The Relationship Between Cognitive Intrusion of Pain, Fear of Surgery, and Comfort

AIM

The aim of this study was to examine the relationship between cognitive intrusion of pain, fear of surgery, and comfort in the perioperative period.

DESIGN

This was a descriptive study conducted with 180 patients hospitalized for surgery in a training and research hospital.

METHODS

A sociodemographic questionnaire, Surgical Fear Questionnaire, General Comfort Questionnaire, and Experience of Cognitive Intrusion of Pain Scale were administered to the participants prior to surgery, while General Comfort Questionnaire and Experience of Cognitive Intrusion of Pain Scale were administered after surgery.

RESULTS

Of the participants with a mean age of 49.94 ± 17.26 years, 62.2% were male and 31.1% had at least one chronic disease. The mean preoperative and postoperative pain scores were 2.65 and 3.47, respectively. There was a statistically significant negative correlation between perioperative experience of cognitive intrusion of pain and perioperative comfort and a positive correlation between perioperative experience of cognitive intrusion of pain and preoperative fear of surgery (p < .05).

CONCLUSIONS

Cognitive intrusion of pain does not change in the perioperative period. As the cognitive intrusion of pain increases, patient comfort decreases and surgical fear increases. Our study contributes to the literature since it is the first study evaluating the cognitive intrusion of pain in the perioperative period.

The Role of the Cardiac Surgery Patient in Pain Management: The Patient Perspective

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes.

Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar

BACKGROUND

Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role.

AIM

To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes.

METHODS

Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA.

RESULTS

A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education.

CONCLUSIONS

There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients

OBJECTIVE

A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology.

METHODS

Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated.

RESULTS

Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator.

CONCLUSION

Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment.

PRACTICE IMPLICATIONS

The clinical and educational importance of empathy in patient-provider relationships are discussed.

Surgery patients' perspectives of their role in postoperative pain: A scoping review

Background

Post-operative pain is a major factor in surgical recovery. There is evidence that pain remains undermanaged. Complications related to the undermanagement of acute pain can increase length of stay and contribute to readmission and the development of chronic pain. It is well acknowledged that pain assessment is critical to pain management and that self-report of pain is the gold standard. As a result, patients play a central role in their own pain management. A preliminary review of the literature failed to provide a clear or consistent description of this key patient role.

Objective

A scoping review was conducted with the objective of reviewing literature that described adult patients' perspectives or highlighted the adult patient's role in post-operative pain management, including assessment. Understanding patients' attitudes toward their roles in pain management through a scoping review of the current literature is critical for informing research and improvements in post-operative pain management.

Design

Scoping review.

Methods

The databases searched for the review included CINAHL, MEDLINE, PubMed, and SCOPUS (ending May 2022). Thematic analysis, using the methodology of Arksey and O'Malley, was applied to the records identified.

Results

Of the 106 abstracts initially identified, 26 papers were included in the final analysis. Two major themes identified through thematic analysis were attitudes toward pain and pain management, with the subthemes of patient expectations and beliefs and desire to treat; and care and communication, with the subthemes of pain assessment and education.

Conclusions

This paper provides one of the first known comprehensive scoping reviews of surgical patients' perspectives of their role in pain management, including assessment, and offers an important global awareness of this patient role. The findings suggest that improved understanding of patients' perspectives of their roles in pain assessment and treatment is critical to improving post-operative pain management. Engaging patients as partners in their care can facilitate enhanced communication and improving congruence in pain assessment and treatment decisions. The complex nature of patients' beliefs, expectations, and subjective experiences of pain present challenges for health care practitioners. These challenges can be met with enhanced education for patients, respect for patients' beliefs and expectations, and the provision of dignified care.

