This research project addressed pain at parturition in pigs using three different approaches. Firstly, a survey study explored UK pig farmer and veterinarian attitudes to pain and the use of pain relief in order to understand the commercial context behind decisions relating to pain and its management. Secondly, an observational study was conducted to investigate the use of behaviour to assess pain associated with the process of giving birth (or farrowing) in pigs. A final experimental study was used to investigate the administration of a pain relief drug post-farrowing to improve pig welfare and increase productivity. In a questionnaire to farmers and veterinarians, individuals were asked to identify the anti-inflammatory drugs they used or prescribed and how often for selected conditions in pigs. They were also asked to rate the painfulness of different conditions and indicate their level of agreement with statements about pain and the use of pain relief. Results showed anti-inflammatories were widely used, with high agreement that pigs recovered better when given these drugs. Farmers and vets gave similar scores for painful conditions but females and younger respondents scored higher for specific conditions. The results suggest that potential barriers to the increased use of pain relief include a lack of up to date knowledge and communication between farmers and vets about pain and how best to treat it. A preliminary investigation was conducted to identify novel behavioural measures to assess pain in sows over the periparturient period. A set of spontaneous putative pain behaviours were characterised and quantified, using observations of sows before, during and after farrowing. These potential behavioural pain indicators were rare or absent before farrowing and the highest levels were seen during farrowing. For the post-farrowing observations, levels were highest for the immediate post-farrowing period and remained higher than pre-farrowing values up to 24 hours after the last piglet was born. Positive correlations between behavioural variables measured during and after farrowing indicate the individual consistency in the expression of these behaviours. Putative pain behaviours, along with other measures of welfare and productivity were then used to test the benefits of administering the non-steroidal anti-inflammatory drug ketoprofen, compared with a saline placebo, 1.5 hours post farrowing in primiparous and multiparous sows. No clear treatment differences were observed for the sow welfare measures, including the putative behavioural indicators of pain. For primiparous sows treated with ketoprofen, fewer piglets died, but this could be due to an unexpected treatment difference in piglet birth weight, which is strongly linked with piglet mortality. Further research is needed to validate the spontaneous behaviours used in this study as indicators of pain in periparturient sows.

<p>Syftet med denna studie var att belysa metoder som vårdpersonal kan använda sig av för att bedöma smärta hos personer med demens och vilka konsekvenser som detta medför. En litteraturstudie gjordes där 16 vetenskapliga artiklar analyserades. Resultatet visade att det finns smärtbedömningsinstrument tillgängliga som kan identifiera smärta hos personer med demens som inte själva verbalt kan beskriva sin smärta. Instrumenten innehöll beskrivningar av beteenden som kunde vara tecken på smärta. En del instrument innehöll förslag till interventioner som kunde utföras och utvärderas. Konsekvenser av användandet av ett smärtbedömningsinstrument visade signifikant minskade smärtbeteenden och ökade farmakologiska och ickefarmakologiska åtgärder.</p><p>Sammanfattningsvis finns det smärtbedömningsverktyg tillgängliga för att identifiera smärta hos personer med demens.</p> / <p>The aim of this study was to illuminate methods healthcare workers can utilize assessing pain among persons with dementia and what consequences it would bring. A literature review was made by analyzing sixteen scientific articles. The result showed that there are pain assessment tools available to identify pain among persons with dementia, who cannot verbally describe their pain. The instruments contained descriptions of behaviours that could be signs of pain. Some of the instruments contained suggestions of interventions that could be performed and evaluated. Consequences of using a pain assessment tool showed significant decrease in discomfort and increased pharmacological and non-pharmacological interventions. In conclusion there are pain assessment tools available to identify pain among persons with dementia.</p>

Syftet med denna studie var att belysa metoder som vårdpersonal kan använda sig av för att bedöma smärta hos personer med demens och vilka konsekvenser som detta medför. En litteraturstudie gjordes där 16 vetenskapliga artiklar analyserades. Resultatet visade att det finns smärtbedömningsinstrument tillgängliga som kan identifiera smärta hos personer med demens som inte själva verbalt kan beskriva sin smärta. Instrumenten innehöll beskrivningar av beteenden som kunde vara tecken på smärta. En del instrument innehöll förslag till interventioner som kunde utföras och utvärderas. Konsekvenser av användandet av ett smärtbedömningsinstrument visade signifikant minskade smärtbeteenden och ökade farmakologiska och ickefarmakologiska åtgärder. Sammanfattningsvis finns det smärtbedömningsverktyg tillgängliga för att identifiera smärta hos personer med demens. / The aim of this study was to illuminate methods healthcare workers can utilize assessing pain among persons with dementia and what consequences it would bring. A literature review was made by analyzing sixteen scientific articles. The result showed that there are pain assessment tools available to identify pain among persons with dementia, who cannot verbally describe their pain. The instruments contained descriptions of behaviours that could be signs of pain. Some of the instruments contained suggestions of interventions that could be performed and evaluated. Consequences of using a pain assessment tool showed significant decrease in discomfort and increased pharmacological and non-pharmacological interventions. In conclusion there are pain assessment tools available to identify pain among persons with dementia.

