slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Assessing PAIN in Patients with Cerebral Palsy PowerPoint Presentation
Download Presentation
Assessing PAIN in Patients with Cerebral Palsy

Loading in 2 Seconds...

play fullscreen
1 / 50

Assessing PAIN in Patients with Cerebral Palsy - PowerPoint PPT Presentation


  • 128 Views
  • Uploaded on

Assessing PAIN in Patients with Cerebral Palsy. Hiroko Matsumoto, MA, PhDc Director of Research, Weinberg Family Cerebral Palsy Center at Columbia University Associate Director of Research, Division of Pediatric Orthopaedics Department of Orthopaedic Surgery

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Assessing PAIN in Patients with Cerebral Palsy' - basia-oneill


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Assessing

PAIN

in Patients with Cerebral Palsy

Hiroko Matsumoto, MA, PhDc

Director of Research, Weinberg Family Cerebral Palsy Center at Columbia University

Associate Director of Research, Division of Pediatric Orthopaedics

Department of Orthopaedic Surgery

Columbia University Medical Center

AAPM&R Annual Assembly

November 2014

slide2

Author Disclosures

  • Research Support:Children’s Spine Foundation, SRS, POSNA, CPIRF
    • Travel Support: Biomet, Medtronic, DePuySynthes, Stryker
slide3

Introduction

  • Patients frequently seek medical attention for pain, the #1 most common reason for visits to the ED (Chang et al, 2014).
  • Experience of pain is subjective (Nakada et al., 2013; DeVon et al., 2014).
slide4

No Objective Measure of Physical Pain

  • Functional MRI studies have shown that the same neural areas recruited in the experience of physical pain are associated with the experience of emotional pain (Eisenberger et al., 2003; Singer et al., 2004; Heckel et al., 2011).

Eisenberger et al., 2003

slide5

No Objective Measure of Physical Pain

  • Although various inflammatory biomarkers may have higher levels during increased report of both acute and chronic pain, noone biomarker can currently assess pain w/ accuracy or certainty.

DeVon et al., 2014

slide6

The Gold Standard

  • Because no objective measure to assess pain exists…

Self-report

is the gold-standard (Schiavenato and Craig, 2010).

slide8

Wong-Baker FACES Pain Rating Scale

Wrong DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Schwartz P: Wong’s Essentials of Pediatric Nursing, 6/e, St. Louis, 2001, P.1301

slide9

Numeric Graphic Rating Scale

McCaffery M, et al, Pain: Clinical Manual 1999, p. 16.

slide10

Visual Analog Scale

Williamson A and Hoggart B. Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing 14, 2005; 798-804.

slide11

Colored Analog Scale

Santos and Castanho, Am J Alzheimer’s Dis Other Demen June 2014, 29(4): 320-325.

slide12

Verbal Rating Scale

Margo McCaffery, RN, MS, FAAN and Chris Pasero, RN, MSNc: Pain Clinical Manual, 2nd Edition, 1999, p.63.

slide13

Pain Thermometer

Herr: Pain Med 2007 Oct-Nov;8(7):585-600.

slide14

Where is Your Pain?

Pain,Vol 1, Melzack R, The McGill Pain Questionnaire: major properties and scoring methods 1975, 277-299.

slide15

Brief Pain Inventory

http://www.npcrc.org/files/news/briefpain_short.pdf

slide16

Caregiver Priorities and Child Health Index of Life with Disabilities

CP CHILD, Self-Report

http://www.sickkids.ca/Research/CPCHILD-Questionaire/CPChild-Questionaire.html

slide17

Cerebral Palsy Quality of Life for Children

CP QOL-Child, Self-Report

http://www.cpqol.org.au/V2%20CPQOL%20child%20report%20Q%209-12.pdf

slide18

Pain: Proxy-Report

and Observational Tools

slide19

FLACC Pain Scale

Gomez et al., (2013)

slide20

CP CHILD, Proxy-Report

http://www.sickkids.ca/Research/CPCHILD-Questionaire/CPChild-Questionaire.html

slide21

Chronic Pain Scale for Nonverbal Adults with Intellectual Disabilities

CPS-NAID

Burkitt, Breau, Salsman, Sarsfield-Turner & Mullen (2009)

slide22

Abbey Pain Scale

The Australian Pain Society.

http://www.apsoc.org.au/PDF/Publications/4_Abbey_Pain_Scale.pdf

slide23

Pain and Discomfort Scale for Pain Assessment among Adults with intellectual disability

PADS

Shindeet al., (2013)

slide24

The Non-Communicating Adult Pain Checklist

NCAPC

Lotan, Moe-Nilssen, Ljunggren, Strand (2010)

slide25

Disability Distress Assessment Tool

DisDAT

Regnard et al., (2006)

slide27

Behavioral Measures of Pain

  • Used in the following populations:
    • Infants, young children;
    • Children and adults w/ intellectual or communication needs.
  • Observe and quantify:
    • Vocalizations;
    • Facial expressions;
    • Body movements.
  • Document changes in patterns of daily life:
    • Eating;
    • Sleeping;
    • Play.
slide28

