Improving patients’ pain experience in a large rural hospital

Medico, Charles J.; King, Megan West; Cole, Gordon; Albright, Danielle; Kowalek, Eric; Bickert, Terri; Venditti, Denise

doi:10.2146/ajhp160009

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Most of the concerns focused on an observed increase in opioid-related adverse events, many of which involved the administration of opioid doses based solely on pain intensity. In 2016 The American Pain Society published a set of guidelines on postoperative pain management [ 5 ]. This was a collaborative paper with several organizations meeting and making the recommendations.…”

Section: Discussionmentioning

confidence: 99%

Phase 2 Assessment of a New Functional Pain Scale by Comparing It to Traditional Pain Scales

Thomas¹,

Adeboye²,

Hart³

et al. 2022

Cureus

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Background Assessment of pain has always been subjective and is commonly assessed using a numeric pain scale (NPS) or Wong-Baker faces scale. The pain intensity score is not standardized and relies on individuals’ past experiences. The disadvantage of using such pain assessment scales and treating the numbers can lead to overdosing on analgesics leading to unwanted side effects. The Robert Packer Hospital/Functional Pain Scale (RPH/FPS) was developed as a tool for the objective assessment of pain and its impact on a patient’s function. Aim The study aimed to validate the RPH/FPS scale against NPS and Wong-Baker faces scale in medical, surgical, and trauma patients. The patients’ were also asked to rank the scales as one (1) being the most preferred to three (3) being the least preferred. Design This prospective, observational cohort study compares the two most common pain scales, the NPS and the Wong-Baker Faces, to the RPH/FPS. Methods Spearman correlation was used to test for correlation between the three scales, and Wilcoxon rank-sum test was used to compare means between the RPH/FPS and NPS. The study participants were also asked to rate their preferences for the scales by rating the most preferred of the three scales as one (1) and the least preferred number three (3). Results The RPH/FPS had a strong correlation with both the NPS and Wong-Baker Faces scales (RPH/FPS vs. NPS R=0.69, p<0.001: RPH-FPS vs. Wong-Baker Faces R=0.69, P<0.001). As for preferences, the RPH/FPS was ranked first on 36.9% of the surveys followed by NPS on 35.9%, and the Wong-Baker Faces on 22.3%. There were 4.9% of the surveys missing the preference rankings. Conclusion The results validate the RPH/FPS scale against the NPS and Wong-Baker Faces scales. This gives the clinicians a tool for objective assessment of pain and its effect on the recovery process, thereby minimizing the observed disconnect that sometimes happens between the reported pain intensity level and the providers' observation of the patient.

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Section: Discussionmentioning

confidence: 99%

Phase 2 Assessment of a New Functional Pain Scale by Comparing It to Traditional Pain Scales

Thomas¹,

Adeboye²,

Hart³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…The simplicity of a 0–10 scale, minimization of subjective pain terminology, and intended comparability across time have contributed to the Numeric Rating Scale’s ubiquity. Notably, there is movement towards more holistic pain assessments that include functional assessments of a patient, whereby the efficacy of pain treatment is related to the degree of activity achieved ( Adeboye et al, 2021 ; Medico et al, 2017 ). The Numeric Rating Scale is criticized for its poor validity in non-English speaking, non-white patient populations and variability in what each number (and change across numbers) mean for different patients ( Adeboye et al, 2021 ; Medico et al, 2017 ; Pathak et al, 2018 ).…”

mentioning

confidence: 99%

“…Notably, there is movement towards more holistic pain assessments that include functional assessments of a patient, whereby the efficacy of pain treatment is related to the degree of activity achieved ( Adeboye et al, 2021 ; Medico et al, 2017 ). The Numeric Rating Scale is criticized for its poor validity in non-English speaking, non-white patient populations and variability in what each number (and change across numbers) mean for different patients ( Adeboye et al, 2021 ; Medico et al, 2017 ; Pathak et al, 2018 ). Despite these significant limitations, the Numeric Rating Scale remains the standard pain assessment tool for inpatient clinical settings ( Safikhani et al, 2017 ; Williamson & Hoggart, 2005 ).…”

mentioning

confidence: 99%

Pain Assessment Disparities by Race, Ethnicity, and Language in Adult Hospitalized Patients

