Friday, November 15, 2019
Assessing Pain in in Post Operative Breast Cancer Patients
Assessing Pain in in Post Operative Breast Cancer Patients Comparison between Briefà Painà Inventory (BPI) and Numerical Rating Scale (NRS) for post-operative pain assessment in Saudi Arabianà breast cancer patients. Questions Doesà BPI assessà post-operative breast cancer painà moreà accurately than NRS? Summary: Effective pain assessment is one of theà fundamentalà criteriaà of theà management ofà pain. It involvesà theà evaluation of pain intensity, location of the pain and response to treatment. There areà aà numberà of multi and one-dimensional assessment toolsà thatà have already been established to assess cancer pain. Among theseà are theà Brief Pain Inventory (BPI) andà theà Numerical Rating Scale (NRS), Breast cancer isà a growing publicà concern in Saudi Arabiaà as rates continue to escalate, with patientsà alsoà suffering multiple problems after surgery. Therefore, my research aim is toà conduct aà comparative studyà of toolsà used toà assess post-operative breast cancer painà inà Saudi Arabianà patientsà and determine which is the most effective. In this process I will use questionnaires for both nurses and patients to collect data,à followed by statistical analysis andà aà comparativeà study betweenà theà BPI and NRS. Research Hypothesis: BPI assessesà post-operative breast cancer painà in Saudi Arabianà patientsà moreà accurately than NRS.à Null hypothesis: There is no significant difference between BPI and NRSà as tools forà assessing post-operative breast cancer painà inà Saudi Arabianà patients Background: Pain is defined asà ââ¬Ëthe normal, predicted physiological response to an adverse chemical, thermal or mechanical stimulus related with surgery, trauma or acute illnessââ¬â¢ (Carr and Goudas, 1999).à Pain assessment is a crucial component for the effective management of post-operative pain in relation to breast cancer. The patientââ¬â¢s report is the mainà resourceà of informationà regarding theà characterisation and evaluation of pain; as such, assessment isà the ââ¬Ëdynamic method of explanation of the syndrome of the pain, patho-physiology andà the basis forà designing a protocol for its managementââ¬â¢Ã (Yomiya, 2011). A recent surveyà questioned almost 900 physiciansà 897 and foundà thatà 76% reported substandardà pain assessmentà proceduresà as the single most important barrierà toà suitableà pain management (Roennà et al, 1993). Breast cancer is characterized byà aà lump or thickening inà theà breast, discharge or bleeding,à aà change in colour ofà theà areola, redness or pitting of skinà and aà marble like area underà theà skin (WebMD, 2014[A1]). Breast cancerà has a high prevalence rate globally and is the second most diagnosed cancer in women. Approximatelyà 1.7 million cases were reported in 2012à aloneà (WCRFI, 2014). In 2014,à just overà 15,000à womenà haveà alreadyà beenà diagnosed with breast cancer: this figure is predicted to rise to around 17,200 in 2020 Breast cancerà has also been identifiedà as one of the major cancer related problems in Saudi Arabia, with 6,922 women wereà assessed[A2]à for breast cancer between 2001-2008 (Alghamdi,à 2013[A3]). Dà Pain assessment tools Polità et alà (2006) conductedà a systematic review of the evidence baseà andà recorded a total ofà 80 different assessment tools thatà containedà at least one pain item. Theà tools were thenà categorised into pain toolsà (n=48)à and general symptoms toolsà (n=32) . They were thenà separated into uni-dimensionalà toolsà (which measure the pain intensity)à and multi-dimensional toolsà (include more than one pain dimension). 33%à of all pain toolsà (n=16) were uni-dimensional, andà 50% of allà general symptom toolsà (n=16)were uni-dimensional. 58% of the uni-dimensional toolsà employedà singleà item scales such asà theà Visualà Analogueà Scale (VAS), Verbal Rating Scales (VRS)à and NRS (Numericalà Ratingà Scale). The most common dimensionà includedà was pain intensity, present in 60% ofà tools. Inà the assessed tools, 60% assessed painà in aà multi-dimensionalà format. Amongà pain tools,à 67% were found à to beà multi-dimensionalà compared with 50% of the general symptom tools.à 38% of all multi-dimensional tools were two-dimensional.à The mostà commonly usedà dimension wasà ââ¬Ëintensityââ¬â¢,à presentà in 75% ofà allà multi-dimensional tools. Other commonà dimensionsà includeà interference, locationà and beliefs. All the dimensions were specifically targeted by two particular tools which were disease-specific tools and tools that measure pains affect, beliefs, and coping-relatedà issues[A4]. Multidimensional Pain assessment tools: Fà Theà adequate measurement of painà requiresà more than one tool. Melzack and Casey (1968)à highlight thatà pain assessmentà ââ¬Ëshould include three dimensions which are sensory-discriminative, motivational-affective and cognitive-evaluativeââ¬â¢.