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Djordjevic CM. Finding a meaning for pain: Definitions, sense-making, and philosophical health. J Eval Clin Pract 2023; 29:1196-1202. [PMID: 37309094 DOI: 10.1111/jep.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Pain has proven to be a refractory problem in US healthcare. This paper argues that starting to address this requires viewing pain-assessment as a form of sense-making that occurs between patients and providers. Section I argues that two standard definitions of 'pain' that are thought to subtend pain assessment are not viable. Section II proffers a very different way to think about the meaning of 'pain'. Section III develops this novel account by pairing Rorty's account of hermeneutics with recent developments in the pain-assessment literature. Finally, section four moves beyond Rorty by linking sense-making to philosophical health. Should this prove persuasive, I will have shown an area in biomedicine where philosophy is not an 'optional add on', but a vitally important part of what should be clinical practice.
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Affiliation(s)
- Charles M Djordjevic
- Lorain County Community College, Elyria, Ohio, USA
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Craig KD. A child in pain: A psychologist’s perspective on changing priorities in scientific understanding and clinical care. PAEDIATRIC AND NEONATAL PAIN 2020; 2:40-49. [PMID: 35548593 PMCID: PMC8975203 DOI: 10.1002/pne2.12034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
My research and clinical career followed a trajectory of increasing appreciation for the importance of social factors as determinants of pain experience and expression. The social contexts of children’s lives determine whether infants and children are exposed to pain, how socialization in family and ethnocultural contexts lead to pain as a social experience, comprised of thoughts and feelings as well as sensory input, how others shape pain experience and expression, less so for automatic/reflexive features than purposeful representations, and how other's appraisals of children’s pain reflect the observer's unique background and capacities for intervening in the child’s interests. A greater understanding of the social dimensions of pain, as reflected in the social communication model of pain, would support innovation of psychological and social interventions.
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Cohen LL, Donati MR, Shih S, Sil S. Topical Review: State of the Field of Child Self-Report of Acute Pain. J Pediatr Psychol 2020; 45:239-246. [PMID: 31665377 DOI: 10.1093/jpepsy/jsz078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Children experience acute pain with routine and emergent healthcare, and untreated pain can lead to a range of repercussions. Assessment is vital to diagnosing and treating acute pain. Given the internal nature of pain, self-report is predominant. This topical review reflects on the state of the field of pediatric acute pain self-report, and proposes a framework for acute pain assessment via self-report. METHOD We examine self-report of acute pain in preschool-age children through adolescents, and we detail a three-step process to optimize acute pain assessment. RESULTS The first step is to decide between a pain screening or assessment. Several 0-10 self-report scales are available for pain screenings. Assessment requires specification of the goals and domains to target. Core criteria, common features, modulating factors, and consequences of acute pain provide a framework for a comprehensive pain assessment. Whereas there are some measures available to assess aspects of these domains, there are considerable gaps. Last, it is important to integrate the data to guide clinical care of acute pain. CONCLUSIONS Self-report of acute pain is dominated by single-item intensity scales, which are useful for pain screening but inadequate for pain assessment. We propose a three-step approach to acute pain assessment in children. However, there is a need for measure development for a comprehensive evaluation of the core criteria, common features, modulating factors, and consequences of pediatric acute pain. In addition, there is limited guidance in merging data found in multifaceted evaluations of pediatric acute pain.
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Affiliation(s)
| | | | - Sharon Shih
- Department of Psychology, Georgia State University
| | - Soumitri Sil
- Department of Pediatrics, Emory University School of Medicine
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Jaaniste T, Noel M, Yee RD, Bang J, Tan AC, Champion GD. Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer. CHILDREN-BASEL 2019; 6:children6120132. [PMID: 31810283 PMCID: PMC6956370 DOI: 10.3390/children6120132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child’s pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children’s self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
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Affiliation(s)
- Tiina Jaaniste
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
- Correspondence:
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Hotchkiss Brain Institute, Calgary, AB T2N 1N4, Canada
| | - Renee D. Yee
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Joseph Bang
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | | | - G. David Champion
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
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Abstract
Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children's pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement;
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Affiliation(s)
- John V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, 60611, IL, USA
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
- Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA
- Children's Hospital of Chicago Research Center, Chicago, IL, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Research Center for the Investigation of Functional and Gastrointestinal Motility Disorders in Children, Nationwide Children's Hospital, 700 Children's Drive, Columbus, 43205, OH, USA.
- College of Medicine, Ohio State University, Columbus, OH, USA.
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Aung MSH, Alquaddoomi F, Hsieh CK, Rabbi M, Yang L, Pollak JP, Estrin D, Choudhury T. Leveraging Multi-Modal Sensing for Mobile Health: A Case Review in Chronic Pain. IEEE JOURNAL OF SELECTED TOPICS IN SIGNAL PROCESSING 2016; 10:962-974. [PMID: 30906495 PMCID: PMC6430587 DOI: 10.1109/jstsp.2016.2565381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Active and passive mobile sensing has garnered much attention in recent years. In this paper, we focus on chronic pain measurement and management as a case application to exemplify the state of the art. We present a consolidated discussion on the leveraging of various sensing modalities along with modular server-side and on-device architectures required for this task. Modalities included are: activity monitoring from accelerometry and location sensing, audio analysis of speech, image processing for facial expressions as well as modern methods for effective patient self-reporting. We review examples that deliver actionable information to clinicians and patients while addressing privacy, usability, and computational constraints. We also discuss open challenges in the higher level inferencing of patient state and effective feedback with potential directions to address them. The methods and challenges presented here are also generalizable and relevant to a broad range of other applications in mobile sensing.
