Pain vs comfort scores after Caesarean section: a randomized trial

Chooi, Cheryl; White, Amanda; Tan, S. G. M.; Dowling, Kate; Cyna, Allan M

doi:10.1093/bja/aes517

Cited by 66 publications

(58 citation statements)

References 20 publications

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“…First, the patient sample is small, a limitation that we share with the majority of earlier physiological investigations [4, 9, 11–13, 15, 24, 37, 38]. Second, consistent with the results of previous research [4, 22–24], we applied the 11-point NRS to assess comfort, although this scale has been formally validated for pain [39, 40] and dyspnoea [41] only.…”

Section: Discussionmentioning

confidence: 97%

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New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

et al. 2017

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BackgroundNoninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony.MethodsThree 30-minute trials of NIV were randomly delivered to 14 patients immediately after extubation to prevent post-extubation respiratory failure: (1) PSP, with an inspiratory support ≥8 cmH2O; (2) NAVA, adjusting the NAVA level to achieve a comparable peak EAdi (EAdipeak) as during PSP; and (3) PSN, setting the NAVA level at 15 cmH2O/μV with an upper airway pressure (Paw) limit to obtain the same overall Paw applied during PSP. We assessed patient comfort, peak inspiratory flow (PIF), time to reach PIF (PIFtime), EAdipeak, arterial blood gases, pressure-time product of the first 300 ms (PTP300-index) and 500 ms (PTP500-index) after initiation of patient effort, inspiratory trigger delay (DelayTR-insp), and rate of asynchrony, determined as asynchrony index (AI%). The categorical variables were compared using the McNemar test, and continuous variables by the Friedman test followed by the Wilcoxon test with Bonferroni correction for multiple comparisons (p < 0.017).ResultsPSN significantly improved patient comfort, compared to both PSP (p = 0.001) and NAVA (p = 0.002), without differences between the two latter (p = 0.08). PIF (p = 0.109), EAdipeak (p = 0.931) and gas exchange were similar between modes. Compared to PSP and NAVA, PSN reduced PIFtime (p < 0.001), and increased PTP300-index (p = 0.004) and PTP500-index (p = 0.001). NAVA and PSN significantly reduced DelayTR-insp, as opposed to PSP (p < 0.001). During both NAVA and PSN, AI% was <10% in all patients, while AI% was ≥10% in 7 patients (50%) with PSP (p = 0.023 compared with both NAVA and PSN).ConclusionsCompared to both PSP and NAVA, PSN improved comfort and patient-ventilator interaction during NIV by facial mask. PSN also improved synchrony, as opposed to PSP only.Trial registrationClinicalTrials.gov, NCT03041402. Registered (retrospectively) on 2 February 2017.

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Section: Discussionmentioning

confidence: 97%

“…Comfort was assessed through an 11-point numeric rating scale (NRS), as previously reported [4, 22–24]. Before protocol initiation, all patients received a detailed explanation of the NRS.…”

Section: Methodsmentioning

confidence: 99%

New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

et al. 2017

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“…[7] Recently, studies have documented that the use of word “comfort” rather than the word “pain” may affect patient's experience of their recovery. [8910] However, further investigations are needed to validate the results of these studies in our patient population.…”

Section: Introductionmentioning

confidence: 92%

A randomized comparative study assessing efficacy of pain versus comfort scores

Jain

Grewal

2017

Saudi J Anaesth

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Context:Use of language with negative emotional content is likely to increase patient's pain and anxiety.Aims:We designed a single-blinded randomized study to compare pain scores with comfort scores and to determine whether the technique of pain assessment affects patient's perceptions and experience.Subjects and Methods:After cesarean section, 180 women were randomized before postanaesthesia interview into two groups. Group P women were asked to rate their pain on a 0–10-point verbal numerical rating scale (VNRS) for pain while Group C women were asked to rate their comfort on a 0–10-point VNRS for comfort. All women were asked whether the surgical wound was associated with injury or healing. The primary outcomes were to compare the incidence of reported pain and to assess pain severity as measured by a 0–10-point VNRS for pain compared with an equivalent inverted VNRS for comfort. The secondary outcomes were whether the wound was associated with injury or healing.Statistical Analysis Used:Data were analyzed using Student's t-test and nonparametric Mann–Whitney U-test, performed at a significance level of α =0.05.Results:In Group P, 62 women (68.9%) reported pain compared with only 49 women (54.4%) in Group C (P < 0.05). There were no significant differences between groups for VNRS at rest and on movement. In Group P, thirty women (33.33%) reported sensations as injury compared with only 11 women (12.22%) in Group C (P < 0.001).Conclusions:Assessment of pain using positive word like comfort decreases its incidence with no effect on its severity when measured by comfort score and also affects patient's postsurgical perceptions.

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“…While this was of practical necessity to demonstrate the effects of this pilot intervention, yet, there may be more efficacious strategies that are more consonant with an acceptance framework. One example is to have children monitor sensations associated with the experience of a feeling of calm or comforting sensations (Piotr Gruska, personal communication; or see for example, Chooi, White, Tan, Dowling, & Cyna, 2013). Future work should explore whether the assessment of pain is experienced as contradicting the message of pain acceptance.…”

Section: Discussionmentioning

confidence: 99%

Acceptance-based interoceptive exposure for young children with functional abdominal pain

Zucker

Mauro

Craske

et al. 2017

Behaviour Research and Therapy

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Functional abdominal pain (FAP) is a common childhood somatic complaint that contributes to impairment in daily functioning (e.g., school absences) and increases risk for chronic pain and psychiatric illness. Cognitive behavioral treatments for FAP target primarily older children (9+ years) and employ strategies to reduce a focus on pain. The experience of pain may be an opportunity to teach viscerally hypersensitive children to interpret the function of a variety of bodily signals (including those of hunger, emotions) thereby reducing fear of bodily sensations and facilitating emotion awareness and self-regulation. We designed and tested an interoceptive exposure treatment for younger children (5–9 years) with FAP. Assessments included diagnostic interviews, 14 days of daily pain monitoring, and questionnaires. Treatment involved 10 weekly appointments. Using cartoon characters to represent bodily sensations (e.g., Gassy Gus), children were trained to be “FBI agents” – Feeling and Body Investigators - who investigated sensations through exercises that provoked somatic experience. 24 parent-child dyads are reported. Pain (experience, distress, and interference) and negative affect demonstrated clinically meaningful and statistically significant change with effect sizes ranging from .48–71 for pain and from .38–.61 for pain distress, total pain: X2 (1, n=24) = 13.14, p < .0003. An intervention that helps children adopt a curious stance and focus on somatic symptoms reduces pain and may help lessen somatic fear generally.

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Pain vs comfort scores after Caesarean section: a randomized trial

Abstract: Asking about pain and pain scores after Caesarean section adversely affects patient reports of their postoperative experiences.

Cited by 66 publications

References 20 publications

New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

New setting of neurally adjusted ventilatory assist for noninvasive ventilation by facial mask: a physiologic study

A randomized comparative study assessing efficacy of pain versus comfort scores

Acceptance-based interoceptive exposure for young children with functional abdominal pain

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