The overall theme of this thesis is the study of sensory pain assessment and describes how digital pain mapping using standardized iconography can be used to help portray and understand the sensory pain experience. The research presented in this thesis is focused on the design, development, and use of a web-based sensory pain assessment tool for individuals with chronic pain called the Pain-QuILT. “QuILT” is an acronym describing the different parameters that are captured by the tool: pain quality, intensity, and location in a digital format that can be tracked over time. The central hypothesis guiding this work is that users of pain assessment tools will tend to favour a digital icon-based sensory pain mapping tool (‘PainQuILT’) over currently available sensory pain assessment tools. “Pain assessment tool” has been operationally defined as a standardized method for capturing information about an individual’s sensory pain experience. In this context, “users” include both individuals experiencing chronic pain and healthcare providers who seek to assess and understand pain. Research to date has focused on phased evaluation of the Pain-QuILT in the context of clinical sensory pain assessment for two distinct user groups: adolescents (aged 12 to 18 years) and adults (aged 19 years and older) with chronic pain. Each stage of research has generated and been informed by user feedback, leading to iterative improvements in tool functionality. Thus, as a whole, this body of work represents an evolving effort to improve the clinical assessment of sensory pain using the approach of icon-based pain mapping in a digital and visual format. Through the collective research presented in this thesis, we have affirmed that digital pain mapping using iconography is a viable solution to the clinical challenge of sensory pain assessment in adolescents and adults with chronic pain. / Dissertation / Doctor of Philosophy (PhD)

Bakgrund: Strukturerad smärtskattning är en högprioriterad åtgärd under patienters sista levnadsvecka enligt Socialstyrelsens styrdokument för palliativ vård. Vården i hemmet ska bedrivas personcentrerat där patientens hälsotillstånd utreds och ska syfta till att lindra lidande. Detta innebär att distriktssköterskor behöver ha färdigheter och kunskaper kring smärta, dess orsak, smärtskattning och behandling. Smärta och dess skattning är betydelsefull och beskrivningen distriktsköterskors erfarenheter av smärtbedömning ökar möjligheten att hitta förbättrings- och förändringsområden.Syfte: Undersöka distriktsköterskors erfarenheter av smärtbedömning vid vård i livets slutskede inom hemsjukvård.Metod: Semistrukturerade intervjuer genomfördes genom videosamtal och bekvämlighetsurval användes under september-november 2022. Sammanlagt intervjuades 15 distriktsköterskor med vana av smärtbedömning vid vård i livets slutskede och analyserades utifrån kvalitativ innehållsanalys.Resultat: I resultatet belyser distriktsköterskorna olika erfarenheter kring användandet av smärtskattningsinstrument i vård i livets slutskede och vilka faktorer som påverkar användningen av smärtskattningsinstrument. Kategorierna som framkom var ”distriktsköterskornas erfarenhet av vikten av att smärtskatta”, ”distriktsköterskornas behov av samordning och kunskap” samt ”distriktsköterskornas erfarenhet av förbättrad smärtlindring”.Slutsats: Tydliga rutiner för användningen av smärtskattningsinstrument och dokumentation kan förbättra vård i livets slutskede inom hemsjukvård. Distriktsköterskorna efterfrågade utbildning i smärtskattningsverktygen anpassade för bedömningar av patienter i livets slutskede.