à This builds on theà earlierà proposal ofà Beecher (1959)à who considered that all tools should include theà two dimensionsà ofà pain and reaction to pain. Cleeland (1989)à considered thatà theà two dimensionsà should be classifiedà as sensory and reactive. Sensory dimensionsà should recordà the intensity or severityà of painà and the reactive dimensions should include accurate measures of interferenceà in theà daily functionà of the patient.à Multi-dimensional pain assessments generally consist ofà sixà dimensions: physiologic, sensory, affective, cognitive, behavioural and sociocultural (McGuire, 1992). Cleeland (1989)à interviewed patients andà foundà thatà seven items could effectively measure the intensity and effects of the pain in daily activities: theseà compriseà ofà general activity, walking, work, mood, enjoyment of life, relations with others and sleep. These elements were later subdividedà into two groups: ââ¬ËREMââ¬â¢Ã (relations with others, enjoyment of life and mood) andà ââ¬ËWAWââ¬â¢Ã (walking, general activity and work). Later, Cleelandà et alà (1996) developedà theà Briefà Painà Inventory (BPI) in bothà itsà short and long form.à It was designedà to capture twoà categoriesà of interference such asà activity and affect onà emotions.à Theà BPI providesà a relativelyà quick and easy methodà of measuringà theà intensityà of pa inà and theà level ofà interferenceà in theà daily activities of theà sufferer. With the BPIà tool, patients are gradedà onà a 0-10 and ità wasà specificallyà designedà for theà assessment ofà cancer related pain. Patientsà areà askedà about the intensity of the pain that they are experiencing at present, as well as the pain intensity overà the last 24 hours asà theà worst, leastà orà averageà pain (alsoà on a scale of 0-10). Eachà scale is boundà by the words ââ¬Ëno painââ¬â¢Ã (0) andà ââ¬Ëpain as bad as you can imagineââ¬â¢Ã (10). Patients are alsoà requestedà to rate the degree to which pain interferesà with theirà daily activities within the sevenà domainsà on a scale of 0-10.à that comprise general activity, walking, mood, sleep, work, relations with other persons, and enjoyment of life using similar scales of 0 toà 10[A5]. These scales are only confined by the words ââ¬Ëdoes not interfereââ¬â¢ and ââ¬Ëinterferesà completely[A6]ââ¬â¢ (Tanà et al, 2004).à Validation of BPI across the world among the different language people has already been justified.à [A7]Additionally, the localization of the pain in the bodyà could beà [A8]assessed and details of current medication are assessed (Caracenià et al, 1996). Uni-dimensional pain assessment tool: à Previous studiesà haveà shownà thatà theà Numericalà Ratingà Scale (NRS) had the power to assess pain intensity for patientsà experiencing chronic pain and was also an effective assessment tool for patients with cancer related pain. Theà NRS consists of a numerical scale range between 0-100 where 0 was considered as one extreme point represented no pain and 100 was considered other extreme point which represented bad/ worse painà (Jensen et al, 1986). Turkà et alà (1993) developedà anà 11 pointà NRS (scale 0-10) where 0 equalledà no pain and 10à equalledà worst pain. Though cancer pain differs from acute, postoperative and chronicà pain experiences, the most common feature is its subjective nature. [A9]à In this regard a consensus meeting on cancer pain assessment and classification was held in Italy in 2009à with theà recommendation thatà pain intensity should be measuredà on aà scaleà ofà 0-10 withà ââ¬Ëno painââ¬â¢Ã andà ââ¬Ëpain as bad as you canà imagine[A10]ââ¬â¢Ã (Hjermstadà et al.,à 2011). Krebsà et al.à (2007) categorised NRS scores as mild (1ââ¬â3), moderate (4ââ¬â6), or severe (7ââ¬â10). A rating ofà 4 or 5à isà the most commonly recommended lower limità for moderate pain and 7 or 8 for severe pain. Aimed at moderate pain assessment,à For the purpose of clinical and administrative use theà recommendation for moderate pain assessment on the scale is a score of 4. Importance of post- operative pain assessment: Post-operative painsà isà very common after surgeryà andà theà use ofà medicationà oftenà dependsà on the intensity of painà that the patient is experiencingà (Chungà et al, 1997). Insufficient assessment of post-operative painà can have aà ââ¬Ësignificant detrimentalà effect on raised levels of anxiety, sleep disturbance, restlessness, irritability, aggression, distress and sufferingââ¬â¢Ã (Carrà et al,à 2005). Additionalà physiologicalà effects can includeà increasedà blood pressure, vomiting and paralytic ileus, increased