Effects of Pain Beliefs on Postoperative Pain and Analgesic Consumption in Spine Surgery Patients

ABSTRACT

PURPOSE: This study evaluates the impact of pain belief on postoperative pain and analgesic consumption in patients undergoing spine surgery. METHODS: This descriptive and cross-sectional study was conducted on 71 patients undergoing spine surgery, who were admitted to the neurosurgery department of a university hospital between January 2021 and April 2022. Descriptive information form, Pain Beliefs Questionnaire, visual analog scale, pain evaluation form, and verbal category scale were used for data collection. RESULTS: Participant mean age was 53 years, and 40.8% underwent spinal disc surgery. A total of 60.2% of the participants experienced moderate postoperative pain, and severe pain was noted during the second postoperative hour, after rest and coughing, which decreased significantly during consecutive hours. Besides, 70.4% of the participants expressed that the level of pain decreased, 43.7% had pain as they expected, 69.0% had intermittent pain, and 53.5% experienced pain at the surgical site. The mean scores obtained from the Organic and Psychological Beliefs subscales of the Pain Beliefs Questionnaire were 4.25 and 4.21, respectively. There was a statistically significant relationship between the Psychological Beliefs and visual analog scale scores after coughing measured in the postoperative 24th and 36th hours. There was also a significant relationship between organic beliefs and working status. There was no statistically significant relationship between analgesic consumption and pain belief. CONCLUSION: Patients undergoing spine surgery experienced moderate pain and had a relatively high level of pain beliefs. Regular evaluation of pain levels and beliefs is required for effective pain management.

Measuring person-centred pain management: Development of a questionnaire using the fundamentals of care framework

AIM

To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management.

DESIGN

Cross-sectional exploratory descriptive design.

METHODS

Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital.

RESULTS

The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement.

CONCLUSION

This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain.

PATIENT OR PUBLIC CONTRIBUTION

Patients and providers were involved in testing the questionnaire.

Comparison between pupillometry and numeric pain rating scale for pain assessments in communicating adult patients in the emergency department

OBJECTIVE

The adequate assessment of pain in the emergency department (ED) can be challenging. Two dynamic pupillary measures used in conscious subjects after a surgical procedure were previously shown to correlate to the magnitude of ongoing pain. The objective of this study was to test the ability of dynamic measures derived from pupillometry to evaluate pain intensity in conscious adult patients admitted to the ED.

METHODS

This prospective, interventional, single-centre study was performed between August 2021 and January 2022 (NCT05019898). An assessment of self-reported pain intensity was performed on ED admission by the triage nurse using a numeric rating scale (NRS). This was followed by two dynamic measures derived from pupillometry that were previously correlated with pain perception: the pupillary unrest under ambient light (PUAL) and the pupillary light reflex (PLR).

RESULTS

Among the 313 analysed patients, the median age was 41 years, and 52% were women. No correlation was found between self-reported pain ratings and PUAL (r = 0.007) or PLR (baseline diameter r = -0.048; decrease r = 0.024; latency r = 0.019; slope = -0.051). Similarly, the pupillometry measures could not discriminate patients with moderate to severe pain (defined as NRS ≥4).

CONCLUSIONS

Pupillometry does not appear to be an effective tool to evaluate pain in the ED environment. Indeed, too many factors influencing the sympathetic system-and thus the dynamic pupillary measures-are not controllable in the ED.

SIGNIFICANCE

Pupillometry does not appear to be an effective tool to evaluate pain in the ED environment. There are several possible explanations for these negative results. The factors influencing the sympathetic system-and thus the PD fluctuations-are controllable in the postoperative period but not in the ED (e.g. full bladder, hypothermia). In addition, numerous psychological phenomena can impact pupillometry measurements such as emotional reactions or cognitive tasks. These phenomena are particularly difficult to control in the ED environment.

A Turkish Study to Identify the Discharge Learning Needs of Spinal Surgery Patients

ABSTRACT

PURPOSE: The aim of this study was to identify the learning needs of spinal surgery patients before hospital discharge. METHODS: This cross-sectional study consisted of 117 spinal surgery patients admitted to the neurosurgery department between October 2019 and March 2020. Data were collected using a descriptive information form, visual analog scale, and the Patient Learning Needs Scale. Data were analyzed using descriptive statistics, Mann-Whitney U and Kruskal-Wallis tests, and Spearman correlation analysis. RESULTS: The mean age of the participants was 54 years, 54.7% were male, and 59% underwent surgery because of spinal disc herniation. The mean Patient Learning Needs Scale score was 188.74. The primary learning needs of the patients were related to the dimensions of activities of living, medication, treatment, and complications, whereas the feelings related to condition were the least-demanded dimension of learning needs. Sex and occupation were the primary factors influencing learning needs. CONCLUSION: The level of learning needs in spinal surgery patients was relatively high. Therefore, discharge education may be planned in line with the learning needs and priorities of these patients, and sex and occupation may be considered while planning discharge education.

The effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review

BACKGROUND

This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control.

METHODS

The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria.

RESULTS

Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I² = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I² = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I² = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I² = 97%; GRADE: very low).

CONCLUSIONS

Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.

Validation and Scoring of the Greek Version of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) Questionnaire

PURPOSE

The aim of this study was to validate the Greek version of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire.

DESIGN

The study was designed as a prospective questionnaire survey.

METHODS

Overall, 210 elective surgical patients were included . SCQIPP consisted of 14 items that were scored on a five point scale. After the translation and linguistic adjustments, the tool was distributed to the surgical wards. Internal consistency reliability was assessed by Cronbach's alpha. The tool construct was generated by a principal axis factoring model with promax rotation.

FINDINGS

Base Cronbach's alpha was 0.814. Due to low inter-item and item-total correlations and the increase of Cronbach's alpha (0.834) when item two was deleted, 13 items were included in the current tool version. Factor analysis identified three district subscales: nursing care, pain management, and support. Subscale and convergent validity were confirmed. The mean score of the validated tool was 55.2 (Range: 44-63). A low level of care was highlighted in most items.

CONCLUSIONS

The Greek version of the SCQIPP questionnaire is a valid and efficient tool for the evaluation of the quality of care of postoperative pain management.

Risk factors for underestimation of patient pain in outpatient colonoscopy

BACKGROUND

Adequate management of patient pain and discomfort during colonoscopy is crucial to obtaining a high-quality examination. We aimed to investigate the ability of endoscopists and endoscopy assistants to accurately assess patient pain in colonoscopy.

METHODS

This was a single-center, cross-sectional study including patients scheduled for an outpatient colonoscopy. Procedure-related pain, as experienced by the patient, was scored on a verbal rating scale (VRS). Endoscopists and endoscopy assistants rated patient pain likewise. Cohen's kappa was used to measure the agreement between ratings and logistic regression applied to test for potential predictors associated with underestimation of moderate-severe pain.

RESULTS

In total, 785 patients [median age: 54 years; females: n = 413] were included. Mild, moderate, and severe pain was reported in 378/785 (48%), 168/785 (22%), and 111/785 (14%) procedures respectively. Inter-rater reliability of patient pain comparing patients with endoscopists was κ = 0.29, p < .001 and for patients with endoscopy assistants κ = 0.37, p < .001. In the 279 patients reporting moderate/severe pain, multivariable analysis showed that male gender (OR = 1.79), normal BMI (OR = 1.71), no history of abdominal surgery (OR = 1.81), and index-colonoscopy (OR = 1.81) were factors significantly associated with a risk for underestimation of moderate/severe pain by endoscopists. Young age (OR = 2.05) was the only corresponding factor valid for endoscopy assistants.

CONCLUSIONS

In a colonoscopy, estimation of patient pain by endoscopists and endoscopy assistants is often inaccurate. Endoscopists need to pay specific attention to subgroups of patients, such as male gender, and normal BMI, among whom there seems to be an important risk of underestimation of moderate-severe pain.

Nurses' Perspectives on Postpartum Pain Management

Introduction:

There is variation in postpartum opioid use by prescriber characteristics that cannot be explained by patient or birth factors. Thus, our objective was to evaluate nursing training, clinical practices, and perspectives on opioid use for postpartum pain management.

Materials and Methods:

In this survey study, postpartum bedside nurses at a single, large academic center were asked about training, factors influencing clinical decisions, and viewpoints regarding pain management and opioid use. Findings were summarized using descriptive analyses.

Results:

A total of 92 nurses completed the survey. A majority (77%) reported having received some formal training on opioid use for pain management. About a quarter (25.7%) felt their training was not adequate. Regarding clinical practices, the majority (71% and 70%, respectively) reported that “routine habit” and “patient preference” most influenced the type and amount of pain medication they administered. Finally, nurses' perspectives on pain management demonstrated a wide range of beliefs. Most nurses strongly agreed with the importance of maximizing nonopioid pain medication before opioid administration. The majority agreed that patient-reported pain score is important to consider when deciding to administer opioids. Conversely, most nurses disagreed that patients should be encouraged to endure as much pain as possible before using an opioid. Similarly, beliefs about the reliability of use of vital signs in assessing pain intensity varied widely.