Bakgrund: Smärta är vanligt förekommande bland icke-verbala intensivvårdspatienter och beror på bakomliggande sjukdomar och behandlingar som de erhåller. Smärtbedömning hos icke-verbala patienter är en utmaning för intensivvårdssjuksköterskan på grund av den icke-verbala patientens oförmåga att uttrycka sig verbalt. Oförmåga att kommunicera kan bero på sänkt medvetandegrad och bakomliggande sjukdomar. Tidigare forskning visar att smärtan hos icke-verbala patienter kan bli underbehandlad och överbehandlad. Felaktig smärtbedömning kan leda till komplikationer och förlängd vårdtid och som följd kan leda till ett lidande för den icke-verbala patienten. Syfte: Syftet var att undersöka intensivvårdssjuksköterskans erfarenheter av smärtbedömning hos den icke-verbala intensivvårdspatienten. Metod: En systematisk litteraturstudie med integrativ design genomfördes. Resultatet bygger på 15 vetenskapliga artiklar varav fyra kvalitativa, två med mixedmetod och nio kvantitativa artiklar. Resultat: Resultaten visar att det finns olika faktorer som påverkar utförandet av smärtbedömning hos icke-verbala intensivvårdspatienter. Arbetsbelastning, brist på rutiner och riktlinjer, brist på skattningsinstrument samt utbildningsnivå och erfarenhet spelar roll. Vidare framkom det att intensivvårdssjuksköterskor använder sig mest av egen smärtbedömning utifrån uppvisat smärtbeteende och vitala parametrar. Slutsats: Med ökad kunskap inom smärtbedömning samt bättre förutsättningar utifrån organisatorisk nivå kan intensivvårdssjuksköterskan förebygga akuta och långsiktiga komplikationer samt minska patientens lidande. / Background: Pain is common among non-verbal intensive care patients and is due to underlying diseases and treatments they receive. Pain assessment in non-verbal patients is a challenge for the critical care nurse due to the non-verbal patient's inability to express themselves verbally. Inability to communicate can be due to reduced level of consciousness and underlying diseases. Previous research shows that the pain of non-verbal patients can be undertreated and overtreated. Incorrect pain assessment can lead to complications and prolonged hospital stay and, as a result, can lead to suffering for the non-verbal patient. Purpose: The purpose was to investigate the intensive care nurse's experiences of pain assessment in the non-verbal intensive care patient. Method: A systematic literature study with an integrative design was conducted. The result is based on 15 scientific articles, of which four are qualitative, two with a mixed method and nine quantitative articles. Results: The results show that there are different factors that influence the performance of pain assessment in non-verbal intensive care patients. Workload, lack of routines and guidelines, lack of assessment instruments as well as level of education and experience play a role. Furthermore, it emerged that intensive care nurses mostly use their own pain assessment based on demonstrated pain behaviour and vital parameters. Conclusion: With increased knowledge in pain assessment and better conditions based on organizational level, the intensive care nurse can prevent acute and long-term complications and reduce the patient's suffering.