adrenaline production, sleep vein thrombosis and pulmonary embolus (Macintyre and Ready, 2002). Effective post-operative pain assessment ensures better pain managementà and can significantly reduce the risk of the symptoms listed above, giving minimal distress or sufferingà to patientsà and reducingà potential complications (Machintosh, 2007). References: Alghamdi IG, Hussain II, Alhamdi MS, El-Sheemy MA (2013) Arabia: an observational descriptive epidemiological analysis of data from Saudi Cancer Registry 2001-2008. Dovepress. Breast cancer: Targets and therapy; 5: 103-109. Caraceni A, Mendoza TR, Mencaglia E (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain; 65: 87-92. Carr D and Goudas L. C. (1999) Acute pain. Lancet 353, 2051-2058. Carr EC, Thomas NV, Wilson-Barnet J (2005) Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective. International Journal of Nursing Studies. 42(5): 521-530. Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anaesthesia and Analgesia 85: 808-816.à Cleeland CS (1989) Measurement of pain by subjective report. Issues in pain measurement. New York: Raven Press; pp. 391-403. Cleeland CS, Nakamura Y, Mendoza TR, Edwards KR, Douglas J, Serlin RC (1996) Dimensions of the impact of cancer pain in a four country sample: new information from multidimensional scaling. Pain 67 (2-3): 267-273. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S (2011) Studies comparing numerical rating scale, verbal rating scale and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. Journal of pain and symptom management. 41 (6): 1073-1093. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27: 117-126. Krebs EE, Carey TS, Weinberger M (2007) Accuracy of the pain numeric rating scale as a screening test in primary care. Journal of general medicine. 22(10): 1453-1458. Machintosh C (2007) Assessment and management of patients with post-operative pain. Nursing Standard. 22 (5): 49-55. Macintyre PE, Ready LB (2002) Acute pain management. Second edition, WB Saunders, Edinburgh. McGuire DB (1992) Comprehensive and multidimensional assessment and measurement of pain. Journal of pain and symptom management; 7(5): 312-319. Melzack R and Casey KL (1968) Sensory, motivational and central control determinants of pain: a new conceptual model. In: Kenshalo DR, editor. The skin senses proceedings. Springfield IL: Thomas; pp. 423-439. National Breast Cancer Foundation (NBCF): 2014;à http://www.nbcf.org.au/Research/About-Breast-Cancer.aspx Polit JCHC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, Conno FD, Forbes K, Furst CJ, Radbruch L, Kaasa S (2006) Pain assessment tools: Is the content appropriate for use in palliative care? Journal of pain and symptom management, 32 (6): 567-580. Roenn JHV, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ (1993) Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Annals of Internal Medicine, 119(2): 121-126. Tan G, Jensen MP, Thornby JI, Shanti BF (2004) Validation of the brief pain inventory for chronic non-malignant pain. The Journal of Pain. 5(2): 133-137. Turk DC, Rudy TE, Sorkin BA (1993) Neglected topics in chronic pain treatment outcome studies: determination of success. Pain (53):3ââ¬â16. WebMD (2014)à http://www.webmd.com/breast-cancer/guide/overview-breast-cancer. World cancer research fund international (WCRFI): 2014;à http://www.wcrf.org/cancer_statistics/data_specific_cancers/breast_cancer_statistics.php. Youmiya K (2011) Cancer pain assessment. The Japanese Journal of Anesthesiology. 60(9): 1046-1052. [A1]I would consider using a more reputable source for describing medical symptoms themselves (Greyââ¬â¢s Anatomy, WHO guidelines etc) [A2]and treated? [A3]Is it worth commenting that breast cancer reporting rates in SA might be different from actual prevalence? Lack of awareness regarding certain cancers often results in late diagnosis or misdiagnosis. [A4]This sentence is unclear. I am assuming that you are stating that all dimensions are present in two particular tools? [A5]Iââ¬â¢ve deleted this as you have highlighted the same domains in the previous paragraph and the reader will already be familiar with this term. [A6]Sentence shows up on copyscape / turnitin but itââ¬â¢s fine as a directly referenced quote. [A7]Is this sentence stating that the BPIs valid internationally because it has been adjusted culturally / linguistically for all groups? [A8]Are you making a suggestion that it could be assessed, or stating that sometimes people do assess localised pain in the body? [A9]Deleted as the next sentence deals with this already. [A10]Again shows up in turnitin: any quotes must be in inverted commas so that tutors / markers will not downgrade or suspect plagiarism.
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