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      Pain point system scale (PPSS): a method for postoperative pain estimation in retrospective studies

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          Abstract

          Purpose

          Pain rating scales are widely used for pain assessment. Nevertheless, a new tool is required for pain assessment needs in retrospective studies.

          Methods

          The postoperative pain episodes, during the first postoperative day, of three patient groups were analyzed. Each pain episode was assessed by a visual analog scale, numerical rating scale, verbal rating scale, and a new tool – pain point system scale (PPSS) – based on the analgesics administered. The type of analgesic was defined based on the authors’ clinic protocol, patient comorbidities, pain assessment tool scores, and preadministered medications by an artificial neural network system. At each pain episode, each patient was asked to fill the three pain scales. Bartlett’s test and Kaiser–Meyer–Olkin criterion were used to evaluate sample sufficiency. The proper scoring system was defined by varimax rotation. Spearman’s and Pearson’s coefficients assessed PPSS correlation to the known pain scales.

          Results

          A total of 262 pain episodes were evaluated in 124 patients. The PPSS scored one point for each dose of paracetamol, three points for each nonsteroidal antiinflammatory drug or codeine, and seven points for each dose of opioids. The correlation between the visual analog scale and PPSS was found to be strong and linear (rho: 0.715; P < 0.001 and Pearson: 0.631; P < 0.001).

          Conclusion

          PPSS correlated well with the known pain scale and could be used safely in the evaluation of postoperative pain in retrospective studies.

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          Most cited references 41

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          Effect of postoperative analgesia on surgical outcome.

           K Holte,  H Kehlet (2001)
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            Comparison of fixed interval and visual analogue scales for rating chronic pain.

            A visual analogue scale (VAS) and a 4-point scale (FPS) have been compared in patients suffering from prolonged constant pain due to chronic inflammatory or degenerative arthropathy. Each patient was treated with a constant low or high dose of paracetamol or dihydrocodeine throughout a four week period. The VAS was accurate, as reliable and more sensitive than the FPS in registering the intensity of chronic pain. Separate records of each estimate, sealed immediately on completion by the patient, resulted in omission of significantly more pain recordings on the FPS, whereas retention by the patients of their previous records did not systematically influence subsequent judgments. In this study, the VAS appeared to be more satisfactory than the FPS for patient self-rating of pain intensity.
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              The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients.

              The psychometric properties of pain intensity scales for the assessment of postoperative pain across the adult lifespan have not been reported. The objective of this study was to compare the feasibility and validity of the Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), and Visual Analog Scale (horizontal (VAS-H) and vertical (VAS-V) line orientation) for the assessment of pain intensity in younger and older surgical patients. At 24h following surgery, 504 patients, who were receiving i.v. morphine via patient-controlled analgesia, completed the pain intensity measures and the McGill Pain Questionnaire (MPQ) in a randomized order. They were asked which scale was easiest to complete, the most accurate measure, and which they would most prefer to complete in the future, as an index of face validity. The amount of opioid self-administered was recorded. Age differences in postoperative pain intensity were not found. However, elderly patients obtained lower MPQ scores and self-administered less morphine than younger people. Psychometric analyses suggested that the NRS was the preferred pain intensity scale. It had low error rates, and higher face, convergent, divergent and criterion validity than the other scales. Most importantly, its properties were not age-related. The VDS also had a favourable profile with low error rates and good face, convergent and criterion validity. Finally, difficulties with VAS use among the elderly were identified, including high rates of unscorable data and low face validity. Its use with elderly postoperative patients should be discouraged.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2012
                07 November 2012
                : 5
                : 503-510
                Affiliations
                [1 ]Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [2 ]Department of Anesthesiology, Hippokration General Hospital, Thessaloniki, Greece
                [3 ]Department of Urology, Hippokration General Hospital, Thessaloniki, Greece
                Author notes
                Correspondence: Dimosthenis Petsas, Karavaggeli 49, Pilaia, Thessaloniki 55535, Greece, Tel +30 231 035 1416, Mobile +30 694 993 8952, Email dpets_anesthesia@ 123456hotmail.com
                Article
                jpr-5-503
                10.2147/JPR.S37154
                3496529
                23152699
                © 2012 Gkotsi et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Anesthesiology & Pain management

                pain point system scale, retrospective studies, pain scale

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