Rambachan

Noorulhuda

Fang

et al. 2023

Pain Management Nursing

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“…In one report, patients attempted to report their pain as immobilizing (10 out of 10), but these patients exhibited functional or stable conditions and some had signs of "narcotic associated sedation." When a follow-up interview was performed, the patients stated they did not understand the numbers on the pain scale or feared they would not be treated if they did not report 10 [ 10 ]. Because of FPS checkpoints with descript losses of function, providers were prevented from overtreating the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Taken together, the traditional pain scores (NPS and FACEs) have been highly subjective, inconsistent, and poorly defined [ 10 ]. What we need is a process where the providers' perception of the pain score meaning is the same as the patient's opinion.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Functional Pain Score by Comparing to Traditional Pain Scores

Adeboye¹,

Hart²,

Senapathi³

et al. 2021

Cureus

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Background: Pain assessments, such as the Numerical Pain Scale (NPS) and Wong-Baker FACEs (FACEs), offer methods to quantify pain with simplistic descriptions on a scale of 0-10 or facial expressions. These tools have limitations and deliver insufficient information to the provider developing a pain management plan. A new Functional Pain Scale (FPS) assesses other scopes of pain, including the loss of function in activities of daily living, sleep habits, and communication. Although NPS and FACEs are traditionally used in clinical practice, FPS provides a functional assessment to help patients self-report their pain to their providers.Aim: Our study attempts to show a comparative data analysis of the FPS to NPS and FACEs. The purpose of our study is not to demonstrate FPS's superiority over NPS and FACEs but to fill the gaps of information necessary to communicate the type of pain a patient has to their provider. Due to its descriptive nature and clear scores, FPS should be implemented within electronic medical records (EMR) to help providers assess patients' pain and evaluate the efficacy of interventions selected based on that pain. Design: A prospective, observational, single-center, cohort study was performed, with simultaneously administered surveys to compare pains scores on a new FPS to the common NPS and FACEs. The target sample was postoperative orthopedic patients above 18 years of age who can read and speak English. Patients were surveyed on all three pain scales: FPS, NPS, and FACEs and were asked to rate their pain perioperatively after their respective orthopedic procedures. Methods: Spearman correlation method was used to test for correlation between the three pain scales and Wilcoxon rank-sum test was used to compare means between FPS and NPS.Results: FPS has a strong correlation with FACEs (r = 0.647, p<0.05) and with NPS (r = 0.634, p<0.05). There is a significant difference in mean scores between FPS and NPS. Conclusion and study implications:The most reliable marker of pain is patient self-reporting. In routine assessment, because pain is one-dimensional, we as providers need to better define the range of 0-10. This can only be done via an algorithm regarding which functions are lost as pain intensities increase. FPS fits those requirements by offering suitable descriptions with each pain score. The implications of the study include a chance to remedy the opioid crisis that plagues healthcare. We need tools that assess and educate patients about their pain level and appropriately convey that information to providers. Furthermore, this study is a chance for innovative tools to be implemented to better change healthcare practice. If FPS gains traction, it can improve pain communication between patients and providers.

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Improving patients’ pain experience in a large rural hospital

Cited by 5 publications

References 12 publications

Phase 2 Assessment of a New Functional Pain Scale by Comparing It to Traditional Pain Scales

Phase 2 Assessment of a New Functional Pain Scale by Comparing It to Traditional Pain Scales

Pain Assessment Disparities by Race, Ethnicity, and Language in Adult Hospitalized Patients

Assessment of Functional Pain Score by Comparing to Traditional Pain Scores

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