Cette étude prospective, randomisée et à l’aveugle a évalué la validité, la réactivité et fiabilité de l’échelle de grimaces félines (Feline Grimace Scale; FGS) chez les chatons. Trente-six jeunes chattes en santé (âgées de 10 semaines à 6 mois) étaient filmées avant puis 1 et 2 h après ovariohystérectomie. La procédure a été effectuée avec un protocole d’anesthésie injectable (sans opioïde), avec ou sans analgésie multimodale. Les chatons en douleur étaient également filmés avant et 1h après avoir reçu une analgésie de secours (buprénorphine 0.02 mg/kg IM). Quatre évaluateurs, aveugles aux conditions expérimentales, ont évalué deux fois à cinq semaines d’intervalle les expressions faciales sur 111 images extraites des vidéos. Les cinq unités d’action (action unit; AU) de la FGS ont été évaluées (position des oreilles, serrage orbital, tension du museau, position des moustaches, position de la tête; avec un score possible de 0 à 2 pour chacune). La validité de construit, la réactivité et la fiabilité inter- et intra-évaluateur de la FGS ont été analysées en utilisant un modèle linéaire avec correction Benjamini–Hochberg, un test Wilcoxon signed-rank et un coefficient de corrélation intra-classes unique (ICCsingle), respectivement (P <0.05). Les ratios des scores FGS totaux (médiane [étendue interquartile, EI]) étaient augmentés 1 et 2 h après l’ovariohystérectomie (médiane [EI] : 0.30 [0.20–0.40] et 0.30 [0.20–0.40], respectivement) comparativement à la mesure de base (médiane [EI] : 0.10 [0.00–0.30]) (P <0.001), et inférieurs après l’analgésie (médiane [EI] : 0.40 [0.20–0.50]) qu’avant son administration (médiane [EI] : 0.20 [0.10–0.38]) (P <0.001). Pour la fiabilité inter-évaluateur, les ICCsingle des ratios des scores FGS totaux étaient 0.68 et compris entre 0.35 et 0.70 pour chaque AU, individuellement. Pour la fiabilité intra-évaluateur, les ICCsingle des ratios des scores FGS totaux étaient compris entre 0.77–0.91 et 0.55–1.00 pour chaque AU. La FGS est un outil d’évaluation de la douleur aiguë valide et réactif chez les chatons avec une fiabilité inter-évaluateur modérée et intra-évaluateur bonne à excellente. / This prospective, randomized, blinded study investigated the construct validity, responsiveness and reliability of the Feline Grimace Scale (FGS) in kittens. Thirty-six healthy female kittens (aged 10 weeks to 6 months) were video recorded before, 1 and 2 h after ovariohysterectomy using an opioid-free injectable anesthetic protocol with or without multimodal analgesia. Painful kittens were additionally filmed before and 1 h after administration of rescue analgesia (buprenorphine 0.02 mg/kg IM). One hundred eleven facial images collected from video recordings were randomly scored by 4 observers, blinded to treatment groups and time points, twice with a 5 weeks interval using the FGS. The five action units (AU) of the FGS were scored (ear position, orbital tightening, muzzle tension, whiskers position and head position; 0–2 each). Construct validity, responsiveness, inter- and intra-rater reliability of the FGS were evaluated using linear models with Benjamini–Hochberg correction, Wilcoxon signed-rank test and single intra-class correlation coefficients (ICCsingle), respectively (P <0.05). The FGS total ratio scores were higher 1 and 2 h after ovariohysterectomy (median [interquartile range, IQR]: 0.3 [0.20–0.40], and 0.30 [0.20–0.40], respectively) than at baseline (median [QR]: 0.10 [0.00–0.30]) (P <0.001), and lower after the administration of rescue analgesia (median [QR]: 0.40 [0.20–0.50]) than before (median [QR]: 0.20 [0.10–0.38]) (P <0.001). The inter-rater ICCsingle was 0.68 for the FGS total ratio scores and 0.35–0.70 for AUs considered individually. The intra-rater ICCsingle was 0.77–0.91 for the FGS total ratio scores and 0.55–1.00 for AUs considered individually. The FGS is a valid and responsive acute pain scoring instrument with moderate inter-rater reliability and good to excellent intra-rater reliability in kittens.

Title: A systematic review of pain assessment tools Objectives: The aim of this thesis is to create a systematic review of the most widely used multidimensional tools (questionnaires) for assessing pain in patients with nonspecific pain of the cervical and lumbar spine. From the available sources, describe their use, the purpose it was generated for, their reliability, validity, and finally arrange the questionnaires from the most used and assess their advantages and disadvantages for use in clinical practice of physiotherapist. Method: The thesis is processed through a systematic review. The subject of the thesis are pain evaluating tools, especially in the cervical and lumbar spine. The studies containing questionnaires used to assess pain in the cervical and lumbar spine were searched out. Data extraction was carried out according to pre-specified criteria. Unsatisfactory studies were excluded. After the relevant questionnaires selection a content analysis of each tool was conducted, built a systematic review of the most commonly used questionnaires and their critical evaluation. Results: On the basis of the entire set of relevant studies I described and evaluated 14 questionnaires. Five of them are designed specifically for low back pain. They are the Roland Morris Disability Questionnaire,...

