthritis, invasive medical treatment, and/or surgical procedures. The purpose of this research was to describe Hispanic inpatient pain intensity and compare pain intensity to non-Hispanic patients. A post hoc descriptive design was used with medical surgical inpatient data for all of 2012 from a large urban medical center in the USA. The sample consisted of 1,466 medical records of Hispanic patients (63.2% identified as English speakers), and 12,977 medical records of non-Hispanic patients from 13 medical, surgical, or critical care units. Electronic medical record data was securely downloaded and prepared for analysis. Data included age, gender, primary language spoken, race, length of stay, number of co-morbidities, and documented pain intensity (0 – 10 scale). Documented pain intensity was greater for Hispanic than non-Hispanic patients, M = 2.1 (SD = 2.12) and M = 1.6 (SD = 1.87), respectively, t(13718) = 10.07, p < .001. Documented pain intensity was greater for English speaking Hispanic patients than Spanish speakers, M = 2.5 (SD = 2.16) and M = 1.5 (SD = 1.91), respectively, t(1397) = 8.06, p < .001. The odds of being documented with moderate or greater pain intensity decreased 30%, Exp (B) = 0.70, CI (0.50 0.97), p = .03 for Spanish speaking patients. Hispanic inpatients’ documented mean pain intensity was mild and statistically significant, but not clinically significantly greater than non-Hispanics’ mean pain intensity. Greater pain intensity documented for English speaking Hispanic inpatients suggests under reporting of pain intensity by Spanish speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioner’s language(s).
(101) Standardized analgesia protocol led by nurses: efficacy maintained when based on hetero-evaluation A Duvivier, S Mayer, and S Lafrenaye; Sherbrooke University Hospital Centre, Sherbrooke, QC, Canada Pediatric pain remains sub-optimally controlled. Use of standardized protocol is one key for better analgesia. We have been using an algorithm in our center for over 10 years for the 5 to 18 YO hospitalized children. Nurses asked for such an algorithm for the 1 to 7 YO children. To do so, we had to first implement a hetero-evaluation scale (EVENDOL). Thirty minute training sessions were provided to nurses about EVENDOL’s applicability. Subsequently, all children 1 to 7 YO admitted for painful medical or surgical conditions were evaluated using EVENDOL. Pain values and analgesia were noted for each patient by electronic and paper charting. Satisfaction and practice changes within the nursing staff were evaluated. Forty children were included. 24 children were under surgical care and 16 under medical care. A total of 260 pain measurements were documented. Overall 95% of this cohort received multimodal analgesia which is two or more types of pain medication. More than 50% of prescribed PRN medications were given on a regular basis. Only 12 of 260 pain assessments were in the severe pain category and they received an appropriate and timely analgesia. 85% of pain scores on day 2 were in the mild pain category. These scores were comparable to those obtained with the 5-18 year old cohort (96%) post implementation of the pain algorithm. Ease of EVENDOL use was rated at 9.3 of 10. Global satisfaction score about the scale was 6.7/10. We stopped the recruitment for the control group prior to implementation of the algorithm because nurses spontaneously transposed the pre-existing 5 to 18 year old standardised analgesia protocol, and used it in the 1-7 year old group. This may explain the excellent pain control despite the absence of a standardised analgesic pain protocol in this age group. Supported by Foundation of Stars.
This study developed a multidimensional postoperative pain scale (MPOPS) in patients with orthopaedic trauma. A literature review, clinician interviews, patient focus groups, and an expert panel identified 33 items. A pre-test was conducted in the hospital on 50 individuals with traumatic orthopaedic injury. Items were eliminated based on poor distribution, low variance, and non-significant associations with VAS pain scores, physiologic measures, opioid consumption, or length of stay (LOS). A 24-item MPOPS was pilot tested in 203 patients admitted to a Level 1 trauma center for lower-extremity (80%), upper-extremity (12%) and pelvis/acetabular (8%) injuries. Study personnel collected physiologic measures and patients completed MPOPS items and a VAS on pain at rest and with movement two times a day until hospital discharge. Postoperative opioid analgesics, LOS, and patient characteristics were collected from the medical record. An assessment at discharge measured pain (Brief Pain Inventory), self-efficacy (Pain Self-Efficacy Scale), and depression and PTSD symptoms (PHQ-9 and PCL-C, respectively). Item reduction and validity assessment was conducted with mixed effects, hierarchical multivariable regression, principal components, and exploratory factor analyses. MPOPS was reduced to 8 items (factor loadings > .40, average interitem correlations > .20, average corrected item-to-total correlations > .50). Two factors accounted for 56% of the variance. Factor 1 included items on pain right now, unbearable pain, and the ability to think clearly, fall asleep, and manage pain. Factor 2 included sharp pain with movement, ability to go home with pain, and fear of movement. Cronbach’s alpha was .75. The MPOPS has the potential to identify patients at-risk for poor outcomes and who may benefit from more aggressive pain management. Additional research is needed to validate this instrument in other samples, assess the relationship to long term pain, psychological, and functional outcomes, and create benchmarks that will guide clinicians in the treatment of postoperative pain.
