Introdução: A avaliação da dor, constitui uma intervenção de enfermagem fundamental para o estabelecimento do tratamento adequado da dor. Portanto, os profissionais de enfermagem devem considerar o uso de instrumentos de avaliação de dor apropriados para as crianças. Dentre os instrumentos de avaliação encontram-se os instrumentos multidimensionais, porém evidenciou-se escassez destes instrumentos em idioma espanhol para a avaliação da dor em crianças com feridas por profissionais de enfermagem Colombianos. Objetivo: Adaptar culturalmente e encontrar evidências de validade do Instrumento Cartões de qualidade da Dor (ICQD) em crianças com feridas para a língua espanhola da Colômbia. Método: Estudo metodológico e transversal, que foi desenvolvido em duas etapas. Etapa 1: adaptação cultural e validação de conteúdo que esteve composta por seis fases; tradução, síntese das traduções, retrotradução, avaliação da versão por um comitê de juízes, avaliação por crianças na escola e no hospital, e pré-teste da versão final; Etapa 2: evidências de validade baseadas no constructo e no critério externo do ICQD, com 90 crianças em idade escolar hospitalizadas portadoras de feridas. O estudo foi realizado em um hospital pediátrico da cidade de Bogotá Colômbia, com previa aprovação do Comitê de ética da EEUSP e do hospital pediátrico. Os dados foram processados através do software IBM-SPSS 19.0 com nível de significância de 5% (p<0.005). Resultados: Todos as fases pertencentes à etapa de adaptação cultural foram realizadas satisfatoriamente, obtendo uma versão do ICQD adaptado. Foram encontradas evidências fortes baseadas no conteúdo com um IVC total de 0,92; PABAK de 0,79 em representatividade; 0,69 em clareza e 0,74 em dimensão teórica mostrando concordância substancial segundo avaliação dos juízes. No pré-teste, o ICQD versão adaptada mostrou ser clara para mais de 70% de crianças escolares hospitalizadas portadoras de feridas. Na etapa de evidências no critério externo, as variáveis de diagnóstico médico, tipo de ferida, localização de ferida, infecção da ferida, mobilidade e intensidade de dor mostraram resultados significativos. Conclusões: O Instrumento Cartões de Qualidade da Dor (ICQD) versão espanhol, mostrou-se adaptado culturalmente em crianças escolares com feridas no contexto Colombiano apresentando evidências de validade baseadas no conteúdo e no critério externo. / Introduction: Pain assessment, is a fundamental nursing intervention to stablish an adequate pain management. Therefore, nursing professionals should consider the use of appropriate pain assessment tools for children. Among the assessment tools are multidimensional instruments, but it became clear the shortage of these instruments in Spanish for assessing pain in injured children by Colombian nursing professionals. Objective: To translate to the Colombian Spanish language and culturally adapt the Pain Quality Cards Instrument (PQCI) and find evidence of its validity for school age children with wounds. Method: methodological and transversal study, which was developed in two phases. phase 1: cultural adaptation, was composed of six stages translation, synthesis of translations, back translation, evaluation of the resulting version by a panel of judges, evaluation by children in school and in hospital, and pretesting of the final version; phase 2: evidence of validity based on the construct and external criterion PQCI, with a sample of 90 school age children hospitalized with wounds. The study was conducted in a pediatric hospital in Bogotá - Colombia, with anticipated approval of the Ethics Committee of EEUSP and a pediatric hospital. Data were processed through the IBM-SPSS 19.0 with a significance level of 5% (p <0.005). Results: All the stages of the cultural adaptation were performed satisfactorily, obtaining a version adapted PQCI. Strong evidence-based content was found with a total CVI of 0.92; PABAK 0.79 in representativeness; 0.69 in clarity and 0.74 in theoretical dimension shows a substantial agreement as assessed by judges. In the pre-test, the adapted PQCI version proved to be clear to over 70% of school age children hospitalized with wounds. In the phase of external criterion validity evidence the variables medical diagnosis, type of wound, wound location, wound infection, mobility and pain intensity showed significant results. Conclusions: Pain Quality Cards Instrument (PQCI) Spanish version proved to be culturally adapted in injured school age children in the Colombian context showing evidence of validity based on the content and external criterion.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.