Le nouveau-né hospitalisé est exposé de manière répétée à des procédures douloureuses ou stressantes pouvant entraîner des conséquences neurodéveloppementales à court et long terme. La prévention de la douleur procédurale est essentiellement basée sur l’utilisation de traitements non pharmacologiques parmi lesquels les solutions sucrées possèdent un niveau de preuve élevé. Cependant, leur efficacité a récemment été remise en cause et leurs mécanismes d’action restent mal compris. Enfin, la dissociation parfois retrouvée entre les réponses comportementales et corticales suggère de monitorer la douleur de manière multimodale. Les objectifs de ce travail étaient : 1) de comparer l’efficacité de l’allaitement maternel et du sucrose sur la douleur procédurale en analysant spécifiquement les réponses corticales, 2) d’étudier les effets périphériques des solutions sucrées au niveau de neurones sensoriels de ratons, 3) d’évaluer l’intérêt d’un modèle d’évaluation multimodale de la douleur chez le nouveau-né à terme et prématuré. Aucune différence entre le sucrose et l’allaitement maternel n’a pu être objectivée sur les réponses corticales(NIRS) à la douleur chez des nouveau-nés à terme à 3 jours de vie. Nous avons objectivé un effet périphérique du glucose et du sucrose sur des neurones sensoriels de ratons nouveau-nés, médié par TRPV1. L'effet du glucose était associé à une diminution de la libération de la substance P. L’évaluation multimodale de la douleur retrouvait des corrélations faibles à modérées entre le score NFCS et la conductance cutanée, le cortisol salivaire et les changements d’ [HbT] mesurés en NIRS. L’étude menée chez les nouveau-nés prématurés nous permettra de préciser l’intérêt de l’utilisation de la variabilité de la fréquence cardiaque (indice NIPE instantané) dans cette indication afin de proposer un modèle multimodal fiable pour de futurs essais randomisés contrôlés. / Hospitalized newborns are exposed to repeated painful or stressful procedures that can lead to short- and long-term neurodevelopmental sequellae.The prevention of procedural pain is essentially based on the use of nonpharmacological treatments among which the sweet solutions appear to be among the most effective. However, their effectiveness has recently been challenged and their mechanisms of action remain poorly understood. Finally, the dissociation frequently found between behavioural and cortical responses shows the importance of monitoring pain in a multimodal way. The objectives of this work were 1) to compare the efficacy of breastfeeding and sucrose on procedural pain by specifically analyzing cortical responses, 2) to study the peripheral effects of sweet solutions on sensory neurons of newborn rats and 3) to evaluate the contribution of a multimodal pain assessment model in term and preterm neonates. No difference between sucrose and breastfeeding was measured on pain-evoked cortical responses (NIRS) in term neonates at 3 days of life.We reported a peripheral effect of glucose and sucrose on afferent sensory neurons from newborns rats mediated byTRPV1. The effect for glucose was associated with a decrease of substance P release.The multidimensional assessment of pain found mild to moderate correlations between the NFCS score, skin conductance, salivary cortisol and changes in [HbT] measured in NIRS.The study conducted in preterm newborns will specify the reliability of heart rate variability (instant NIPE index) in thisindication to provide a suited multimodal pain assessment model for future randomized controlled trials.