Conclusions:

Bedside nurses rely on routine habits, patient preference, and patient-reported pain score when administering opioids for postpartum pain management. Increased training opportunities to improve consistency and standardization of opioid administration may be beneficial.

Association of preoperative pain beliefs with postoperative pain levels in abdominal surgery patients

AIMS AND OBJECTIVES

This study aimed to analyse the association of preoperative pain beliefs with postoperative pain levels in abdominal surgery patients.

BACKGROUND

Postoperative pain is related to not only clinical and demographic characteristics but also pain beliefs. The perception, intensity and expression of pain as a subjective experience varies among individuals and cultures. Personal beliefs about pain play an important role in pain experiences and responses.

DESIGN

This cross-sectional study consisted of 126 abdominal surgery patients admitted to the General Surgery and Gynecological Surgery Clinics between September 2018-January 2019. The STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) checklist was used as a guideline for this study.

METHODS

Data were collected through descriptive information forms, pain characteristics questionnaires, Visual Analogue Scales and pain beliefs questionnaires. One-way variance analysis and Pearson's correlation and t tests were used for data analysis.

RESULTS

The mean age of the participants was 48.63 ± 14.27 years. A total of 37.3% of the participants experienced moderate pain and 35.7% experienced severe pain at the 8th postoperative hour. Pain intensity significantly decreased at 16, 24 and 32 h postoperatively. In the predischarge interviews, 92.1% of the patients expressed limitations in physical activities due to pain. There was a relationship between 8-16 h postoperatively and sex and pain expectancy. Mean scores obtained from the organic and psychological beliefs subscales of the Pain Belief Questionnaire were 3.12 ± 0.79, and 2.37 ± 1.11, respectively. The psychological beliefs score was negatively associated with the level of education, and the organic beliefs score was higher for those participants who had undergone gynaecological surgery. There was a weak and positive correlation between the organic beliefs and psychological beliefs subscales of the Pain Beliefs Questionnaire.

CONCLUSION

Patients had moderate to severe postoperative pain, and sex and pain expectations affected the experienced level of pain. Most participants believed that the pain was organic in origin. The level of education exerted a significant impact on pain beliefs.

RELEVANCE TO CLINICAL PRACTICE

Characteristics and perception of pain and pain beliefs are important factors that should be determined to personalise pain relief care and maintain effective pain management.

Factors Affecting the Satisfaction Levels of Patients who Underwent Orthopedic Knee Surgery in the Early Postoperative Period

The aim of this study was to investigate the effects of biopsychosocial parameters in the early postoperative period on the satisfaction of patients. Seventy-seven patients (female/male: 61/16, age: 40.28 ± 17.67 years) who underwent arthroscopic meniscectomy (n = 43), anterior cruciate ligament reconstruction (n = 25) and total knee arthroplasty (n = 9) were included in this study. The satisfaction levelwas evaluated using the Orthopedics Service Inpatient Satisfaction Survey (OTISS). In addition, the pain intensity, anxiety, depression, and independence level in daily living activities of the patients were evaluated. There was a very weak negative correlation between the anxiety and the satisfaction level with the physiotherapist and secretary (r: -0.274, p: 0.016; r:-0.265, p: 0.020). A very weak negative correlation was found between the pain intensity at activity and satisfaction with the nurse (r: -0.227, p: 0.048). There were very weak correlations between feeding and satisfaction with the physiotherapist (r: 0.292, p: 0.010), secretary (r: 0.285, p: 0.012), doctor (r: -0.269, p: 0.018), nurse (r: 0.300, p: 0.008) general satisfaction (r: 0.251, p: 0.028) and OTISS total score (r: -0.305, p: 0.007). In conclusion, the pain intensity, anxiety, and independence level in the early postoperative period were related to the satisfaction levels of patients who have undergone orthopedic knee surgery.

Recognising the importance of language in effective pain assessment

Pain is a highly personal experience that can be challenging to define. In addition, evidence has indicated that the assessment of pain by healthcare professionals is often suboptimal and its severity often underestimated. In clinical practice, the use of language can be a significant influencing factor in the effective management of pain, with terms such as pain, discomfort and comfort used interchangeably. This article explores how language can both act as a barrier to, and assist, nurses to understand the patient's pain experience.