O uso de Ambiente Virtual de Aprendizagem (AVA) é reconhecido como uma nova dinâmica de ensino, considerada relevante, porque permite que o indivíduo seja capacitado e se insira numa nova realidade virtual, que possibilita a interatividade e o conhecimento de novas tecnologias. O presente estudo teve como objetivos desenvolver um AVA e avaliar o conhecimento adquirido por meio da metodologia WebQuest (WQ), sobre o tema \"Avaliação da Dor\" por estudantes de graduação em enfermagem. Trata-se de uma pesquisa exploratório-descritiva na vertente quantitativa. O estudo foi realizado no 1o semestre de 2013, com 93 alunos do 7o e 8o semestre de um curso de graduação em enfermagem divididos em três etapas: planejamento, desenvolvimento e descrição da implementação do AVA proposto; comparação da aprendizagem de dois grupos de alunos, que utilizaram a estratégia WQ (n=52) e aula tradicional (n=41) por meio de pré-teste e pós-teste; avaliação da estratégia WQ quanto aos aspectos pedagógicos e técnicos na visão dos alunos de graduação em enfermagem estudados. Para o desenvolvimento do AVA, disponibilizado na plataforma Moodle, foi utilizado a metodologia WQ contemplando os seguintes passos: planejar, formatar, publicar e gabaritar. Os resultados demonstraram na comparação entre os momentos pré e pós-teste, para cada grupo, que em ambos, os escores diferenciaram-se entre o pré e pós-teste e a diferença foi estatisticamente significante em cada grupo. Constatou-se a melhora de desempenho entre o pré e pós-teste em ambos os grupos. No caso do grupo da WQ, a média para os escores do pré-teste foi de 9,04 (DP=2,08) e no pós-teste de 13,81 (DP=2,24). Já, no grupo da aula presencial a média para os escores do pré- teste foi de 7,44 (DP=2,04) e no pós-teste foi de 10,48 (DP=2,85). Quando analisados os dados separadamente, observou-se uma diferença entre o pré e pós- teste maior no grupo da WQ, quando comparados com o grupo que recebeu aula presencial, representando em diferença de escore um ganho de 4,77 escores no grupo que participou da WQ (de 9,04 para 13,81). Referente à avaliação realizada pelos alunos que participaram da estratégia WQ, os resultados demonstraram que a avaliação dos aspectos pedagógicos e técnicos, na visão dos alunos, foi positiva. No cálculo da nota de cada domínio avaliado, observou-se que a média da nota do \"tempo de reposta\" foi a menor dos cinco domínios (91,67%), seguida pela \"interação\" (95,00%), \"qualidade\" (95,00%), \"atividade\" (96,67%), e \"conteúdo\" (97,08%). A pesquisa alcançou os objetivos propostos e pode concluir que o uso da estratégia WQ como ambiente virtual de aprendizagem aplicada no ensino superior, para o ensino da avaliação da dor, é uma possibilidade a ser considerada, incentivando a aprendizagem ativa e colaborativa e facilitando o desenvolvimento da relação de parceria e colaboração entre os atores do processo ensino- aprendizagem. / The usage of virtual learning environment (VLE) is acknowledged as a new method of teaching, considered relevant, because it allows the individual be enabled and his entrance into a new virtual reality, that allows interactivity and knowledge of new technologies. The current study aimed to develop a VLE and evaluate the knowledge acquired through WebQuest (WQ) methodology about \"Pain Assessment\" by nursing undergraduates. It is an exploratory-descriptive study in a quantitative aspect. This study was carried out during the first semester of 2013, with 93 students of 7th and 8th semester of a nursing college split in three stages: planning, developing and describing the implementation of VLE; comparing the learning of two groups of students, whom utilized the WQ strategy (n=52) and traditional class (n=41) through pre-test and post-test; evaluation of WQ strategy concerning pedagogical aspects and techniques in those nursing undergraduates\'s view. To the development of VLE, available at Moodle platform, it was taken into consideration WQ methodology comprising the following steps: planning, formatting, publishing and insertion in HTML (HiperText Markup Language). Results showed that, in the comparison between pre-test and post-test moments, to each group, in both of them scores in pre-test were different from the ones in post-test, and the difference was statistically significant in each group. It was identified a performance improvement between the pre-test and post-test in both groups. In WQ group, the average to the pre-test scores was 9,04 (SD=2,08) and, in the post-test, 13,81 (SD=2,24). In the traditional class group, the average for pre-test scores was 7,44 (SD=2,04) and, in the post-test, 10,48 (SD=2,85). When analyzed data separately, it was observed a larger difference between pre-test and post-test in WQ group, when compared to the group who attended classes, representing, in score difference, a profit of 4,77 scores in WQ group (from 9,04 to 13,81). Regarding the evaluation made by the students that have taken part of WQ strategy, results showed that evaluation of pedagogical and technical aspects, in students view, was positive. In the grade calculation of each area evaluated, it could be observed that the average of the grade of \"answer obtained\" was the lowest of the five areas (91,67%), followed by \"interaction\" (95,00%), \"quality\" (95,00%), \"activities\" (96,67%), and \"content\" (97,08%). The study has approached its aim and led to the conclusion that the usage of WQ strategy as a virtual learning environment applied to higher education, for the teaching of pain assessment, is a possibility to be considered, encouraging an active and collaborative learning, making the development of partnership and collaboration among participants of teaching-learning process.

A Escala Facial de Dor - Revisada (EFD-R) é uma das escalas mais recomendadas na mensuração da intensidade da dor aguda em crianças. A versão original desta escala foi testada em crianças canadenses. O objetivo deste trabalho foi avaliar a validade, interpretação e preferência da versão brasileira da Escala Facial de Dor - Revisada (EFD-R-B), em duas amostras de crianças brasileiras: uma envolvendo dor aguda procedural e outra dor aguda pós-cirúrgica. Na primeira amostra participaram 77 crianças com idades entre 6 e 12 anos, do sexo feminino e masculino, que foram submetidas à coleta de sangue (dor procedural). As crianças estimaram a intensidade da sua dor, antes e após a punção venosa, na EFD-R-B. Na estimação após a punção venosa, a Escala Colorida Analógica (ECA) foi administrada junto com a EFD-R-B e, além disso, as crianças indicaram as faces que expressavam uma dor leve, moderada e severa, a escala que preferiam e o porquê. Na segunda amostra, participaram 53 crianças com idades entre 6 e 12 anos, do sexo feminino e masculino, que tinham sido submetidas a pequenas cirurgias (dor pós-cirúrgica). Nesta amostra, as crianças estimaram, na EFD-R-B e na ECA, a intensidade da dor