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Affiliation(s)
- Min S Hane Aung
- Department of Information Science, Cornell University, Ithaca, NY 14853 USA
| | - Faisal Alquaddoomi
- Department of Computer Science University of California, Los Angeles, CA 90095 USA
| | - Cheng-Kang Hsieh
- Department of Computer Science University of California, Los Angeles, CA 90095 USA
| | - Mashfiqui Rabbi
- Department of Information Science, Cornell University, Ithaca, NY 14853 USA
| | - Longqi Yang
- Jacobs-Technion Cornell Institute, New York, NY 10011 USA
| | - J P Pollak
- Jacobs-Technion Cornell Institute, New York, NY 10011 USA
| | - Deborah Estrin
- Jacobs-Technion Cornell Institute, New York, NY 10011 USA
| | - Tanzeem Choudhury
- Department of Information Science, Cornell University, Ithaca, NY 14853 USA
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Louriz M, Belayachi J, Armel B, Dendane T, Abidi K, Madani N, Zekraoui A, Benchekroun AB, Zeggwagh AA, Abouqal R. Factors associated to unrelieved pain in a Morrocan Emergency Department. Int Arch Med 2014; 7:48. [PMID: 25400695 PMCID: PMC4233084 DOI: 10.1186/1755-7682-7-48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/24/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In the light of the impact that pain has on patients, emergency department (ED) physicians need to be well versed in its management, particularly in its acute presentation. The goal of the present study was to evaluate the prevalence of unrelieved acute pain during ED stay in a Moroccan ED, and to identify risk factors of unrelieved pain. METHODS Prospective survey of patients admitted to the emergency department of Ibn Sina teaching university hospital in Rabat (Morocco). All patients with acute pain over a period of 10 days, 24 hours each day were included. From each patient, demographic and clinical data, pain characteristics, information concerning pain management, outcomes, and length of stay were collected. Pain intensity was evaluated both on arrival and before discharge using Numerical Rating Scale (NRS). Comparison between patient with relieved and unrelieved pain, and factors associated with unrelieved pain were analyzed using stepwise forward logistic regression. RESULTS Among 305 patients who complained of acute pain, we found high levels of intense to severe pain at ED arrival (91.1%). Pain intensity decreased at discharge (46.9%). Unrelieved pain was assessed in 24.3% of cases. Patients with unrelieved pain were frequently accompanied (82.4% vs 67.1%, p = 0.012), and more admitted daily than night (8 am-20 pm: 78.4% vs 64.9%; 21 pm-7 am: 21.6% vs 35.1%, p = 0.031), and complained chiefly of pain less requently (56.8% vs 78.8%, p<0.001). They had progressive pain (73% vs 44.2%, p<0.001), and had a longer duration of pain before ED arrival (72-168 h: 36.5% vs 16.9%; >168 h: 25.5% vs 17.7%, p<0.001). In multivariate analysis, predictor factors of unrelieved pain were: accompanied patients (OR = 2.72, 95% CI = 1.28- 5.76, p = 0.009), pain as chief complaint (OR = 2.32, 95% CI = 1,25-4.31, p = 0.007), cephalic site of pain (OR = 6.28, 95% CI = 2.26-17.46, p<0.001), duration of pain before admission more than 72 hours (72-168 h (OR = 7.85, 95% CI = 3.13-25.30, p = 0.001), and >168 h (OR = 4.55, 95% CI = 1.77-14.90, p = 0.02). CONCLUSION This study reported high levels of intense to severe pain at ED arrival. However, one quarter patients felt on discharge from the ED that their pain had not been relieved. The relief of pain in ED depend both sociodemographic, clinical, and pain characteristics factors.
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Affiliation(s)
- Maha Louriz
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Jihane Belayachi
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Bouchra Armel
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Tarek Dendane
- Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Khalid Abidi
- Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Naoufel Madani
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Aicha Zekraoui
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | | | - Amine Ali Zeggwagh
- Medical Intensive Care Unit, Ibn Sina University Hospital, 10000 Rabat, Morocco
| | - Redouane Abouqal
- Medical Emergency Department, Ibn Sina University Hospital, 10000 Rabat, Morocco ; Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculté de Médecine et Pharmacie- Université Mohamed V Souissi, 10000 Rabat, Morocco
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Schiavenato M, Alvarez O. Pain assessment during a vaso-occlusive crisis in the pediatric and adolescent patient: rethinking practice. J Pediatr Oncol Nurs 2013; 30:242-8. [PMID: 23850944 DOI: 10.1177/1043454213494014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pain assessment of the child and adolescent with sickle cell disease is complex and challenging. We present a paradigm of pain assessment during a vaso-occlusive crisis in children and adolescents based on the Pain Assessment as a Social Transaction model. Using this model, the assessment of pain severity in sickle cell disease is uniquely highlighted as comprising at least 4 key factors: the limitations of current pain assessment tools, the existence of acute pain of various origins and the emergence and coexistence of chronic pain, the prevalence of cognitive deficits, and the sociocultural dynamics in America. Improved tools for pain assessment and targeted practitioner education are warranted.
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Affiliation(s)
- Martin Schiavenato
- 1University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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