Os objetivos deste estudo foram mensurar a intensidade de dor durante o trabalho de parto com ou sem analgesia raqui-peri combinada através de métodos psicofísicos, quais sejam estimação de categorias (escala analógica visual-VAS) e de estimação de magnitude, verificar a estabilidade, validar a escala psicofísica de percepção da dor e caracterizar os descritores de dor durante o trabalho de parto. Os métodos psicofísicos utilizados foram estimação de magnitudes e emparelhamento intermodal. Quatro experimentos foram realizados: Experimento 1 - Tarefa de determinação de limiares de dor; Experimento 2 - estimação de magnitudes e estimação de categorias, Experimento 3 - estimação de magnitudes e comprimento de linhas e Experimento 4- validação da escala psicofísica. Participaram 68 parturientes (42 receberam analgesia e 26 sem analgesia), internadas no centro obstétrico do Hospital do interior do estado de São Paulo, idade entre 18 a 35 anos, com feto único, estado físico ASA I ou II e que estavam em trabalho de parto. As diferentes sensações de dor foram avaliadas a cada 60 minutos (após a rotina obstétrica), até a finalização do parto (parturientes que não receberam analgesia) ou até a realização da analgesia de parto indicada pela equipe médica. A analgesia de parto foi realizada por meio da técnica raqui-peri combinada. Quinze minutos após a instalação do cateter uma nova avaliação da dor foi realizada, quando o período de observação foi finalizado. O trabalho de parto com ou sem analgesia foi de responsabilidade da equipe médica, não tendo o pesquisador influenciado, a participante poderia ou não ter aceitado. Os resultados obtidos foram que cada participante apresentou um tempo próprio na determinação do seu limiar. Os aspectos fisiológicos e psicológicos evidenciam que a dor é uma experiência única e individual. Para comparação da intensidade da dor durante o trabalho de parto nos grupos com analgesia (após medicação) e sem analgesia, através do teste estatístico de Mann-Whitney, constatou-se que houve uma diferença significativa entre as intensidades de dor nos 2 grupos (p<0,001). A escala psicofísica da intensidade de dor antes da analgesia foi validada com o expoente de 0,63, depois da analgesia o expoente foi de 0,95 e sem analgesia o expoente foi de 0,91. O coeficiente de correlação de Kendall (W) aplicado a estimação de magnitude e comprimento de linha antes, depois e sem analgesia, mostrou W=0,46, W=0,90 e W=0,66 respectivamente, indicando correlação entre os dados. Os descritores de dor mais atribuídos pelas parturientes durante o trabalho de parto foram insuportável, desesperadora e terrível. / The aim of this study was to measure the pain intensity during labor with or without combined spinal-epidural analgesia utilizing psychophysical methods, whether they be category estimations (visual analogical scale VAS) , or magnitude estimations, to verify the stability, to validate the psychophysical scale of pain perception, and to characterize the pain descriptors during labor pain. The psychophysical methods utilized were magnitude estimations and cross-modal matching. A total of four experiments were performed: Experiment 1 Pain threshold determination task; Experiment 2 magnitude estimations and category estimations; Experiment 3 magnitude estimations and line lengths; and Experiment 4 psychophysical scale validation. The study was comprised of 68 parturients (42 received analgesia, and 26 without analgesia), admitted in the Obstetrics center of the Interior Hospital in the state of Sao Paulo, age ranging from 18 to 35, with a singleton fetus, physical state ASA I or II, and who were in labor.The diverse pain sensations were assessed every 60 minutes (after obstetric routine), until the the end of labor (parturients who did not receive analgesia) , or until the application of labor analgesia recommended by the medical team.The analgesia was applied by means of combined spinal epidural analgesia . Fifteen minutes after installing the catheter, a new pain assessment was carried out when the observation period was concluded. Labor with or without analgesia was the responsibility of the medical team, not undergoing influence from the researcher, and the participant could accept or decline. The results were that each participant presented personal timing in determining their threshold. The physiological and psychological aspects evidenced that pain is a unique and individual experience.For the comparison of pain intensity during childbirth labor in the groups with analgesia and the groups without analgesia (after measurement), utilizing the Mann-Whitney statistical test, a significant difference between the pain intensities for both groups (p<0,001) was found. The psychophysical scale for pain intensity before analgesia was validated with the exponent 0,63, after analgesia the exponent was 0,95, and without analgesia 0,91. Kendall`s correlation coefficient (W) was applied to the magnitude estimations and the line-lengths before, after and without analgesia , W=0,46, W=0,90, and W=0,66 resepctively, indicating correlation between the data. The parturients` most attributed pain descriptors during labor were: unbearable, despairing, and terrible.