que estavam sentindo no momento da entrevista. Também indicaram as faces que expressavam uma dor leve, moderada e severa, o limiar de tratamento da dor, a escala que preferiam e o porquê. Na comparação entre as pontuações obtidas na EFD-R-B e na ECA (validade convergente), nas duas amostras, os valores dos coeficientes Kendall\'s tau foram altos e significativos: =0,75 para o grupo de dor procedural e =0,79 para o grupo de dor pós-cirúrgica (p=0,00 nas duas amostras). No grupo de dor procedural, a EFD-R-B refletiu as mudanças na intensidade da dor vivenciada pelas crianças antes e após a punção venosa (validade concorrente): Teste de Wilcoxon z=-6,65; p=0,00. Considerando uma escala de 0 a 10 para a EFD-R-B, a mediana e a amplitude interquartil (AIQ) para as faces indicadas como expressivas de intensidade leve, moderada e severa, foram 2 (2-2), 4 (4-6) e 10 (10-10) respectivamente, no grupo de dor procedural, e 2 (2-2), 6 (4-8) e 10 (10-10) respectivamente, no grupo de dor pós-cirúrgica. Na estimação do limiar de tratamento da dor (grupo de dor pós-cirúrgica), a mediana (AIQ) foi 6 (4-10). No grupo de dor procedural, a EFD-R-B foi a escala preferida por 57,1% das crianças e a ECA por 41,6%; no grupo de dor pós-cirúrgica, a EFD-R-B foi escolhida por 66% das crianças e a ECA por 34%. Estas proporções somente foram significativas no grupo de dor pós-cirúrgica (X²=5,453 p=0,02). Nossos resultados mostram que a EFD-R-B possui propriedades similares à escala original e boa aceitação entre as crianças entrevistadas. A determinação dos valores das diferentes intensidades de dor e do limiar de tratamento da dor, para cada participante, representa uma evidência importante sobre a interpretação da EFD-R. / The Faces Pain Scale Revised (FPS-R) is one of the most recommended tools in measuring the intensity of acute pain in children. The aim of this study was to assess validity, interpretability and preference of the Brazilian version of the FPS-R (FPS-R-B), in two different clinical samples. The first sample contained seventy-seven children, 6 to 12 years old and both sexes, undergoing venipuncture for blood sample (procedural pain). These children estimated their perceived pain intensity in FPS-R-B before and after venipuncture. Furthermore, after venipuncture, children were asked: a) to evaluate the intensity of their needle pain using the Coloured Analogue Scale (CAS), b) to indicate on the Faces scale the intensities representing the mild, moderate and severe pain, and c) to choose the scale they preferred and indicate the reasons for the preference. The second sample included fifty-three children, 6 to 12 years old and both sexes, undergoing minor surgery (postoperative pain). Following surgery, children were asked: a) to provide a rating of their current pain intensity using the FPS-R-B and the CAS, b) to indicate on the Faces scale the intensities representing the mild, moderate and severe pain, c) to estimate, on the FPS-R-B, the intensity of pain that their felt to warrant pharmacologic intervention (pain treatment threshold), and d) to choose the scale they preferred and indicate the reasons for the preference. The degree of concordance between FPS-R-B and CAS ratings (convergent validity), for both samples, was high and statistically significant Kendall\'s tau value was 0.75 for the first sample, and 0.79 for the second sample, (p<0.05) . FPS-R-B reflected the changes in pain intensity before and after venipuncture (concurrent validity): Wilcoxon Test z=- 6.24; p< 0.05. On the 0-10 scale for the FPS-R-B, the median and interquartile range (IQR) of the intensities that represented mild, moderate and severe pain were 2 (2-2), 4 (4-6) e 10 (10-10) respectively, for the first sample, and 2 (2-2), 6 (4-8) e 10 (10-10) respectively, for the second sample. The median and IQR for pain treatment threshold were 6 (4-10). Fifty-seven percent of children in the first sample and 64.8% in the second sample preferred the FPS-R-B. These proportions were statistically significant for the second sample (X²=5,453 p<0,05). Our data show that the FPS-R-B has similar statistical properties to the original. New evidences were presented regarding interpretability of the FPS-R by determining each children\'s treatment threshold and estimate of mild, moderate and severe pain. In this study, the FPS-R-B was preferred by the majority of children.

Bakgrund: Smärta hos intensivvårdspatienter är vanligt förekommande och kan medföra förlängd vårdtid och leda till flera negativa konsekvenser för patienten samt bidra till ökad mortalitet. Smärtskattning med ett validerat smärtskattningsinstrument som Critical-Care Pain Observation Tool (CPOT) kan underlätta smärtskattningen och förbättra smärtbehandlingen samt minska översedering. Syfte: Syftet med denna studie är att beskriva om införandet av smärtskattningsverktyget CPOT, anpassat för patienter i ventilatorbehandling, påverkar dygnsdoserna av smärtlindrande- och sederande läkemedel samt om sederingsbehandlingen förändras. Syftet är även att undersöka hur ofta sjuksköterskorna smärtskattar patienterna med CPOT och om antalet smärtskattningar överensstämmer med gällande rekommendationer. Metod: Kvantitativ journalgranskningsstudie med retrospektiv design. Vuxna patienter som ventilatorbehandlades under minst ett dygn på en intensivvårdsavdelning i Sverige inkluderades (n=55). Resultat: Totalt 55 patienter inkluderades i två grupper, före och efter införandet av CPOT. Doserna av smärtlindrande läkemedel ökade i gruppen som undersöktes efter att CPOT infördes. Patienterna erhöll i genomsnitt 1,4 mg morfin/kg/dygn jämfört med 1,1 mg morfin/kg/dygn innan införandet. Dosen av det sederande läkemedlet Propofol® minskade efter införandet av CPOT från 48,3 mg/kg/dygn till 47,5 mg/kg/dygn. Alla patienter i studiegruppen förutom två (92 %) smärtskattades vid minst ett tillfälle under mätdygnet efter införandet av CPOT. Slutsats: Doserna av smärtlindrande läkemedel var högre och doserna av det sederande läkemedlet Propofol® var lägre efter införandet av CPOT. Skillnaderna var dock inte statistiskt signifikanta. Patienterna i studiegruppen hade en något ytligare sederingsnivå enligt RASS-skalan. Patienterna smärtskattades med CPOT i genomsnitt 1,6 gånger under mätdygnet. Studien kan bidra till en ökad medvetenhet om vikten av att skatta smärta med ett validerat bedömningsinstrument hos intensivvårdspatienter. / Background: Critically ill intensive care patients frequently experience pain and pain may lead to consequences such as prolonged length of hospital stay and increased mortality. The Critical-care Pain Observation Tool (CPOT) is a validated tool for pain assessment in mechanical ventilated patients and is used to enable pain assessment, improve pain management and reduce over-sedation.  