Symptoms versus HRQOL

  • All of previous instruments (self-report and proxy/observational), assess pain symptoms rather than HRQOL.
    • Symptom: A physical sign or indication of disease;
    • Health Related Quality of Life (HRQOL): Physical, mental, emotional, social functioning, which takes into account impact of symptoms (Bjornson and McLaughlin, 2001).
  • Both symptoms and HRQOL are patient-reported outcomes, meaning the patient reports his/her state of wellbeing.
slide29

Importance of HRQOL in CP

  • Pain is highly prevalent among patients with CP (Novak et al., 2012, Schwartz et al. 1999, Engel et al., 2003).
  • Pain is inadequately evaluated and treated in patients with CP (Hirsh et al., 2011).
  • Important to measure HRQOL as opposed to symptoms alone:
    • Want to know impact of pain on patients’ ability to function in everyday life.
slide30

Static versus Dynamic

Static Q’s

Dynamic Q’s

slide31

Static versus Dynamic

Static

  • Static: Questions to follow do not change based on patient responses.
  • Questions presented in same sequence, regardless of prior answers.

Questionnaires

slide32

Static versus Dynamic

CAT

Computer Adaptive Test

  • Dynamic option: Questions are presented in changing sequence, with following sequence based on prior answers.
  • Purpose:
    • Minimizes # questions;
    • Greater measurement precision;
  • Presented as Computer Adaptive Test (CAT).
slide33

Static versus Dynamic

  • Previous instruments, although acceptable for pain assessment arestatic instruments.
slide34

PROMIS

  • PROMIS: Patient-Reported Outcomes Measurement Information System.
  • NIH-funded psychometric evaluation that has grown significantly over last several years: (http://www.hhs.gov/asl/testify/t051208a.html)
    • $82-million in 1997;
    • $90-million since 2004.
  • PROMIS measures the following metrics: (NIHPromis.org)
    • Patient-reported outcomes: Objective,e.g. symptoms, function (http://www.nihpromis.org/measures/measureshome)
    • Health-related quality of life: Subjective, e.g. how a patient feels about their symptoms, function (http://www.nihpromis.org/measures/domainframework1)
slide35

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

  • “PROMIS creates an opportunity for clinicians and patients to develop a common language around self-reported health status and in the process allow better assessment of the unique information from patients thereby enabling improvedquality of care and quality of clinical research.” (NIHPromis.org)
slide36

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

439 Q’s

3 components

325 Q’s

150 Q’s

slide37

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

82 Q’s in item bank

slide38

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

  • Universal self-reported pain scoring system, where:
    • Higher score means = higher pain intensity;
    • Lower score = lower pain intensity.
  • Raw scores from short form or Computer Adaptive Test (CAT) are converted into scaled scores.
  • Scaled scores are calibrated so that: (NIHpromis.org/faqs)
    • A score of 50-points is the average score of the US population;
    • 10 -points is equal to one standard deviation.
slide39

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

  • One of the biggest advantages of the PROMIS scaled scores is that they have been adjusted so that adult and pediatric scores can be compared directly.

e.g. Raw score of 19

(Peds pain interference)

Mean: 50

e.g. Raw score of 16

(Adult pain interference)

40

60

Scaled score of:

60

68%

of population

slide40

What is PROMIS?

A comprehensive instrument to assess pain and pain behaviors

Item Bank

Short Form

CAT

Computer Adaptive Test

914 Q’s

Dynamic Q’s

Static Q’s

slide41

PROMIS

Adult Item Bank: e.g. from Pain Behavior

slide42

PROMIS

Adult Item Bank: e.g. from Pain Interference

slide43

PROMIS

Adult Item Bank: e.g. from Pain Intensity

slide44

PROMIS

Pediatric Item Bank: e.g. from Pain Interference

slide45

Pain Self-Report in IDD Patients

  • Communication of a patient’s pain to a treating clinician is limited by their ability to self-report (Schiavenato and Craig, 2010).
  • Patients with Intellectual and Developmental Disabilities (IDD) have motor, sensory, and/or cognitive impairments leading to difficulty conveying their experiences and thus, their pain.
  • Currently, no comprehensive method exists to assess the level of pain in all IDD patients.
slide46

COMPAs: Future Work

  • COMPAs: NIH R01 grant
    • Creation of Outcome Measures in Pain Assessment;
    • Empowering Disabled Persons.

Proxy

Self

slide47

COMPAs: Future Work

  • COMPAs: NIH R01 grant
    • Creation of Outcome Measures in Pain Assessment;
    • Empowering Disabled Persons.

Modified

Self

Proxy

Self

slide49

Key Summary Points

  • Importance of measuring pain health related quality of life, not just pain symptoms.
  • PROMIS is a robust and comprehensive NIH-funded tool to measure health related quality of life.
  • Dynamic CAT versions of instruments allow for greater precision with less examiner burden than static instruments.
  • PROMIS is a unique HRQOL tool with scaled scores to directly compare:
    • Pediatric v. adult scores;
    • Self v. proxy scores.