O objetivo geral deste estudo foi avaliar a dor crônica advinda de diferentes tipos de cânceres. Os objetivos específicos foram descrever as características sociais dos participantes, caracterizar a dor percebida por meio de indicadores específicos e identificar os 10 descritores de dor crônica de maior e menor atribuição conforme a percepção da amostra. Participaram do estudo 45 mulheres com câncer de mama, 45 homens com câncer de próstata e 60 indivíduos de ambos os sexos com câncer de sistema digestivo. Para a mensuração da dor foram utilizados os 50 descritores de dor crônica que compõem a Escala Multidimensional de Avaliação de Dor (EMADOR), utilizando-se o método psicofísico de estimação de categorias. Os resultados da caracterização social das 3 amostras foram: a média de idade foi de 60 anos, 54% eram do gênero masculino, 58,7% casados, 65,3% pertencentes à religião católica e 50,6% tinham ensino fundamental completo. Na caracterização da dor foi evidenciado que, referente ao sítio primário do tumor, 30% estavam localizados na mama, 30% na próstata e 14,7% no estômago. O início da queixa dolorosa ocorreu em 40,7% dos participantes antes do diagnóstico da doença, 52,7% relataram somente 1 sítio de dor e 55,4% relataram que a mesma era intermitente. A intensidade da dor atribuída nas 3 amostras, considerando a média aritmética, demonstrou que os participantes com tumores de sistema digestivo reportaram os maiores escores (7,58 ± 2,59) e 26,6% desta amostra relataram escores acima de 8 para todos os descritores apresentados. Na avaliação dos descritores 10 descritores de maior atribuição foi observado que, 5 estavam presentes nas 3 amostras: -dolorosa?, -desconfortável?, -chata?, -desagradável? e o descritor -incômoda?, o qual foi o mais atribuído tanto pelos participantes com câncer de sistema digestivo quanto pelos participantes com câncer de próstata, demonstrando a similaridade da linguagem da dor nos diferentes grupos. Sobre a dimensão dos descritores de maior atribuição nas 3 amostras houve predomínio de descritores de dor crônica que caracterizaram a dimensão afetiva (50%), seguido pelos de dimensão cognitiva (26,6%) e pelos de dimensão sensitiva (23,3%). Concluímos que, mesmo sendo a dor oncológica um fenômeno considerado individual, multidimensional com comprometimento em diversos domínios da vida, a sua linguagem apresenta semelhança independente do sítio do tumor e do gênero e a dimensão afetiva da dor deve ser melhor explorada nas avaliações clínicas. / The aim general of this study was to evaluate chronic pain arising from different types of cancers. The specific objectives were to describe the social characteristics of the participants, to characterize the pain perceived by specific indicators and descriptors to identify the 10 major and minor award chronic cancer pain as perceived in the sample. The study included 45 women with breast cancer, 45 men with prostate cancer and 60 individuals of both sexes with cancers of the digestive system. For the measurement of pain were used 50 descriptors of chronic pain comprising the Multidimensional Pain Evaluation Scale (EMADOR), using the psychophysical method of category estimation. The results of the social characterization of the 3 samples were mean age was 60 years, 54% were male, 58.7% married, 65.3% belonging to the Catholic area and 50.6% had completed elementary education as schooling. The characterization of pain was evident that, for the primary tumor site 30% were located in the breast, prostate 30% and 14.7% in the stomach. The onset of pain complaint occurred in 40.7% of the participants before the diagnosis of disease, 52.7% reported only one site of pain and 55.4% reported that it was intermittent. Pain intensity given in three samples, considering the arithmetic mean, showed that participants with tumors of the digestive system report higher scores (7.58 ± 2.59) and 26.6% of this sample reported scores above average in 8 arithmetic mean of all the descriptors presented. In the evaluation of the descriptors was seen observed that among the 10 descriptors with higher scores, five were present in three samples: \"painful,\" \"uncomfortable\", \"boring,\" \"unpleasant,\" and the descriptor \"incommode? that was the longer assigned by both the participants with cancer of the digestive system and by the participants with prostate cancer, demonstrating the similarity of the language of pain in different groups. The dimension of descriptors with higher scores in three groups, there was a predominance of chronic pain descriptors that characterize the affective dimension (50%), followed by the cognitive dimension (26.6%) and size sensitive (23.3%). We conclude that even though cancer pain phenomenon considered an individual, multidimensional impairment in several areas of life, their language has similarities regardless of tumor site and gender, and affective dimension of pain should be further explored in the clinical ratings.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005. / The aim of this study was to evaluate the Myofascial Diagnostic Scale, for its inter-examiner reliability and to assess its reliability and validity as an assessment tool in the diagnosis and treatment of Myofascial Pain Syndrome. / M

M.Cur. / The objective of this study explores and describes the experiences of first-time mothers regarding pain management during the first stage of labour. A qualitative approach involving phenomenology was used. Midwives were also interviewed to determine their assessment and management strategies in this regard in order to get a broader perspective on the focus of interest. The data collected from the mothers revealed three themes and they are: the care rendered, needs/wishes and beliefs/feelings of the mothers regarding the care given. These themes were further subdivided into small headings/categories as specified in the data and elaborated on. Eight categories of care strategies emerged from the data gathered from the midwives. Information from both the mothers and midwives were then extensively discussed and compared to the existing literature. Conclusions were drawn and recommendations formulated, in the form of guidelines, to assist midwives and other health-care professionals to improve their caring modalities in the management of patients with pain during the first stage of labour.