Aim: The aim is to examine if the implementation of CPOT affects the doses of analgetics, sedatives administered to the Intensive Care Unit (ICU) patients and/or the sedation levels using RASS-scores. The aim was also to study how often pain-assessments were performed by nurses. Method: A quantitative study with retrospective design, data was collected from patients’ medical records. Included were adult patients treated under mechanical ventilation &gt;24h at an intensive care unit in Sweden (n=55). Results: For this study 55 patients were included and divided into two groups, before and after the introduction of CPOT at the intensive care unit. The amount of analgetics increased among the patients after CPOT was implemented, they were given 1,4 mg of morphine/kg/24h compared to 1,1 mg of morphine/kg/24h before the implementation. The amount of sedatives, Propofol®, given to the patients decreased from 48,3 mg/kg/24h to 47,5 mg/kg/24h after CPOT was implemented. CPOT was used to assess pain levels in all patients except for two (98%) after the implementation of CPOT. Conclusion: The doses of analgetics were higher and the doses of sedatives (Propofol®) were lower after the implementation of CPOT. However, the differences between groups were not statistically significant. Patients were less sedated, according to RASS-scores, after the implementation of CPOT. Nurses used CPOT on an average 1, 6 times/ 24 h. This study can be used to increase the awareness for the need of using a validated tool for assessing pain in ICU-patients.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-16T21:50:43Z No. of bitstreams: 1 Yasmin El Hage.pdf: 1970287 bytes, checksum: a115ee670601d955883a00022faa7af9 (MD5) / Made available in DSpace on 2018-07-16T21:50:43Z (GMT). No. of bitstreams: 1 Yasmin El Hage.pdf: 1970287 bytes, checksum: a115ee670601d955883a00022faa7af9 (MD5) Previous issue date: 2016-12-12 / Introduction: Temporomandibular dysfunction (TMD) is a complex multifactorial dysfunction commonly associated with other conditions such as cervical spine disorders. Although there is evidence of the correlation between a TMD and neck dysfunctions, treatment approaches address local and direct. Since TMD etiology is multidimensional, the present study hypothetize that a cervical and thoracic approach could reduce the signs and symptoms of TMD. Purpose: To evaluate the effects of a manual therapy protocol applied to the cervical and thoracic region on the signs and symptoms of TMD, as well as the temperature of the temporomandibular joint (TMJ), masticatory and cervical muscles. Methods: 30 subjects with a diagnosis of TMD according to RDC/TMD classified as severe or moderate, according to the Fonseca’s Anamnestic Index (FAI) were randomized into two groups: experimental (miofacial release and joint mobilization) and placebo ultrassound. The interventions were performed twice a week, 8 sessions total. Volunteers were assessed for TMD severity by FAI; Pain in TMJ and masticatory muscles, using a Numerical Pain Scale (END); Mandibular range of motion (ROM), through pachymetry; Level of pain and craniofacial dysfunction, according to the Craniofacial Pain and Dysfunction Index (CF-IDD); Cervical dysfunction level, according to Neck Disorders Index (NDI); Regarding the surface temperature of the TMJ and the anterior temporal muscles, masseter and upper trapezius, under pre and post intervention conditions, and under a 30 days follow-up. The study was approved by the Ethics and Research Committee of Universidade Nove de Julho and is registered in Clinical Trials under the number NCT02822469.Statistical analysis: Data distribution was normal. ANOVA was performed followed by Tukey's multiple comparison for group versus time interaction. The category changes between the moments and the groups were analyzed following a contingency table using the proportional comparison test for each category. The level of significance of 5% was considered. Results: Of the 186 volunteers screened, only 28 complete the study. No statistically significant difference was found between groups for any of the variables studied. Conclusion: The proposed treatment protocol applied to the thoracic and cervical region did not alter pain, ROM, TMD severity, cervical dysfunction level and superficial temperature of the TMJ and the masseter, anterior temporal and upper trapezius muscles in patients with severe and/or moderate TMD. / Introdução: Disfunção temporomandibular (DTM) é uma disfunção complexa e multifatorial comumente associada à outras condições como desordens da coluna cervical. Apesar de haver evidências da correlação entre a DTM e disfunções cervicais, as propostas de tratamento incluem abordagem local e direta. Uma vez que a etiologia da DTM é multidimensional, o presente estudo hipotetiza que uma abordagem cervical e torácica poderia reduzir os sinais e sintomas de DTM. Objetivo: Avaliar os efeitos de um protocolo de terapia manual aplicado sobre a região cervical e torácica sobre os sinais e sintomas da DTM, bem como sobre a temperatura da articulação temporomandibular (ATM), músculos mastigatórios e cervicais. Metodologia: 30 sujeitos com diagnóstico de DTM conforme o RDC/TMD, classificada como grave ou moderada, de acordo com o Índice Anamnésico de Fonseca (IAF) foram randomizados em 2 grupos: experimental (liberação miofascial e mobilização articular) e ultrassom placebo. As intervenções foram aplicadas 2 vezes por semana, totalizando 8 sessões. Os sujeitos foram avaliados quanto à gravidade da DTM, pelo IAF; dor na ATM e nos músculos mastigatórios, utilizando a escala numérica de dor (END); amplitude de movimento mandibular (ADM), por meio da paquimetria; nível de dor e disfunção craniofacial, de acordo com o Índice de Dor e Disfunção Craniofacial (IDD-CF); nível de disfunção do cervical, conforme o Índice de Disfunção Cervical (NDI); e quanto a temperatura da superfície da ATM e dos músculos temporal anterior, masseter e trapézio superior, nas condições pré intervenção, pós intervenção e follow-up após 30 dias do término do protocolo. O estudo foi aprovado pelo comitê de ética e cadastrado no clinical trials sob o número NCT02822469. Análise estatística: Os dados apresentaram distribuição normal e foram analisados utilizando a ANOVA seguido de comparação múltipla de Tukey para a interação grupo versus momento. As mudanças de categorias entre os momentos e os grupos foram analisadas seguindo uma tabela de contingência por meio do teste de comparação de proporções para cada categoria. Considerou-se o nível de significância de 5%. Resultados: Dos 186 voluntários triados, apenas 28 completaram o estudo. Não foi encontrada diferença estatisticamente significante entre os grupos para nenhuma das variáveis estudadas. Conclusão: O protocolo de tratamento proposto, aplicado sobre a região torácica e cervical não alterou a dor, ADM, gravidade da DTM, nível de disfunção cervical e temperatura superficial da ATM e dos músculos masseter, temporal anterior e trapézio superior em pacientes com DTM grave e moderada.

L’évaluation de la douleur chez le chat est souvent un défi en raison de leur nature discrète et les changements de comportement potentiels dans des situations inhabituelles et stressantes, telles que l'environnement vétérinaire. Différents outils d’évaluation de la douleur (c.-à.-d. des échelles de douleur) basés sur l'observation des comportements ont été proposés pour les chats; cependant, la majorité de ces outils manque de tests de validité, de fiabilité et/ou de généralisabilité. De plus, les échelles de douleur sont peu utilisées dans la pratique clinique. Des outils simples, pratiques et fiables tels que les échelles de grimace (instruments d'évaluation de la douleur basés sur l'expression faciale), ont le potentiel de changer ce scénario. Elles ont été développées pour plusieurs espèces, excluant le chat. L'objectif général de cette thèse était de développer un nouvel instrument basé sur l'expression faciale pour l'évaluation de la douleur aiguë chez les chats, la « Feline Grimace Scale » (FGS) et d'explorer ses applications et ses limitations. Nos hypothèses étaient que la FGS permettrait l’identification de la douleur chez les chats avec précision (dans différentes conditions telles que la douleur d’origine naturelle et postopératoire); elle serait valide et fiable (parmi différents évaluateurs); elle serait capable de détecter la réponse aux analgésiques; et finalement, elle pourrait être appliquée en temps réel dans le contexte clinique. La FGS a été développée et validée en utilisant une approche psychométrique pour détecter la douleur aiguë chez les chats. Cette échelle discriminait entre les chats en douleur de ceux qui ne le sont pas; détectait la réponse à différents analgésiques; et corrélait fortement avec un autre système de notation de la douleur. Une bonne fiabilité inter et intra-observateur a été démontrée, non seulement parmi les vétérinaires, mais aussi parmi les propriétaires de chats, les étudiants vétérinaires et les techniciens en santé animale. L’utilisation de la FGS en temps réel était aussi réalisable. D’autre part, nos résultats suggèrent que le genre de l'évaluateur influencerait l'évaluation de la douleur, car les évaluatrices attribuaient des scores plus élevés que les évaluateurs. La FGS est un outil valide, fiable et pratique pour l'utilisation potentielle en recherche ou en clinique; en temps réel ou par l’évaluation des images. Elle pourrait être aussi applicable dans une large gamme de conditions douloureuses et par des évaluateurs avec différents niveaux d'expertise, et potentiellement aussi à la maison (par les propriétaires de chats). Cela représente un progrès substantiel dans l’identification et la gestion de la douleur féline, vers les plus hautes exigences en matière de soins vétérinaires. / Pain assessment in cats is challenging due to a number of reasons, including their discrete nature and potential behavioral changes in unfamiliar and stressful situations, such as the veterinary environment. Different pain assessing instruments (i.e. pain scales) that rely on the observation of behaviors have been proposed for cats; however, the majority lack validity, reliability and/or generalizability testing. Additionally, the adherence to their use in clinical practice is low and warrants improvement. Simple, practical and reliable tools such as grimace scales (facial expression-based pain assessment instruments), have the potential of changing this scenario. They have been developed for several species, among which the cat was not included. The overall aim of this thesis was to develop a novel facial expression-based instrument for acute pain assessment in cats, the Feline Grimace Scale (FGS) and to explore its applications and limitations. Our hypotheses were that the FGS would be able to accurately identify pain in cats (in different conditions such as naturally-occurring or spontaneous and postoperative pain); it would be valid and reliable (among different raters); it would be able to detect the response to analgesics; and its application in real-time in the clinical context would be feasible. The FGS was developed and validated using a comprehensive psychometric approach to detect acute pain in cats. It has demonstrated a high discriminative ability between painful and non-painful cats; it is capable of detecting the response to different analgesic drugs and it is strongly correlated with another pain scoring system. Furthermore, it demonstrated good inter- and intra-rater reliability, not only among veterinarians, but also among cat owners, veterinary students and nurses (technicians). Real-time scoring using the FGS was proven feasible. On the other hand, our results suggested that the rater gender may influence pain assessment, as female raters assigned higher scores than males. The FGS is a valid, reliable and practical tool potentially for both research and clinical use in real-time or using image assessment; that may be applicable in a wide range of painful conditions, by raters with different degree of expertise, and potentially at home (by cat owners). This represents a substantial progress in feline pain management, towards the highest standards in veterinary care.

