Assessing Pain in in Post Operative Breast Cancer Patients

Assessing hurt in in Post Operative Breast crab louse PatientsComparison between Brief disquiet line of descent (BPI) and Numerical Rating Scale (NRS) for post-operative pain assessment in Saudi Arabianbreast crabmeat patients.QuestionsDoesBPI assesspost-operative breast cancer painmoreaccurately than NRS?SummaryEffective pain assessment is one of thefundamentalcriteriaof themanagement ofpain. It involvestheevaluation of pain military strength, location of the pain and reception to treatment. There areanumberof multi and one-dimensional assessment toolsthathave already been established to assess cancer pain. Among theseare theBrief Pain Inventory (BPI) andtheNumerical Rating Scale (NRS), Breast cancer isa growing publicconcern in Saudi Arabiaas rates continue to escalate, with patients as well assuffering multiple problems after surgery. Therefore, my research aim is toconduct acomparative studyof toolsused toassess post-operative breast cancer paininSaudi Arabianpatientsand determine which is the nearly effective. In this process I will use questionnaires for both nurses and patients to collect data,followed by statistical analysis andacomparativestudy betweentheBPI and NRS.Research HypothesisBPI assessespost-operative breast cancer painin Saudi Arabianpatientsmoreaccurately than NRS.Null hypothesisThere is no significant difference between BPI and NRSas tools forassessing post-operative breast cancer paininSaudi ArabianpatientsBackgroundPain is defined asthe normal, predicted physiological response to an adverse chemical, thermal or mechanical stimulus related with surgery, trauma or stabbing illness (Carr and Goudas, 1999).Pain assessment is a crucial component for the effective management of post-operative pain in relation to breast cancer. The patients composition is the mainresourceof informationregarding thecharacterisation and evaluation of pain as such, assessment isthe dynamic method of explanation of the syndrome of the pain, patho-physiol ogy andthe basis fordesigning a communications protocol for its management(Yomiya, 2011). A recent surveyquestioned almost 900 physicians897 and foundthat76% reported substandardpain assessmentproceduresas the single most primary(a)(prenominal) barriertosuitablepain management (Roennet al, 1993).Breast cancer is characterized byalump or thickening inthebreast, discharge or bleeding,achange in colour oftheareola, redness or pitting of skinand amarble like area undertheskin (WebMD, 2014A1). Breast cancerhas a high prevalence rate globally and is the second most diagnosed cancer in women. Approximately1.7 million cases were reported in 2012alone(WCRFI, 2014). In 2014,just over15,000womenhavealreadybeendiagnosed with breast cancer this figure is predicted to rise to around 17,200 in 2020 Breast cancerhas also been identifiedas one of the major cancer related problems in Saudi Arabia, with 6,922 women wereassessedA2for breast cancer between 2001-2008 (Alghamdi,2013A3).DPain assessment toolsPolitet al(2006) conducteda taxonomic review of the evidence baseandrecorded a total of80 different assessment tools thatcontainedat least one pain item. Thetools were thencategorized into pain tools(n=48)and viridity symptoms tools(n=32) . They were thenseparated into uni-dimensionaltools(which measure the pain enduringness)and multi-dimensional tools( allow in more than one pain dimension). 33%of all pain tools(n=16) were uni-dimensional, and50% of allgeneral symptom tools(n=16)were uni-dimensional. 58% of the uni-dimensional toolsemployedsingleitem surpasss such astheVisualAnalogueScale (VAS), Verbal Rating Scales (VRS)and NRS (NumericalRatingScale). The most common dimensionincludedwas pain intensity, present in 60% oftools. Inthe assessed tools, 60% assessed painin amulti-dimensionalformat. Amongpain tools,67% were foundto bemulti-dimensionalcompared with 50% of the general symptom tools.38% of all multi-dimensional tools were two-dimensional.The mostcommonly useddimen sion wasintensity,presentin 75% ofallmulti-dimensional tools. former(a) commondimensionsinclude baulk, locationand beliefs. All the dimensions were specifically targeted by two particular tools which were disease-specific tools and tools that measure pains affect, beliefs, and coping-relatedissuesA4.Multidimensional Pain assessment toolsFThe capable measurement of painrequiresmore than one tool. Melzack and Casey (1968)highlight thatpain assessmentshould include three dimensions which are sensory-discriminative, motivational-affective and cognitive-evaluative.This builds on theearlierproposal ofBeecher (1959)who considered that all tools should include thetwo dimensionsofpain and reaction to pain. Cleeland (1989)considered thatthetwo dimensionsshould be classifiedas sensory and thermolabile. Sensory dimensionsshould recordthe intensity or severityof painand the reactive dimensions should include accurate measures of interferencein thedaily functionof the patient.Multi-dimensional p ain assessments generally consist ofsixdimensions physiologic, sensory, affective, cognitive, behavioural and sociocultural (McGuire, 1992). Cleeland (1989)interviewed patients andfoundthatseven items could efficaciously measure the intensity and effects of the pain in daily activities thesecompriseofgeneral activity, walking, work, mood, enjoyment of conduct, relations with others and sleep. These elements were later subdividedinto two groups REM(relations with others, enjoyment of life and mood) andWAW(walking, general activity and work). Later, Cleelandet al(1996) developedtheBriefPainInventory (BPI) in bothitsshort and long form.It was designedto capture twocategoriesof interference such asactivity and affect onemotions.TheBPI providesa relativelyquick and easy methodof measuringtheintensityof painand thelevel ofinterferencein thedaily activities of thesufferer.With the BPItool, patients are gradedona 0-10 and itwasspecificallydesignedfor theassessment ofcancer related pain. P atientsareasked about the intensity of the pain that they are experiencing at present, as well as the pain intensity overthe last 24 hours astheworst, leastoraveragepain (alsoon a scale of 0-10). Eachscale is boundby the words no pain(0) andpain as uncollectible as you can imagine(10). Patients are alsorequestedto rate the degree to which pain interfereswith theirdaily activities within the sevendomainson a scale of 0-10.that comprise general activity, walking, mood, sleep, work, relations with other persons, and enjoyment of life using similar scales of 0 to10A5. These scales are only confined by the words does non interfere and interferescompletelyA6 (Tanet al, 2004).Validation of BPI across the world among the different language people has already been justified.A7Additionally, the localization of the pain in the bodycould beA8assessed and exposit of current medication are assessed (Caraceniet al, 1996).Uni-dimensional pain assessment toolPrevious studieshaveshownthattheNumeri calRatingScale (NRS) had the power to assess pain intensity for patientsexperiencing chronic pain and was also an effective assessment tool for patients with cancer related pain. TheNRS consists of a numerical scale range between 0-100 where 0 was considered as one extreme point represented no pain and 100 was considered other extreme point which represented bad/ worse pain(Jensen et al, 1986). Turket al(1993) developedan11 pointNRS (scale 0-10) where 0 equalledno pain and 10equalledworst pain. Though cancer pain differs from acute, postoperative and chronicpain experiences, the most common feature is its subjective nature. A9In this regard a consensus meeting on cancer pain assessment and classification was held in Italy in 2009with the pass thatpain intensity should be measuredon ascaleof0-10 withno painandpain as bad as you canimagineA10(Hjermstadet al.,2011). Krebset al.(2007) categorized NRS scores as mild (13), agree (46), or severe (710). A rating of4 or 5isthe most commonly recommended lower ascertainfor moderate pain and 7 or 8 for severe pain. Aimed at moderate pain assessment,For the purpose of clinical and administrative use therecommendation for moderate pain assessment on the scale is a score of 4.Importance of post- operative pain assessmentPost-operative painsisvery common after surgeryandtheuse ofmedicationoftendependson the intensity of painthat the patient is experiencing(Chunget al, 1997). Insufficient assessment of post-operative paincan have asignificant prejudiciouseffect on raised levels of anxiety, sleep disturbance, restlessness, irritability, aggression, distress and suffering(Carret al,2005). Additionalphysiologicaleffects can includeincreasedblood pressure, vomiting and paralytic ileus, increased adrenaline production, sleep vein thrombosis and pulmonary embolus (Macintyre and Ready, 2002). Effective post-operative pain assessment ensures better pain managementand can significantly reduce the stake of the symptoms listed above , giving minimal distress or sufferingto patientsand reducingpotential complications (Machintosh, 2007).ReferencesAlghamdi IG, Hussain II, Alhamdi MS, El-Sheemy MA (2013) Arabia an observational descriptive epidemiological analysis of data from Saudi malignant neoplastic disease Registry 2001-2008. Dovepress. Breast cancer Targets and therapy 5 103-109.Caraceni A, Mendoza TR, Mencaglia E (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain 65 87-92.Carr D and Goudas L. C. (1999) Acute pain. Lancet 353, 2051-2058.Carr EC, Thomas NV, Wilson-Barnet J (2005) Patient experiences of anxiety, depression and acute pain after surgery a longitudinal perspective. outside(a) Journal of Nursing Studies. 42(5) 521-530.Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anaesthesia and Analgesia 85 808-816.Cleeland CS (1989) Measurement of pain by subjective report. Issues in pain measurement. Ne w York Raven Press pp. 391-403.Cleeland CS, Nakamura Y, Mendoza TR, Edwards KR, Douglas J, Serlin RC (1996) Dimensions of the impact of cancer pain in a four country sample new information from four-dimensional scaling. Pain 67 (2-3) 267-273.Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S (2011) Studies comparing numerical rating scale, verbal rating scale and visual analogue scales for assessment of pain intensity in adults a systematic literature review. 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Springfield IL Thomas pp. 423-439.National Breast Cancer Foundation (NBCF) 2014http//www.nbcf.org.au/Research/About-Breast-Cancer.aspxPolit JCHC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, Conno FD, Forbes K, Furst CJ, Radbruch L, Kaasa S (2006) Pain assessment tools Is the study appropriate for use in palliative care? Journal of pain and symptom management, 32 (6) 567-580.Roenn JHV, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ (1993) Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Annals of Internal Medicine, 119(2) 121-126.Tan G, Jensen MP , Thornby JI, Shanti BF (2004) Validation of the brief pain inventory for chronic non-malignant pain. The Journal of Pain. 5(2) 133-137.Turk DC, Rudy TE, Sorkin BA (1993) Neglected topics in chronic pain treatment outcome studies determination of success. Pain (53)316.WebMD (2014)http//www.webmd.com/breast-cancer/guide/overview-breast-cancer.World cancer research fund international (WCRFI) 2014http//www.wcrf.org/cancer_statistics/data_specific_cancers/breast_cancer_statistics.php.Youmiya K (2011) Cancer pain assessment. The Japanese Journal of Anesthesiology. 60(9) 1046-1052.A1I would consider using a more reputable source for describing medical symptoms themselves (Greys Anatomy, WHO guidelines etc)A2and treated?A3Is it worth commenting that breast cancer reporting rates in SA might be different from actual prevalence? Lack of awareness regarding certain cancers often results in late diagnosing or misdiagnosis.A4This sentence is unclear. I am assuming that you are stating that all dimensions are present in two particular tools?A5Ive deleted this as you have highlighted the analogous domains in the previous paragraph and the reader will already be familiar with this term.A6Sentence shows up on copyscape / turnitin but its fine as a directly referenced quote.A7Is this sentence stating that the BPIs valid internationally because it has been adjusted culturally / linguistically for all groups?A8Are you making a suggestion that it could be assessed, or stating that sometimes people do assess localised pain in the body?A9Deleted as the next sentence deals with this already.A10Again shows up in turnitin any quotes must be in inverted commas so that tutors / markers will not downgrade or suspect plagiarism.