(103) The relation of age on the treatment of patients presenting to the emergency department with pain: a comparison of emerging adults and adults S Kapoor, B Thorn, P Block, and J White; The University of Alabama, Tuscaloosa, AL Oligoanalgesia is a significant problem in the Emergency Departments (ED). Previous research has indicated that children and adolescents are more likely to experience under-treatment of pain in the ED due to a variety of factors. It is likely that emerging adults, individuals aged between 18 and 29 years, experience similar age-related disparities. However, there is a paucity of literature examining the experience of emerging adults in context of pain treatment during ED visits. The present study aimed to compare emerging adults presenting to the ED with a primary complaint of pain to adults (patients 30 years and older) in terms of pain variables and treatment. Forty-two emerging adults and 83 adults were recruited for the study. The mean ages of emerging adults was 23.56, with adults averaging 44.87. Participants completed a packet of demographic and pain-related psychosocial measures. Additionally, information about ED analgesic administration was obtained from the medical records. Chi-square analyses revealed that emerging adults were three times more likely to present with pain due to an acute etiology (82%) as compared to only 59% adults (41% presented with exacerbations of chronic pain). Although self-reported pain intensity at triage, duration of current episode of pain, and pain catastrophizing was not significantly different between the two groups, emerging adults were 3.41 times less likely to receive analgesics during the ED visit. Furthermore, emerging adults reported significantly lower levels of state anxiety as well as lower scores on the sensory and affective scales on the McGill Pain Questionnaire-Short Form. Results suggest that, similar to children and adolescents, emerging adults may be at a greater risk for treatment disparities in the ED. In the future, studies should examine the extent of such disparities and ways to promote adequate analgesia across age groups.
S1
Abstracts for Poster Presentations, American Pain Society 33rd Annual Meeting, April 30-May 3, 2014, Tampa, FL A. Diagnosis, Assessment, and Reviews
(102) Development of a multidimensional postoperative pain scale (MPOPS) for the hospital setting
A01 Acute Pain
K Archer, R Castillo, C Abraham, S Heins, W Obremskey, and S Wegener; Vanderbilt University Medical Center, Nashville, TN
(100) Hispanic inpatient pain intensity D McDonald, M Ambrose, and B Morey; Saint Francis Hospital and Medical Center, Hartford, CT Hispanic adults continue to experience significant pain from chronic conditions such as arthritis. Insufficient research exists regarding inpatient pain management for Hispanic patients and the impact from co-morbid conditions such as arthritis, invasive medical treatment, and/or surgical procedures. The purpose of this research was to describe Hispanic inpatient pain intensity and compare pain intensity to non-Hispanic patients. A post hoc descriptive design was used with medical surgical inpatient data for all of 2012 from a large urban medical center in the USA. The sample consisted of 1,466 medical records of Hispanic patients (63.2% identified as English speakers), and 12,977 medical records of non-Hispanic patients from 13 medical, surgical, or critical care units. Electronic medical record data was securely downloaded and prepared for analysis. Data included age, gender, primary language spoken, race, length of stay, number of co-morbidities, and documented pain intensity (0 – 10 scale). Documented pain intensity was greater for Hispanic than non-Hispanic patients, M = 2.1 (SD = 2.12) and M = 1.6 (SD = 1.87), respectively, t(13718) = 10.07, p < .001. Documented pain intensity was greater for English speaking Hispanic patients than Spanish speakers, M = 2.5 (SD = 2.16) and M = 1.5 (SD = 1.91), respectively, t(1397) = 8.06, p < .001. The odds of being documented with moderate or greater pain intensity decreased 30%, Exp (B) = 0.70, CI (0.50 0.97), p = .03 for Spanish speaking patients. Hispanic inpatients’ documented mean pain intensity was mild and statistically significant, but not clinically significantly greater than non-Hispanics’ mean pain intensity. Greater pain intensity documented for English speaking Hispanic inpatients suggests under reporting of pain intensity by Spanish speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioner’s language(s).