People with dementia often have difficulties expressing their needs. Untreated pain within this group can be manifested as depression, agitation or loss in appetite. It can be a challenging task for a nurse to estimate, treat and evaluate pain for people with dementia. With good knowledge and an empathic approach, nurses can often recognize and relieve pain amongst these people. Despite this, litterature often suggest that unrecognized and untreated pain is common within this group. / Personer med demens har ofta svårt att uttrycka sina behov. Obehandlad smärta hos personer med demens kan visa sig som exempelvis depression, agitation eller minskad aptit. Att som sjuksköterska kunna bedöma, behandla och utvärdera smärta hos personer med demenssjukdom kan vara en utmanande uppgift. Med goda kunskaper och ett empatiskt bemötande kan sjuksköterskan ofta uppmärksamma och lindra smärta hos dessa personer. Trots detta finns det mycket i litteraturen som tyder på ouppmärksammad och underbehandlad smärta hos denna patientgrupp.

This thesis is an investigation of the impact of abdominal surgeries and assisted parturition in dairy cows on physiological and behavioural parameters, and the potential management of pain through the use of non-steroidal inflammatory drugs (NSAIDs) or a mechanical brush. This research is novel and necessary because of the paucity of pain research in dairy cows. Three abdominal surgery studies were conducted. The first was a randomized clinical field trial, conducted on commercial dairy herds in southern Ontario, Canada, to evaluate the effect of ketoprofen following correction of left displaced abomasum. The second and third studies were randomized clinical trials evaluating NSAIDs following the first stage of a two-stage fistulation surgery. The second tested ketoprofen versus saline, while the third compared ketoprofen and meloxicam. The key findings from these studies were that there were indicators of pain following surgery (such as decreased milk production, dry matter intake, and changes in lying behavior) and that there were beneficial effects of administering NSAIDs following abdominal surgery(improved eating and lying behavior), although these effects were not sufficient to alleviate all of the surgical pain. Two trials were conducted in parturient cows. The first trial examined the effects of meloxicam administration 24 h following assisted calving. There were beneficial effects of NSAID on feeding behavior, however, further research is needed to investigate the full potential of providing an NSAID as a post-calving pain therapy. The second trial described the use of a mechanical brush by parturient cows. This study yielded insight on the brush use of these cows, as well as on their maternal, auto-grooming, and scratching behaviors. Cows used the brush before parturition, and when the calf was present, auto-grooming and scratching behaviors were significantly reduced, and calf licking time was greater in the brush group compared to the no brush group. The findings described in this dissertation provide insights into the expression and assessment of pain and its management following abdominal surgery in dairy cattle. This study has also identified areas of future research for both assessment and management of pain following abdominal surgery and following assisted calving. / NSERC IPS II, Boehringer-Ingelheim (Canada) Ltd., OMAFRA, Merial Canada Inc.

Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.

Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.

Class of 2006 Abstract / Objectives: To evaluate the use of the numerical pain scale at the Sierra Vista Regional Health Center Emergency Department in adult patients presenting with a chief complaint of pain. Methods: A retrospective chart review was performed on 299 charts of patients presenting to the emergency department with a chief complaint of pain. Results: Pain was assessed in 86.2% of 299 patients at triage, 26.4% post-intervention, and 58.2% at discharge. The average pain value reported by patients at triage was 6.3. Subsequent average pain value post-intervention was 4.1 and 2.9 at discharge. The average pain value at triage compared to the average pain value at discharge was statistically different (p<0.05). Conclusions: Pain assessment using the NRS is not being performed adequately in all patients presenting to the emergency department at SVRHC with a chief complaint of pain.

Bibliography: pages 113-118. / This study aims to investigate the use of hospitalized children's free drawings to assess the presence of post-operative pain in patients where language barriers previously prevented the use of existing pain assessment methods. This research involved 50 children ages 6 - 13 years, mostly from impoverished families, treated at the Red Cross Children's Hospital. The design is exploratory-descriptive in nature. The methodology was to collect drawings (110) on admission, after surgery (described as minor to moderate), when the children were expected to be experiencing pain, and also on discharge from hospital. These drawings were compared for picture content and children's responses to a combination of two scales developed and tested elsewhere (Word Graphic Scale and the Pain Ladder Scale), in an attempt to devise an alternative route to gauge subjective pain through drawings. Parental (44) and respondent (6) interviews provided information on parental reaction to children when in pain, and patient pain behaviour. Evidence suggests that children's free drawings can be successfully used in assessing the presence of pain but not the intensity thereof, and are recommended for use in the treatment process.

Palliative care has become an integral part of healthcare throughout the United States. The goals of this discipline are focused on improving patient quality of life during times of illness. These goals are universal throughout medicine and apply to all practicing providers. An interdisciplinary council developed core competencies for this discipline which includes pain assessment and management as a key component. Throughout healthcare, the assessment and management of pain continues to be a challenge for providers. A review of the literature has demonstrated that untreated pain has become an increasing burden on the patient population. Many providers feel training during their medical education is insufficient and they entered the workforce unprepared. An evaluation of current standards put forth by educational governing bodies has shown the regulations regarding palliative care, pain assessment in particular, to be scattered and non-specific. It is apparent a more concise curriculum, dedicated to palliative care and pain assessment is needed for all future medical providers to hone the essential tools needed to properly evaluate and treat pain. The proposed intervention consists of an educational module which combines a didactic session and student role playing module focused on pain assessment. This intervention will focus on Physician Assistant students in particular, as this profession will continue to play a large role in healthcare. Didactic sessions focused on pain assessment, a core competency of palliative care, will be presented to the students. A role playing exercise following these didactics will allow students to practice such pain assessment skills and also explore what it may be like to be a patient in pain and provide them with insight on the importance of adequately assessing related symptoms. The current model of education regarding palliative care has proven to be ineffective, especially regarding pain assessment. A more concise, dedicated module for this essential skill is needed for students to become more efficient, effective providers. With the ability to assess patients more effectively, providers will be able to manage patients’ pain and decrease the burden untreated pain has put on the population as a whole.