Der heute noch gängige Einsatz von Injektionsanästhetika bei Laborratten basiert zum großen Teil auf empirischen Daten. Auf der Grundlage des deutschen Tierschutzgesetzes sind Wissenschaftler verpflichtet, das nach dem derzeitigen Kenntnisstand schonendste Betäubungsmittel zu verwenden. Die wissenschaftlichen Daten zur intra- und postoperativen Belastung bei vielen Anästhetika sind lückenhaft. Daher wurden in dieser Studie im Sinne des „Refinements“ von Tierversuchen verschiedene Injektionsnarkosen bei 69 männlichen und weiblichen 6-8 Wochen alten Sprague-Dawley-Ratten im Rahmen einer stereotaktischen Gehirnoperation (OP) verglichen, bei der zumeist Injektionsnarkosen Verwendung finden. Die Ratten wurden entweder mit Chloralhydrat (CH: 3,6 %, 430 mg/kg intraperitoneal [i.p.] KGW), mit der vollständig antagonisierbaren Anästhesie (Medetomidin 0,15 mg/kg Körpergewicht [KGW], Midazolam 2 mg/kg KGW, Fentanyl 0,005 mg/kg KGW intramuskulär [i.m]) ohne (VAA-Gruppe) bzw. mit Antagonisierung (sog. VAA+A-Gruppe) zum OP-Ende (Atipamezol 0,75 mg/kg, Flumazenil 0,2 mg/kg, Naloxon 0,12 mg/kg subcutan [s.c.]) anästhesiert und nach Erreichen des Stadiums der chirurgischen Toleranz (cT), gekennzeichnet durch den Ausfall des Zwischenzehenreflexes an des Hintergliedmaße (ZZR hi.), einer 60-minütigen OP unterzogen. Eine weitere Gruppe erhielt eine i.p.-Bolusinjektion Propofol in einer Dosis von 120 mg/kg KGW, die sich im Rahmen von Vorversuchen als geeignet herausgestellt hatte, um bei Ratten eine Hypnose zu bewirken. Anschließend wurde Propofol zu Erzeugung und Aufrechterhaltung einer cT per Dauerinfusion i.v. (4 - 6 mg/kg/h) verabreicht. Kontrolltiere erhielten eine Injektion mit isotoner Kochsalzlösung (i.p.) ohne OP. Die Erfassung des KGWs erfolgte 3 Tage vor bis 2 Tage nach der OP. Im Vorfeld wurde jedes Tier über 3 Tage an das Tragen eines Pulsoximeterclips am Hals gewöhnt. Dies diente der Ermittlung von Basiswerte für die Atemfrequenz (AF), Herzfrequenz (AF) und die periphere Sauerstoffsättigung (SpO2)am wachen, freibeweglichen Tier am Tag der Anästhesie mittels MouseOx®-Pulsoximeter. In Narkose wurden die Tiere mittels Pulsoximeter, Reflextests (ZZR hi., Lid- [LR] und Cornealreflex [CR]) und Rektalthermometer überwacht. Die externe Wärmezufuhr wurde über eine elektrische Wärmeplatte (37 °C) vorgenommen Zu zwei Zeitpunkten erfolgten Blutabnahmen zur Bestimmung der Adrenalin- (A) und Noradrenalinwerte (NA) mittels HPLC. Der Verlust der cT wurde anhand festgelegter Kriterien bestimmt (ZZR hi. positiv, Zuckungen, lautes Vokalisieren, Zähneknirschen) und die Tiere ggf. nachdosiert. Prä- und postoperativ wurde immunreaktives Corticosteron (iCS) mittels ELISA aus Kotproben ermittelt. Zudem wurde die prä- vs. postoperative Belastung durch Etablierung eines nummerischen Scoresystems und Videoüberwachung der Tiere bewertet. 48 h nach der OP wurden die Ratten euthanasiert und relevante Organe und Gewebe für die histopathologische und immunhistochemische Untersuchung entnommen, um mögliche Anästhetika bedingte Irritationen sowie eine stressinduzierte Aktivierung von c-Fos-Proteinen in schmerz-assoziierten Gehirnregionen zu analysieren. Eine weitere Gruppe erhielt eine Inhalationsnarkose mit 3 % Isofluran (ISO) ohne OP und diente der Ermittlung von A und NA Basiswerten. Die AF lag bei 104 ± 1,05 Atemzüge/min, die HF bei 396 ± 2,10 Herzschläge/min und die SpO2 bei 95,7 ± 0,09 % (Angaben als Mittelwerte ± Standardfehler). Die Verwendung des MouseOx®-Pulsoximeters erwies sich als geeignete Methode zur Ermittlung von Wachwerten bei freibeweglichen Ratten. Alle CH-anästhesierten Tiere erreichten das cT-Stadium. Die Dauer der cT lag bei 49,14 ± 4,48 min, die Narkosedauer bei 155,66 ± 8,21 min. Während der Narkose zeigten die Tiere Tachykardie, Tachypnoe sowie eine geringgradig erniedrigte SpO2 und eine leichte Hypothermie. Erhöhte A/NA-Spiegel wiesen auf eine deutlich höhere intraoperative Stressbelastung in der CH-Gruppe hin. Auch iCS war in der CH-Gruppe im Vergleich zu VAA/VAA+A signifikant erhöht. Vom Tag der Anästhesie/OP auf den Folgetag verloren CH-Tiere durchschnittlich 9,4 g KGW. Postoperativ waren bei den Tieren keine bis geringe Anzeichen für Schmerz und/oder Disstress zu erkennen. Histopathologisch zeigten alle Ratten eine Peritonitis und Perihepatitis, 44 % der Tiere multifokale, akute Lebernekrosen und 22 % eine Perisplenitis. 95 % der mittels VAA anästhesierten Tiere erreichten die cT mit einer Dauer von 47,83 ± 7,05 min (VAA) bzw. 44,77 ± 5,27 min (VAA+A). Bei VAA-Tieren betrug die gesamte Narkosedauer 182,23 ± 20,58 min. Bei der VAA-Anästhesie insgesamt waren signifikante geschlechtsspezifische Unterschiede in der Latenzzeit bis zum Erreichen der 1. cT, der cT-Dauer und der Narkosedauer festzustellen. Die VAA-Anästhesie führte zu einer mittelgradiger Atemdepression und milden Hypothermie bei signifikant niedrigeren A/NA-Werten im Vergleich zu CH. Eine Nachdosierung ging mit einem vorrübergehenden signifikanten Abfall der SpO2 einher. Tiere der VAA+A-Gruppe erwachten 3,05 ± 0,21 min nach der s.c. Antagonisierung aus der Narkose. Anschließend zeigten sie starke Aufregung und Unruhe und ein verändertes Aktivitätsmuster, eine Stunde später teils Piloerektion sowie Ataxien. Die Körperkerntemperatur (KT) der VAA+A-Tiere sank innerhalb 1. Stunde nach der Antagonisierung signifikant ab. Einige Tiere wiesen eine Myositis als Folge der i.m. Applikation auf. Nach PROP-Anästhesie erreichten nur 36 % der Tiere das cT. Im Narkoseverlauf kam es bei diesen Tieren zu einer starken Beeinträchtigung der Atemfunktion. PROP-Tiere wiesen einen signifikanten Abfall der KT und Anzeichen verlängerter Sedation nach Wiedererwachen sowie die höchsten iCS-Gehalte auf. Insgesamt verstarben 4 von 11 Tieren wegen starker Atemdepression intra- oder postoperativ. Interessanterweise waren die nach ISO-Anästhesie ermittelten A/NA-Konzentrationen signifikant höher gegenüber allen Injektionsanästhesie-Gruppen. Die Ergebnisse dieser Studie belegen, dass die CH-Anästhesie mit gesteigerter Stresshormonfreisetzung einherging. Die Verwendung 3,6 %iger CH-Lösungen ist insbesondere wegen der massiven histopathologischen Befunde abzulehnen, obwohl die Tiere subjektiv ein scheinbar gutes Wohlbefinden aufwiesen. Die i.p. Applikation von Propofol erzeugte nur eine oberflächliche Anästhesie. Aufgrund der starken postanästhetischen Exzitationen sollte sie nur bedingt für kurze, nicht schmerzhafte Manipulation verwendet werden. Die initiale i.p. Propofol-Gabe mit anschließender i.v.-Infusion ist der reinen i.v. Gabe unterlegen und nicht empfehlenswert. Die VAA-Anästhesie ist für Ratten für stereotaktische OPs hingegen gut geeignet. Dabei ist eine exogene Wärmezufuhr auch nach der Antagonisierung zwingend notwendig, da das Thermoregulations-vermögen nach Wiedererwachen nicht ausreichend wiedererlangt wurde. Auf eine Belastung durch die unerwünschten Wirkungen der Antagonisierung wie Aufregung und Unruhe sowie durch die postanästhetische Hypothermie konnte nur anhand subjektiver Kriterien geschlossen werden. Hier sind weitere Untersuchungen nötig. Sofern kein Anästhesienotfall besteht, kann allerdings auf die Antagonisierung verzichtet werden, da in der Nachschlafzeit unter externer Wärmezufuhr (37 - 38 °C) kein wesentliches Risiko einer lebensbedrohlichen Hypothermie bzw. Kreislauf- und Atemdepression besteht. / Injectable anesthetics are still commonly used today, but mainly this is based on empirical data. In line with the German Animal Welfare Act, researches have to choose the least stressful anesthetic. However, scientific data about pain and distress during and after anesthesia are rare. To contribute to the refinement of animal experiments, we therefore investigated the suitability of different injectable anesthetics during a stereotactic surgery, for which kind of surgery injectable anesthetics are mostly used, in 69 male and female, 6 - 8 weeks old Sprague-Dawley rats. Rats were anesthetized with either chloral hydrate (CH: 3.6 %, 430 mg/kg intraperitoneal [i.p.]), with a complete reversible anesthesia (medetomidine 0.15, midazolam 2, fentanyl 0.0005 mg/kg intramuscular [i.m]) without (MMF) and with reversal (MMF with reversal) at the end of surgery (atipamezole 0.75, flumazenile 0.2, naloxone 0.12 mg/kg subcutaneous [s.c.]) or with propofol (PROP). The PROP-group received an i.p. bolus injection of propofol (120 mg/kg), shown to generate hypnosis in proceedings, followed by constant intravenous infusion (4 - 6 mg/kg/h) to achieve and maintain surgical tolerance (st). After reaching surgical anesthesia, indicated by loss of the pedal withdrawal reflex of the hind limb, a 60 minute surgery was undertaken. Rats with saline injection and without surgery served as control. Body weight of each rat was assessed 3 days before the surgery until 2 days after surgery. Over 3 days prior anesthesia and surgery, rats were adapted to wear a collar clip for MouseOx® pulse oximeter, used to gain basal of respiratory rate (RR), heart rate (HR) and peripheral oxygen saturation (pO2) values in awake and freely moving rats. During narcosis, monitoring was conducted via pulse oximeter, reflex tests (pedal withdrawal reflex, corneal and palpebral reflex) and rectal thermometer. All animals were placed on an electrical heating pad (37 °C). Levels of adrenalin and noradrenalin (A/NA) were analyzed at two designated time points via HPLC. Movement of the body or the extremities, audible vocalizations and teeth grinding were classified as defined criteria for the loss of st. If animals lost st during surgery, they received an additional anesthetic dose. Immunoactive corticosteron (iCS) in feces was determined by ELISA immunoassay before and after surgery. Moreover, different signs of pain and distress were scored by using a numerical pain scale and including video recordings. Rats were sacrificed 48 h after surgery for histopathological and immunhistochemical examination to analyze potential irritation on abdominal organs and tissue as well as stress-induced activation of c-Fos-protein in brain regions associated with pain. Furthermore, 5 rats were deeply anesthetized with 3 % isoflurane (ISO) and immediately sacrificed for reference values of A and NA. The RR assessed by MouseOx® pulse oximeter was 104 ± 1.05 brpm with a HR of 396 ± 2.10 bpm and an pO2 of 95.7 ± 0.09 % (results present the mean ± standard error). The MouseOx® pulse oximeter was found in the present study to be suitable to measure accurate values for awake and freely moving rats. All rats undergoing CH anesthesia reached st. The duration of the st was 49.14 ± 4.48 min, duration of narcosis was 155.66 ± 8.21 min. During the whole narcosis animal showed tachypnoea, tachycardia as well as minimal depressed pO2-levels and a slightly hypothermia. Elevated levels of A/NA indicated a high intraoperative distress. In addition, iCS levels were significantly elevated in comparison to the MMF-group. CH-rats lost 9.4 g of bodyweight from day of surgery to the following day. Overall, post-surgical little or no signs of pain and distress were observed after awakening from anesthesia, but all CH-rats exhibited peritonitis and perihepatitis, 44 % acute multifocal liver necrosis and 22 % perisplenitis. 95 % in the MMF-group reached satisfactory surgical anesthesia with duration of 47.83 ± 7.05 min (MMF) or 44.77 ± 5.27 min (MMF with reversal). Without reversal, MMF anesthesia lasted 182.23 ± 20.58 min. Gender-differences were noted in the latency to st, duration of st as well as duration of narcosis. Rats undergoing MMF anesthesia showed moderate depression of respiratory function and mild hypothermia. The A/NA levels were lower than in the CH-rats. Rats that received additional doses of MMF to maintain st showed a transient significant decrease of pO2. Core body temperature decreased significantly during 1 h after reversal. Post-mortem examination revealed myositis in some of the MMF-rats. MMF-rats with reversal awaked from anesthesia after 3.05 ± 0.31 min. Afterwards the rats were restless and agitated. After 1 h some of the rats exhibited piloerection and ataxic movements. Only 36 % of PROP-rats reached sufficient surgical anesthesia, accompanied by a pronounced respiratory depression. PROP-rats exhibited a significant decrease of core body temperature and signs of prolonged sedation after awakening from anesthesia. 