(101) Standardized analgesia protocol led by nurses: efficacy maintained when based on hetero-evaluation A Duvivier, S Mayer, and S Lafrenaye; Sherbrooke University Hospital Centre, Sherbrooke, QC, Canada Pediatric pain remains sub-optimally controlled. Use of standardized protocol is one key for better analgesia. We have been using an algorithm in our center for over 10 years for the 5 to 18 YO hospitalized children. Nurses asked for such an algorithm for the 1 to 7 YO children. To do so, we had to first implement a hetero-evaluation scale (EVENDOL). Thirty minute training sessions were provided to nurses about EVENDOL’s applicability. Subsequently, all children 1 to 7 YO admitted for painful medical or surgical conditions were evaluated using EVENDOL. Pain values and analgesia were noted for each patient by electronic and paper charting. Satisfaction and practice changes within the nursing staff were evaluated. Forty children were included. 24 children were under surgical care and 16 under medical care. A total of 260 pain measurements were documented. Overall 95% of this cohort received multimodal analgesia which is two or more types of pain medication. More than 50% of prescribed PRN medications were given on a regular basis. Only 12 of 260 pain assessments were in the severe pain category and they received an appropriate and timely analgesia. 85% of pain scores on day 2 were in the mild pain category. These scores were comparable to those obtained with the 5-18 year old cohort (96%) post implementation of the pain algorithm. Ease of EVENDOL use was rated at 9.3 of 10. Global satisfaction score about the scale was 6.7/10. We stopped the recruitment for the control group prior to implementation of the algorithm because nurses spontaneously transposed the pre-existing 5 to 18 year old standardised analgesia protocol, and used it in the 1-7 year old group. This may explain the excellent pain control despite the absence of a standardised analgesic pain protocol in this age group. Supported by Foundation of Stars.
This study developed a multidimensional postoperative pain scale (MPOPS) in patients with orthopaedic trauma. A literature review, clinician interviews, patient focus groups, and an expert panel identified 33 items. A pre-test was conducted in the hospital on 50 individuals with traumatic orthopaedic injury. Items were eliminated based on poor distribution, low variance, and non-significant associations with VAS pain scores, physiologic measures, opioid consumption, or length of stay (LOS). A 24-item MPOPS was pilot tested in 203 patients admitted to a Level 1 trauma center for lower-extremity (80%), upper-extremity (12%) and pelvis/acetabular (8%) injuries. Study personnel collected physiologic measures and patients completed MPOPS items and a VAS on pain at rest and with movement two times a day until hospital discharge. Postoperative opioid analgesics, LOS, and patient characteristics were collected from the medical record. An assessment at discharge measured pain (Brief Pain Inventory), self-efficacy (Pain Self-Efficacy Scale), and depression and PTSD symptoms (PHQ-9 and PCL-C, respectively). Item reduction and validity assessment was conducted with mixed effects, hierarchical multivariable regression, principal components, and exploratory factor analyses. MPOPS was reduced to 8 items (factor loadings > .40, average interitem correlations > .20, average corrected item-to-total correlations > .50). Two factors accounted for 56% of the variance. Factor 1 included items on pain right now, unbearable pain, and the ability to think clearly, fall asleep, and manage pain. Factor 2 included sharp pain with movement, ability to go home with pain, and fear of movement. Cronbach’s alpha was .75. The MPOPS has the potential to identify patients at-risk for poor outcomes and who may benefit from more aggressive pain management. Additional research is needed to validate this instrument in other samples, assess the relationship to long term pain, psychological, and functional outcomes, and create benchmarks that will guide clinicians in the treatment of postoperative pain.
(103) The relation of age on the treatment of patients presenting to the emergency department with pain: a comparison of emerging adults and adults S Kapoor, B Thorn, P Block, and J White; The University of Alabama, Tuscaloosa, AL Oligoanalgesia is a significant problem in the Emergency Departments (ED). Previous research has indicated that children and adolescents are more likely to experience under-treatment of pain in the ED due to a variety of factors. It is likely that emerging adults, individuals aged between 18 and 29 years, experience similar age-related disparities. However, there is a paucity of literature examining the experience of emerging adults in context of pain treatment during ED visits. The present study aimed to compare emerging adults presenting to the ED with a primary complaint of pain to adults (patients 30 years and older) in terms of pain variables and treatment. Forty-two emerging adults and 83 adults were recruited for the study. The mean ages of emerging adults was 23.56, with adults averaging 44.87. Participants completed a packet of demographic and pain-related psychosocial measures. Additionally, information about ED analgesic administration was obtained from the medical records. Chi-square analyses revealed that emerging adults were three times more likely to present with pain due to an acute etiology (82%) as compared to only 59% adults (41% presented with exacerbations of chronic pain). Although self-reported pain intensity at triage, duration of current episode of pain, and pain catastrophizing was not significantly different between the two groups, emerging adults were 3.41 times less likely to receive analgesics during the ED visit. Furthermore, emerging adults reported significantly lower levels of state anxiety as well as lower scores on the sensory and affective scales on the McGill Pain Questionnaire-Short Form. Results suggest that, similar to children and adolescents, emerging adults may be at a greater risk for treatment disparities in the ED. In the future, studies should examine the extent of such disparities and ways to promote adequate analgesia across age groups.
S1