M.Cur. / Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research. During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations. During phase two, the altered instrument was tested in private and provincial hospitals. Testing of the altered labour pain assessment instrument on patients in active labour yielded quantitative data. A statistician at the University of Johannesburg was consulted to assist with tabulation, frequencies and statistical tests needed. The midwives from the private and provincial hospitals also completed the second Delphi open-ended questionnaire. A Likert scale was included in the second Delphi instrument as midwives have less time available to complete questionnaires. The qualitative analysis of their responses was compared to those of the second Delphi round experts to avoid an inflated estimate of validity that might have been brought forth by the very small second Delphi round sample. The instrument was finally altered and, during phase three, guidelines were developed on how to implement the labour pain assessment instrument in nursing practice.The experts concluded the instrument as a simple tool that can measure and assist with labour pain control, assess the progress of labour and the patient’s condition, assist with training, guide inexperienced midwives in pain assessment and serve as a research tool. The labour pain assessment instrument can be a valuable tool in assisting clinicians and midwives with labour pain control during the first stage of labour and initiate standards for pain measurement. The challenge remains to convince institutions to improve pain control during labour and protect themselves from potential pain maltreatment litigation by using a valid and reliable pain measurement instrument.

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No description available.

BAKGRUND: En av våra snabbast växande folksjukdomar i dagens samhälle är demens. Individer med demenssjukdom besitter olika hinder därav bl.a. kognitiv påverkan eller kognitiv svikt, vilket i sig medför svårigheter av kommunikationsart. Detta medför vidare problematik kring identifieringen av smärtsymtom. SYFTE: Att undersöka hur sjuksköterskor bedömer smärta hos äldre personer med en diagnostiserad demenssjukdom. METOD: Litteraturstudien utformades som en litteraturöversikt över förekommande forskning där syfte och frågeställningar besvaras utifrån resultat av tidigare vetenskapliga studier. Artikelsökningarna inriktades på de bibliografiska referensdatabaserna CINAHL samt PubMed där både kvantitativa och kvalitativa studier har granskats. RESULTAT: Tre huvudteman identifierades: Observation som instrument, självskattningsskalor som instrument samt sjuksköterskan som instrument. Observationsinstrumenten ADD, PACSLAC-D, PAINAD, DisDAT, NOPPAIN samt STI visade sig vara mest användbara för patienter med svår demens. För de individer med mild till måttlig demens lämpar sig självskattningsinstrument som VAS, VRS och FPS. Utöver instrumenten krävs även att sjuksköterskan har kunskap om såväl demens som individen bakom demensdiagnosen. Även riktlinjer, ett gott intraprofessionellt samarbete och anhörigas kunskap om individen är komponenter som har betydelse för att lindra smärta hos individer med demens. SLUTSATS: Konklusionen av resultatet visar att sjuksköterskans kunskap om demenssjukdom samt kunskap om individen bakom diagnosen utgör tillsammans med anhöriga en grund för att identifiera smärta. / BACKGROUND: One of our fastest growing endemic diseases in today's society is dementia. Individuals with dementia possess different series of obstacles including cognitive loss or cognitive impairment, which raises difficulties of communication. This causes further concerns relating to the relief of painful symptoms. OBJECTIVE: To investigate nurses' pain assessment in older people with diagnosed dementia. METHOD: The study was designed as a literature overview, research where the aim and questions answered on the basis of results of previous scientific studies. Searches for articles were focused on the bibliographic reference databases CINAHL and PubMed where both quantitative and qualitative studies have been reviewed. RESULTS: Three main themes were identified: Nurses knowledge as instruments, observation as an instrument and self- rating scales as instruments. Observation instruments ADD, PACSLAC -D, PAINAD, DisDAT, NOPPAIN and STI proved to be most useful for patients with severe dementia. For those individuals with mild to moderate dementia were self -report instrument such as VAS, VRS and FPS suitable. In addition to the instruments also requires that the nurse has knowledge of both dementia as the individual behind the dementia diagnosis. Although guidelines and a good knowledge of the individual is important to relieve pain in people with dementia. CONCLUSION: The results shows that the nurse's knowledge of dementia as a disease, and knowledge of the individual behind the diagnosis, together with relatives included a basis for identifying pain.

no / Context. There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. Objectives. To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. Methods. Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort ScaleeDementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in DementiaeComfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. Results. We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more ‘‘mostly descriptive’’ (median 0.63 vs. 0.44) and fewer ‘‘highly subjective’’ items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. Conclusion. This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 x, 80 leaves / The aim of this study was to evaluate the Myofascial Diagnostic Scale, for its inter-examiner reliability and to assess its reliability and validity as an assessment tool in the diagnosis and treatment of Myofascial Pain Syndrome.