4 of 11 rats died from respiratory failure during or after surgery. Surprisingly, levels of A/NA after ISO inhalation anesthesia were significantly higher compared to the injection groups. The results of this study indicate that CH anesthesia is associated with an increased liberation of stress hormones. The use of a 3.6 % solution of CH has to be refused especially because of the pathohistological findings, despite animals showed subjectively a good well-being. Propofol administered as an i.p. bolus produced only hypnosis. Therefore, i.p. injections are marely useful for short and non-painful procedures. However, post-anesthetic excitations represent limitations. The initial i.p. propofol bolus followed by intravenous infusion is therefore less suitable than an absolute intravenous administration. Thus, i.p. injections cannot be recommended. The complete reversible combination MMF is considered as suitable for stereotactic surgeries of Sprague-Dawley rats. There is an urgent need to continue heating after awakening, because thermoregulation is insufficiently restored after reversal of MMF anesthesia. Distress through the undesirable effects of the reversal like agitation and restlessness and through hypothermia was presumed only by subjective criteria. Further investigations are needed here. If there is no emergency situation, reversal should be avoided. In case of permanent external heating (37 - 38 °C) there is no major risk of life-threatening hypothermia or depression of respiratory or cardiovascular function during sleeping time.

Chronic pain in children and adolescents is common; approximately 5% of children and adolescents report chronic pain along with moderate to high pain-related disability. Chronic pain is a subjective experience and can best be explained by a bio-psycho-social approach, which suggests reciprocal relations between different levels of this multidimensional phenomenon. The different dimensions of chronic pain need to be considered for a comprehensive assessment. Due to the subjective nature of pain, the child’s self-report is usually considered the best available and most valid estimate of the pain experience. A reliable and multidimensional assessment is an indispensable requirement for treatment planning. To date, questionnaires in German language are available to assess a wide range of relevant parameters in pediatric chronic pain. However, so far, no validated self-report tool exists to assess sensory and affective pain perception in children. These two parameters are of relevance since they describe aspects of the biological as well as the psychological dimension of chronic pain. Furthermore, a comprehensive diagnostic approach combining parameters from the three dimensions of chronic pain does not yet exist for children and adolescents. Such a comprehensive approach could be used for sample descriptions and standardized comparisons across different populations; it could serve as an approach for treatment planning or to classify outcome. This doctoral thesis is aimed at further developing the available diagnostic measures for older children and adolescents with chronic pain based on the above mentioned gaps in pediatric pain assessment. Research was performed on three patient samples. Sample 1 includes data from a prospective assessment at the German Pediatric Pain Centre from August 2008 to March 2009 (N(1)=139). Sample 2 includes retrospective data from patients who were treated at the German Pediatric Pain Centre from July 2005 to June 2010 (N(2)=1242). Sample 3 consists of pediatric pain patients who started an intensive interdisciplinary inpatient treatment between November 2009 and July 2011 (N(3)=83). In a first study, a tool to assess sensory and affective pain perception, the Pain Perception Scale for Adolescents, was adapted and validated in an adolescent clinical sample (Sample 1). The Pain Perception Scale for Adolescents allows pain patients to provide a valid and reliable self-report of parameters for both the biological and psychological dimensions of pain. In a second study, this tool was applied to a further sample of adolescents with migraine and tension-type headache (subsample of Sample 2). It was demonstrated that, contrary to the official headache classification guidelines, the sensory pain perception in this sample did not differentiate between migraine and tension-type headache. To develop a multidimensional assessment approach, in a third study, an adult classification system (Chronic Pain Grading) was applied to a sample of pediatric pain patients (Sample 2). This approach proved useful as a valid measure for a brief operationalization of pain problem severity, including pain intensity and pain-related disability only, and as an outcome measure. However, it displayed major shortcomings with regards to treatment stratification. To further develop an approach for treatment stratification and treatment planning, a fourth study focused on developing a new multidimensional approach for subgroup classification (subsample of Sample 2). The stability of subgroups was demonstrated in a cross-validation with an independent sample (Sample 1). Furthermore, the identified subgroups displayed distinct treatment outcomes after a standardized treatment program (Sample 3). In conclusion, this doctoral thesis offers an addition to diagnostic measures for older children and adolescents with chronic pain by adding the Pain Perception Scale for Adolescents and by proving the validity of the Chronic Pain Grading for the application in this patient group. These tools allow a valid description of adolescents’ subjective pain experience. Results from this doctoral thesis also indicate that the findings from adults cannot be readily transferred to children and adolescents. The final output of this doctoral thesis is a bio-psycho-social classification approach that identifies subgroups of adolescents with chronic pain with treatment relevant differences. This is a first step toward the development of subgroup-specific treatment.