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery

Os fatores idade e sexo modificam a experiência dolorosa em animais e seres humanos. Os efeitos dos hormônios gonadais têm sido estudados em diversos modelos experimentais de dor, no entanto, o efeito do envelhecimento na percepção à dor carece de mais investigação. O efeito do envelhecimento na dor neuropática ainda não está bem estabelecido. Neste estudo se procurou avaliar possíveis variações na percepção da dor da hiperalgesia mecânica, em função da idade, presença e ausência de hormônios gonadais e sexo em ratos Wistar machos e fêmeas, jovens e idosos no modelo de dor neuropática, ligadura da quinta raiz lombar. Os animais foram divididos nos seguintes grupos: ratos jovens orquiectomizados e não-orquiectomizados, ratos idosos orquiectomizados e não-orquiectomizados, ratas jovens ooforectomizadas com ou sem reposição de 17beta-estradiol e ratas idosas. Foi testado o limiar de retirada da pata após estímulo mecânico antes da ligadura e no 7º, 14º, 21º e 28o dias após a ligadura. Os resultados mostraram que todos os animais apresentaram comportamento hiperalgésico após ligadura da quinta raiz lombar durante os 28 dias de observação. A hiperalgesia ocorreu independentemente do sexo do animal, da presença ou ausência de hormônios gonadais ou idade. Não houve diferença entre ratos jovens e idosos não-orquiectomizados (p = 0,420), entre ratos jovens e idosos orquiectomizados (p = 0,560). Entre os ratos idosos com e sem orquiectomia houve diferença no 14º (p = 0,038) e 28º (p = 0,002) dias. Ratas jovens ooforectomizadas sem reposição de 17beta-estradiol apresentaram menor hiperalgesia que ratas ooforectomizadas com reposição durante todo o período (p = 0,001). Não houve diferença entre ratos idosos orquiectomizados e ratas idosas (p = 0,09). Ratos jovens não-orquiectomizados apresentaram menor hiperalgesia mecânica que ratas jovens ooforectomizadas com reposição de 17beta-estradiol (p = 0,001), o mesmo não ocorreu entre machos e fêmeas jovens gonadectomizados sem reposição hormonal (p = 0,511). Ratas jovens ooforectomizadas sem reposição de 17beta-estradiol e ratas idosas mostraram diferença apenas no 7º dia (p = 0,002). Os resultados permitiram concluir que a reposição de 17beta-estradiol aumentou a hiperalgesia mecânica aos estímulos mecânicos após ligadura da quinta raiz lombar em ratas jovens ooforectomizadas, a hiperalgesia mecânica não diferiu entre os sexos em ratos jovens machos e fêmeas, a presença da gônada masculina diminuiu a hiperalgesia mecânica em ratos idosos e que houve diminuição da hiperalgesia mecânica em ratas idosas / Age and sex modify the pain experience in animals and humans. The effects of gonadal hormones have been studied in various experimental pain models, however, the effect of aging on pain perception needs further investigation. The effect of aging on neuropathic pain is not well established. In this study, we sought to determine how aging and gonadal hormones affect mechanical hyperalgesia using spinal nerve ligation as a neuropathic pain model in aged and young male and female Wistar rats. Animals were divided into seven groups: aged female, ovariectomized young females with 17beta-estradiol replacement, ovariectomized young females without 17beta-estradiol replacement, orchiectomized and non-orchiectomized aged and young males. Rats were tested for mechanical hyperalgesia in the plantar surface of the left hindpaw before nerve ligation and on days 7, 14, 21 and 28 after nerve ligation. All animals of all groups showed mechanical hyperalgesic behavior after spinal nerve ligation during entire period of 28 days. Hyperalgesia was independent of the sex of the animal, the presence or absence of gonadal hormones or age. There was no difference between non-orchiectomized aged and young males (p = 0.420), and between orchiectomized aged and young males (p = 0.560). There was difference between aged male rats with and without orchiectomy in days 14 (p = 0.038) and 28 (p = 0.002). Young ovariectomized female rats without 17beta-estradiol replacement had less hyperalgesia than young ovariectomized female rats with replacement (p = 0.001). There was no difference between aged orchiectomized male rats and old female rats (p = 0.09). Young non-orchiectomized male rats showed less mechanical hyperalgesia than young ovariectomized female rats with 17beta-estradiol replacement (p = 0.001), that did not occur between young orchiectomized males rats and young ovariectomized females rats without 17beta-estradiol replacement (p = 0.51). Young ovariectomized female rats without 17beta-estradiol replacement and old female rats showed differences only on day 7 (p = 0.002). These data suggest that estradiol presented a pronociceptive effect in young female rats in mechanical hyperalgesia in the neuropathic pain model, spinal nerve ligation, withdrawal threshold did not differ between sex, the presence of male gonadal hormones reduces mechanical hyperalgesia in old male rats and there is reduced mechanical hyperalgesia in aged female rats

The general aim of this thesis was to classify and describe long-term pain two years after a stroke and to describe the experiences of pain, and the consequences it has on the persons’ lives. The studies were conducted from a multidimensional perspective on pain, combining quantitative and qualitative methods. Three types of long-term pain were classified and described among the 43 participants included, aged 33-82 years. These were central post-stroke pain, nociceptive, mainly shoulder pain, and tension-type headache. Pain onset, within one to six months in most of the cases was after discharge from the hospital. Continuous pain or pain almost every day was reported by nearly two-thirds. The pain was mostly described as troublesome, annoying and tiring in all pain groups. The rating of pain intensity revealed individual differences among the participants within the pain groups. In addition to long-term pain, the participants suffered several impairments and nearly half of them were dependent on others, and two-thirds on assistive devices. Several coping strategies were described, most often problem-focused. Their health-related quality of life was decreased, mostly related to their long-term pain and physical impairments. Their experiences of caring revealed the need of improvements in knowledge about longterm pain, attention and understanding among the professionals, and continuity in the contacts. / On the day of the public defence the status of article III was: Accepted for publication and the status of article IV was: In press.

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery