Subjective and objective measurements of postoperative pain in cats. Evaluation of client-specific outcome measures and activity monitoring to measure pain relief in cats with osteoarthritis. Comparison of the effectiveness of a behavioural graded activity program and manual therapy in patients with sub-acute neck pain: design of a randomized clinical trial. Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats. A randomized controlled trial of an Internet-based cognitive-behavioural intervention for non-specific chronic pain: an effectiveness and cost-effectiveness study. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. A comparison of pain-assessment tools for use with elderly long-term-care residents. Validating nurses' and nursing assistants' report of assessing pain in older people with dementia. A new analogue scale for assessing children's pain: an initial validation study Feline musculoskeletal pain index: responsiveness and testing of criterion validity. Communicative dimensions of pain catastrophizing: social cueing effects on pain behaviour and coping Assessing pain in persons with dementia: relationships among the non-communicative patient's pain assessment instrument, self-report, and behavioral observations. A comparison of pain rating scales by sampling from clinical trial data. Problem elicitation to assess patient priorities in ankylosing spondylitis and fibromyalgia. Pain measurement in persons with intellectual disabilities. Pain-QuILT: Assessing Clinical Feasibility of a Web-based Tool for the Visual Self-Report of Pain in an Interdisciplinary Pediatric Chronic Pain Clinic Sensory stimulation (snoezelen) versus relaxation: a potential strategy for the management of chronic pain
OBJECTIVE To evaluate the ability of various subjective and objective measurements to determine the presence and degree of postoperative pain in cats . DESIGN R and omized controlled prospect i ve clinical study . ANIMALS 18 healthy client-owned cats . PROCEDURE Cats were r and omly assigned to 3 groups of 6 : control , tenectomy , and onychectomy . Jugular catheters were placed the day prior to surgery . All surgeries were performed by the same surgeon , and all observations were made by the same blinded trained observer . One hour prior to surgery and at assigned intervals for 36 hours after surgery , heart rate , respiratory rate , and rectal temperature were measured . Scores were assigned for 3 interaction responses , including response to palpation , by use of simple descriptive scales , and to 2 pain assessment s by use of visual analogue scales . Blood was collected to measure plasma beta-endorphin and cortisol concentrations .  Butorphanol was administered to all cats before surgery and to any cat subjectively assessed to be experiencing pain after surgery . RESULTS Only visual analogue scale scores and response to palpation scores differed significantly between control and surgical groups . CONCLUSIONS AND CLINICAL RELEVANCE Determination of the presence of pain in cats can be made on the basis of observation and interaction by a trained observer . Physiologic measurements , including plasma cortisol and beta-endorphin concentrations , did not differentiate between control cats and cats that underwent surgery BACKGROUND There are no vali date d systems for measuring pain from osteoarthritis in cats . HYPOTHESIS Owner subjective assessment s and an activity monitor ( AM ) can be used to detect pain in cats with osteoarthritis and to assess efficacy of treatments . ANIMALS Thirteen cats older than 10 years old , with owner-assessed decreases in activity , painful arthritic joints , and clinical ly normal blood work were included and evaluated for 3 weeks . METHODS A collar-mounted AM measured activity and a client-specific outcome measure ( CSOM ) question naire characterized the severity of impairment . Overall global quality of life was also evaluated for each treatment . In weeks 2 and 3 , meloxicam ( 0.1 mg/kg , day 1 ; 0.05 mg/kg , days 2 - 5 ) or a placebo was administered in a blinded , r and omized , cross-over manner to test the assessment systems . RESULTS The cats had a median of 4 arthritic appendicular joints .  Activity counts for the week when cats ( complete data on activity ; n=9 ) were administered meloxicam were significantly higher than at baseline ( P = .02 ) but not after placebo ( P = .06 ) . Baseline activity counts were not significantly different from placebo ( P = .6 ) . The CSOM data ( n=13 ) showed that owners considered their cats to be more active on meloxicam compared with baseline ( P = .001 ) and placebo ( P < .004 ) , and more active on placebo than at baseline ( P < .01 ) . Global quality of life improved significantly with meloxicam ( P < .042 ) . CONCLUSIONS AND CLINICAL IMPORTANCE Both an AM and a CSOM system can detect behavior associated with pain relief in cats that are arthritic . Objective activity data might allow subjective assessment systems to be vali date d for use in clinical studies The objective is to present the design of a r and omized clinical trial ( RCT ) on the effectiveness and cost effectiveness of a behavioural grade d activity programme compared with manual therapy in patients with sub-acute neck pain . Sub-acute is defined as pain existing for 4 - 12 weeks . The behavioural grade d activity programme is a time-contingent increase in activities from baseline towards pre-determined goals . Manual therapy consists mainly of specific spinal mobilization techniques and exercises . The primary outcomes are global perceived effect and functional status . Secondary outcomes are kinesiophobia , distress , coping , depression and somatization . The intensity and persistence of the pain and its interference with activities are also assessed . Direct and indirect costs are measured by means of cost diaries . Measurements take place at baseline and 6 and 12 weeks after r and omization . To assess the long-term effect , measurements will also take place after 6 and 12 months . Finally some challenges are discussed concerning the use of a behavioural grade d activity programme , manual therapy and outcomes OBJECTIVE To determine the items ( question topics ) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners . ANIMALS 100 r and omly selected client-owned cats from 6 months to 20 years old . PROCEDURES Cats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system . Two groups were identified : high DJD pain and low DJD pain . Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain . Interviews with 45 cat owners were performed to generate items . Fifty-three cat owners who had not been involved in any other part of the study , 19 veterinarians , and 2 statisticians assessed 6 preliminary instrument design s. RESULTS 22 cats were selected for each group ; 19 important items were identified , result ing in 12 potential items for the instrument ; and 3 additional items were identified from owner interviews . Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats . CONCLUSIONS AND CLINICAL RELEVANCE Behaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain . Fifteen items were identified as being potentially useful , and the preferred instrument design was identified . This information could be used to construct an owner-based question naire to assess feline DJD-associated pain . Once vali date d , such a question naire would assist in evaluating potential analgesic treatments for these patients BACKGROUND Cognitive-behavioural treatment can nowadays be delivered through the Internet . This form of treatment can have various advantages with regard to availability and accessibility . Previous studies showed that Internet-based treatment for chronic pain is effective compared to waiting-list control groups . METHODS We conducted a r and omized controlled trial comparing an Internet-based cognitive-behavioural intervention with e-mail therapist contact to a face-to-face cognitive-behavioural group intervention . Of the 72 participants who were r and omly assigned to an Internet or a group course , 50 participants completed the intervention . Participants were assessed at baseline ( T0 ) , immediately after the 7-week course ( T1 ) and at the booster session 2 months later ( T2 ) . Pain-related catastrophizing was the primary outcome measure . Pain intensity , fatigue , pain-related interference , locus of control , pain coping , global health-related quality of life and medical expenses were secondary outcome variables . RESULTS Significant improvement was found on catastrophizing , pain coping , locus of control and aspects of global health-related quality of life in both the Internet and the group courses directly after the course and at the booster session . Pain intensity was improved in both courses at the booster session . At T2 , improvement in catastrophizing , pain intensity , pain coping and some quality of life dimensions was significantly greater in completers of the Internet course than in the group course . Furthermore , the Internet course was cost-effective compared to the group course . CONCLUSIONS We conclude that the Internet-based cognitive-behavioural intervention was at least as effective as the face-to-face group intervention and , on some outcome measures appeared to be even more effective OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia . DESIGN In a cross-sectional descriptive study nursing home ( NH ) residents  were videotaped at rest and during a structured movement procedure . Following one training session and one practice session , two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools . SETTING Fourteen NHs in Western Washington State participating in a r and omized controlled trial of an intervention to enhance pain assessment and management .  PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment . MEASURES  Checklist of Nonverbal Pain Indicators ( CNPI ) and the Pain Assessment in Advanced Dementia ( PAINAD ) , demographic and pain-related data ( Minimum Data Set ) , nursing assistant reports of participants ' usual pain intensity , and Pittsburgh Agitation Scale . RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater . Inter-rater reliability for pain presence was fair ( K = 0.25 for CNPI with movement ; K = 0.31 for PAINAD at rest ) to moderate ( K = 0.43 for CNPI at rest ; K = 0.54 for PAINAD with movement ) . There were significant differences in mean CNPI and PAINAD scores at rest and during movement , providing support for construct validity . However , both tools demonstrated marked floor effects , particularly when participants were at rest . CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD , findings from the current study indicate that these measures warrant further study with clinical users , should be used cautiously both in research and clinical setting s and only as part of a comprehensive approach to pain assessment The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication AIMS AND OBJECTIVES To evaluate the usefulness of  registered nurses ' ( RNs ) and nursing assistants ' ( NAs ) pain report among 304 institutional older people with dementia and eluci date the factors influencing the agreement of pain reports within dyadic assessors . BACKGROUND Using informant reports has been suggested as an effective strategy to solve the dilemma of pain assessment in people with dementia . However , the validity of pain information provided by institutional caregivers is still under-investigated . DESIGN A prospect i ve study was undertaken in six dementia special care units in Northern Taiwan . METHODS Both the four-item pain inventory and Doloplus-2 scale were used to investigate different raters ' pain reports . RESULTS Across pain variables , fair to moderate agreement was noted in RNs ' assessment ( Kappa = 0.29 - 0.42 ) , but poor agreement in NAs assessment ( Kappa = 0.11 - 0.24 ) . Comparing mean scores on intensity , frequency of pain and Doloplus-2 , statistically systematic bias existed in most pairs , but the greater bias occurred in NAs ' assessment . In logistic regression analysis , when pain was assessed by the  pain inventory  , residents ' cognitive impairment level and caregiver 's age were associated with the agreement of pain presence perceived in either resident-nurse or resident-NA pairs . Nevertheless , when pain was rated by the Doloplus-2 scale , only residents ' physical function influenced the agreement of pain report for both research assistants (RAs)-nurse and RAs-NA pairs . CONCLUSIONS Nurses ' pain report across pain variables may be more reliable than NAs . Furthermore , factors influencing the agreement of pain assessed by self-report measurement or behavioural observations may be different , needing further investigation . RELEVANCE TO CLINICAL PRACTICE Pain inquiry and behavioural observation should be performed routinely as the fifth vital sign for developing effective care plans . Institutional caregivers should be used as alternative or complementary informants for assessing pain in older people with dementia & NA ; A new instrument was design ed to provide a practical clinical measure for assessing children 's pain intensity and pain affect .  The pocket size measure includes a Coloured Analogue Scale ( CAS ) to assess intensity and a facial affective scale to assess the aversive component of pain . Both scales have numerical ratings on the back , so that the person administering it can quickly note the numbers that represent a child 's pain . This study was conducted to determine : the validity of the new instrument by evaluating the psychophysical properties of the intensity scale and by evaluating the discriminant validity of the intensity and affective scales . Since visual analogue scales ( VAS ) are valid and reliable measures for assessing children 's pain , children 's ability to use the new analog scale was compared with their performance on a VAS . Children 's ability to rate pain affect using an affective scale , in which the 9 faces on a Facial Affective Scale ( FAS ) are presented in an ordered sequence from least to most distressed , was compared to their performance on the original FAS , in which the same faces were presented in a r and om order . Using a parallel groups design , 104 children ( 5–16 years ; 60 female , 44 male ; 51 healthy and 53 with recurrent headaches ) were r and omized into two groups : CAS or VAS . Children used the assigned scale to complete a calibration task , in which they rated the sizes of 7 circles varying in area ( 491 , 804 , 1385 , 2923 , 3848 , 5675 and 7854 mm2 ) . The psychophysical function relating perceived circle size to actual physical size was determined for the CAS and VAS . Children 's  CAS and VAS  responses on the calibration task yielded similar mathematical relationships ; & PHgr;cas = 0.035I0.87 , & PHgr;vas = 0.027I0.89 , where & PHgr ; = perceived magnitude and I = stimulus intensity . The R2 values were 0.921 and 0.922 for the CAS and VAS groups , respectively . Analyses of covariance revealed no significant differences in the characteristics of these relationships , i.e. , R2 , slope , or y intercept , by scale type . Children used the same scale to complete the Children 's Pain Inventory ( CPI ) , in which they rated the intensity and affect of 16 painful events ( varying in nature and extent of tissue damage ) . Children 's  CAS and VAS  responses on the CPI were similar . Analyses of covariance indicated that there were no differences in either intensity or affective ratings by scale type . However , the mean number of painful events experienced by children increased significantly with age ( P = 0.0001 ) . Intensity ratings decreased significantly with age ( P = 0.002 ) , but affective ratings did not vary with age . The new instrument has equivalent psychometric properties to a 165 mm VAS . However , the CAS was rated as easier to administer and score than the VAS , so it may be more practical for routine clinical use . Since the CAS has fulfilled the first two criteria for a pain measure ( psychophysical properties and discriminant validity ) , it is ethical to proceed with the formal definitive test for construct validity , in which children from various clinical population s use the CAS scale to assess their own pain BACKGROUND Progress in establishing if therapies provide relief to cats with degenerative joint disease (DJD)-associated pain is hampered by a lack of vali date d owner-administered assessment methods . HYPOTHESIS That an appropriately developed subjective owner-completed instrument ( Feline Musculoskeletal Pain Index-FMPI ) to assess DJD-associated impairment would have responsiveness and criterion validity . ANIMALS Twenty-five client-owned cats with DJD-associated pain . METHODS FMPI responsiveness ( ability to detect the effect of an analgesic treatment ) and validity ( correlation with an objective measure ) were explored through a stratified , r and omized , double blinded , placebo-controlled , crossover 10-week clinical study . Meloxicam was administered to effect pain relief . A linear mixed model , backward stepwise regression , and Pearson correlations were used to assess responsiveness and criterion validity with the assumption that the NSAID would increase activity . RESULTS Positive responses of cats to placebo ( P = .0001 ) and meloxicam treatment ( P = .0004 ) were detected ; however , the instrument did not detect any difference between placebo and meloxicam ( linear mixed model ) , even for the high impairment cases . Percent meloxicam target dose administered , temperament , and total baseline FMPI score were covariates that most affected FMPI scores . Controlling for significant covariates , most positive effects were seen for placebo treatment . Positive treatment effects on activity were detected , but only for the cases design ated as most highly impaired . CONCLUSIONS AND CLINICAL IMPORTANCE Neither responsiveness nor criterion validity were detected by the inclusion criteria for cases in this study . The data suggest that further work is indicated to underst and factors affecting activity in cats to optimize inclusion criteria & NA ; The study was design ed to assess whether the social context of a pain experience impacted on the relation between catastrophizing and duration of pain behaviour . Based on a communal coping model , the prediction was that the presence of an observer during a pain procedure would differentially influence the display of pain behaviour in high and low catastrophizers . University undergraduates taking part in a cold pressor procedure were r and omly assigned to one of two conditions : ( 1 )  participant alone ( n=30 ) , or ( 2 ) observer present ( n=34 ) . Analysis of video records revealed that high pain catastrophizers displayed communicative pain behaviours ( e.g. facial displays , vocalizations ) for a longer duration when an observer was present compared to high pain catastrophizers who were alone during the pain procedure . The duration of pain management behaviours ( e.g. holding , rubbing ) did not vary significantly as a function of catastrophizing . When the observer was present , high catastrophizers also reported using fewer cognitive coping strategies than low catastrophizers . The pattern of findings suggests that in the presence of an observer , high pain catastrophizers show a propensity to engage in strategies that more effectively communicate their pain , and are less likely to engage in strategies that might minimize pain . Theoretical implication s of the findings are discussed Pain is a common problem for many older adults , with up to 50 % of community-dwelling and 70 % to 80 % of nursing home residents experiencing pain regularly . Effective  pain  management requires thorough assessment , appropriate intervention , and systematic re assessment . Pain assessment , however , is complicated by dementia , which impairs memory , reasoning , recognition , and communication , and affects elders ' ability to verbally report pain . As such , observational measures are needed to assess pain in this vulnerable population . The Non-communicative Patient 's Pain Assessment Instrument ( NOPPAIN ) was developed for this purpose , but more validation of this measure is needed . Thus , the purpose of this study was to ( 1 ) evaluate reliability of the NOPPAIN tool when used by nurses and to ( 2 ) compare NOPPAIN ratings with self-report and other well-established behavioral rating procedures . Forty participants ( 20 cognitively intact and 20 impaired ) were r and omly selected for this study from a larger sample . In the parent study , participants were asked to perform everyday activities ( i.e. , sit , st and , walk in place , transfer in and out of bed ) while being videotaped . The tapes , all previously scored using microanalytic observational coding , were rated again by naïve raters using the NOPPAIN measure . Results indicated ( 1 ) high inter- and intrarater reliability of the NOPPAIN and ( 2 ) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding . Findings support the reliability and validity of the NOPPAIN measurement tool and suggest this easy-to-use tool may be adequate for measuring pain indicators in older adults OBJECTIVE The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales . DESIGN  Multiple simultaneous pain assessment s by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( VRS-4 ) and an 11-point numeric rating scale ( NRS-11 ) with a 100-mm visual analog scale ( VAS ) . The sensitivity of the scales ( i.e. , their ability [ power ] to detect differences between treatments ) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size . RESULTS There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient . Simulation experiments showed that the VAS was systematic ally more powerful than the VRS-4 in all simulations performed . The sensitivity of the VAS and NRS-11 was approximately equal . CONCLUSIONS In this acute pain model , the VRS-4 was less sensitive than the VAS . The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity . The choice between the VAS and NRS-11 can thus be based on subjective preferences OBJECTIVE To elicit patient priorities as outcome measures in ankylosing spondylitis ( AS ) and fibromyalgia ( FM ) ; to relate these measures to other outcomes ; to assess construct validity and sensitivity to change of the problem elicitation technique ( PET ) question naire . METHODS One hundred thirty-four patients with AS were r and omly allocated to weekly sessions of group physical therapy or daily exercises at home , whereas 73 patients with FM were r and omized into one of 3 groups ( low impact fitness , biofeedback , controls ) . The PET question naire was applied by trained interviewers at baseline and at 6 ( FM ) and 9 ( AS ) month followup . A PET score was calculated at each assessment . Construct validity of the PET was assessed by correlation and multiple regression of baseline values with other disease outcomes ( pain , stiffness , patient 's global assessment , Sickness Impact Profile ( SIP ) , Health Assessment Question naire ( HAQ ) , Arthritis Impact Measurement Scale ( AIMS ) , patient utilities ) . Sensitivity to change of PET was assessed against changes in these outcomes and by comparing the efficiency of the PET with other outcomes . RESULTS Patients with FM identified more problems ( mean 6.8 ) than patients with AS ( mean 4.4 ) . Moreover , more patients with AS than with FM were unable to identify any problem at baseline ( 10 % compared to 1 % ) . The  PET score improved from 14.9 to 11.3 ( p = 0.0001 ) in patients with AS but did not change from 21.8 to 21.1 ( p = 0.24 ) in patients with FM . Construct validity testing of the PET score showed statistically significant ( p < 0.05 ) correlations with AIMS , utilities , SIP , HAQ , pain , stiffness , and patient 's global health in both groups of patients ( r varying from 0.22 to 0.66 ) . By multiple regression pain explained 29 % of the variance in PET scores among patients with AS . In FM patient global assessment accounted for 39 % of total variance of PET scores , whereas pain explained another 15 % . Changes in  PET scores correlated significantly ( p < 0.05 ) with changes in AIMS , utilities , pain , stiffness , and patient global health in both AS and FM ( r varying from 0.22 to 0.51 ) . Some 6 % of the variance in changes in  PET scores was explained by changes in pain in patients with AS and 35 % by changes in pain and subjective health in patients with FM . Assessment of sensitivity to change revealed that efficiency of the PET score was 0.6 in patients with AS and 0.09 in those with FM . Compared to other outcomes this was reasonable in patients with AS but low in those with FM . CONCLUSION Obtaining patient priorities was generally feasible . In both groups of patients construct validity of the PET question naire was satisfactory . The PET was much more sensitive to change in patients with AS than in patients with FM OBJECTIVE The goal was to study the utility of nonverbal facial expressions as a research tool for assessing pain in persons with intellectual disabilities . Biases and stereotypes related to age , gender , physical attractiveness , and intellectual disability that may influence the ability of observers to evaluate pain reactions were also examined . DESIGN Facial reactions to an intramuscular injection of 40 adults ( mean age = 49.6 years ) with an intellectual disability were videotaped and objective ly examined using the Facial Action Coding System . Self-reported pain ratings were obtained using a Colored Visual Analogue Scale for pain . Pain reactions were also rated by untrained observers . RESULTS A significant proportion of participants ( 35 % ) was unable to provide valid self-report . The intensity of objective ly coded facial activity as well as observer-rated pain intensity showed significant increases from baseline to injection segments . Observers ' pain ratings were primarily determined by the intensity of facial activity and were not significantly affected by stereotypes based on perceived level of intellectual disability , gender , age , or physical attractiveness . CONCLUSIONS The findings support the validity of both objective ly coded and observer-rated facial expressions of pain as research tools in treatment outcome studies involving persons with intellectual disabilities . Self-report has substantial limitations for the assessment of pain in this population Objectives : To evaluate clinical feasibility of the Pain-QuILT ( previously known as the Iconic Pain Assessment Tool ) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team . The Pain-QuILT ( PQ ) , a web-based tool that records the visual self-report of sensory pain in the form of time-stamped records , was directly compared with st and ard interview questions that were transformed to a paper-based tool . Methods : Qualitative , semi-structured interviews were used to refine the PQ . Adolescents with chronic pain aged 12 to 18 years used the PQ and comparator tool ( r and omized order ) to self-report pain before a scheduled clinic appointment , and then took part in a semi-structured interview . The health team used these pain reports ( PQ and comparator ) during patient appointments , and later participated in focus group interviews . Interview audio recordings were transcribed verbatim and underwent a simple line-by-line content analysis to identify key concepts . Results : A total of 17 adolescents and 9 health team members completed the study . All adolescents felt that the PQ was easy to use and underst and . The median time required for completion of the PQ and comparator tool was 3.3 and 3.6 minutes , respectively . Overall , 15/17 ( 88 % ) of adolescents preferred the PQ to self-report their pain versus the comparator . The health team indicated that the PQ was a clinical ly useful tool and identified minor barriers to implementation . Discussion : Consultations with adolescents and their health team indicate that the PQ is a clinical ly feasible tool for eliciting detailed self-report records of the sensory experience of chronic pain Purpose : The sensory environment ( Snoezelen ) has been advocated by those working in the field of learning disabilities and mental health as a strategy to induce relaxation . The purpose of the current study was to explore this potential within the field of pain management where the use of relaxation techniques is often employed as a strategy for the management of chronic pain . Thus the current study was design ed in order to determine the use of the sensory environment compared against a traditional relaxation programme used within a District General hospital pain clinic . Method : Seventy three patients were r and omly allocated into either a control or experimental group . Data collection involved the administration of question naires , which were selected in order to reflect the multidimensional nature of the chronic pain experience . Hence measures included : pain intensity , pain quality , anxiety , depression , self-efficacy , coping and sickness impact . Analysis was performed using SPSS and included Friedman two-way analysis and repeated measures analysis of variance . Results : The results indicated that the experimental group experienced a significant increase in pain ( p = 0.03 ) , but they improved significantly in disability associated with sleep ( p = 0.01 ) , psychosocial ( p = 0.03 ) and sickness impact total ( p = 0.004 ) . The experimental group experienced a significant decrease in pain ( sensory - p = 0.002 ) , ( number of words chosen - p = 0 . 008 ) , ( pain rating index - p = 0.002 ) . Furthermore a reduction in disability associated with physical ( p = 0.009 ) , psychosocial ( p = 0.009 ) , sleep ( p = 0.001 ) , recreation ( p = 0.001 ) and SIP total ( p = 0.001 ) . Repeated measures analysis of variance revealed a significant improvement with the experimental group in terms of pain ( p = 0.04 ) and self-efficacy ( p = 0.02 ) . Conclusions : The patients who attended the sensory environment did slightly better that those who attended the traditional relaxation programme in terms of self-efficacy . Thus the current study indicates the potential for future research into chronic pain management
Studies were primarily related to the assessment of pain in relation to surgical procedures , and no clear distinction was made concerning the onset of acute and chronic pain .
The metrics used within the tools appeared to focus primarily on the sensory aspect of pain , with no study clearly discriminating between the sensory and affective components of pain .
Objectives The objectives were to review systematic ally the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality ; and to examine behavioural metrics ( considering both the sensory and affective domains ) used to assess pain .