Pain characteristics in patients with unexplained chest pain and patients with ischemic heart disease.
ABSTRACT Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain.
The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain.
A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter.
The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001).
Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles.
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ABSTRACT: The McGill Pain Questionnaire (MPQ) provides a quantitative profile of 3 major psychologic dimensions of pain: sensory-discriminative, motivational-affective, and cognitive-evaluative. Although the MPQ is frequently used as a pain measurement tool, no studies to date have compared the characteristics of chronic post-surgical pain after different surgical procedures using a quantitative scoring method. Three separate questionnaire surveys were administered to patients who had undergone surgery at different time points between 1990 and 2000. Surgical procedures selected were mastectomy (n = 511 patients), inguinal hernia repair (n = 351 patients), and cardiac surgery via a central chest wound with or without saphenous vein harvesting (n = 1348 patients). A standard questionnaire format with the MPQ was used for each survey. The IASP definition of chronic pain, continuously or intermittently for longer than 3 months, was used with other criteria for pain location. The type of chronic pain was compared between the surgical populations using 3 different analytical methods: the Pain Rating Intensity score using scale values, (PRI-S); the Pain Rating Intensity using weighted rank values multiplied by scale value (PRI-R); and number of words chosen (NWC). The prevalence of chronic pain after mastectomy, inguinal herniorrhaphy, and median sternotomy with or without saphenectomy was 43%, 30%, and 39% respectively. Chronic pain most frequently reported was sensory-discriminative in quality with similar proportions across different surgical sites. Average PRI-S values after mastectomy, hernia repair, sternotomy (without postoperative anginal symptoms), and saphenectomy were 14.06, 13.00, 12.03, and 8.06 respectively. Analysis was conducted on cardiac patients who reported anginal symptoms with chronic post-surgical pain (PRI-S value 14.28). Patients with moderate and severe pain were more likely to choose more than 10 pain descriptors, regardless of the operative site (P < 0.05). The prevalence and characteristics of chronic pain was remarkably similar across different operative groups. This study is the first to quantitatively compare chronic post-surgical pain using similar methodologies in heterogeneous post-surgical populations.Clinical Journal of Pain 01/2004; 20(2):70-5. · 2.55 Impact Factor
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ABSTRACT: A self-administered pain assessment tool called the Pain-O-Meter (POM) was developed for the purposes of improving assessment and management of pain in acute and chronic pain patients. The POM is a hard, white, plastic tool that measures 8-in. long by 2-in. wide and 1-in. thick. Two methods for assessing pain are located on the POM. The first is a 10-cm visual analogue scale (POM-VAS) with a moveable marker that patients use to rate their pain. The second is a list of 15 sensory and 11 affective word descriptors (WDS). Each WDS is assigned an intensity value that can be as low as 1 or as high as 5. A pain intensity score is provided for the sensory and the affective WDSs. This psychometric study, which employed correlational and comparative designs, investigated the test-retest reliability and the concurrent and construct validity of the POM-VAS and the POM-WDS in 279 patients with acute or chronic pain. High correlations were found between initial and repeat pain intensity ratings on the POM-VAS (r = 0.88, P < 0.001) and POM-WDS (r + 0.84, P < 0.001) (test-retest reliability). Correlations between the POM-WDS and the McGill Pain Questionnaire (MPQ) (r = 0.69, P < 0.001) and POM-VAS (r = 0.85, P < 0.001) supported the concurrent validity of the POM-WDS. Construct validity was also supported for the Pain-O-Meter by showing that pain scores decreased significantly for POM-WDS (t + 5.53, P < 0.001), and POM-VAS (t = 6.18, P < 0.001) after the patients were treated with pain medication. The use of a pain tool, such as the POM, could improve patient care by facilitating the documentation of pain and evaluation of pain relief measures.Journal of Pain and Symptom Management 10/1996; 12(3):172-81. · 2.60 Impact Factor
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ABSTRACT: The aim of this research was to describe men and women who were discharged from the emergency department after having an initial suspicion of acute myocardial infarction ruled out in terms of patient characteristics, symptom reevaluation, electrocardiogram and exercise stress test. Consecutive patients below the age of 65 years who came to the emergency department of Sahlgrenska Hospital with acute chest pain or other symptoms raising suspicion of acute myocardial infarction for whom the suspicion was ruled out either directly in the emergency department or less than 1 day after hospital admission were included in the study. Four hundred and eighty-four patients participated, of whom 295 (61%) were men. Men had a higher prevalence of ischaemic heart disease. The cause of pain was judged similarly at reevaluation compared with in the emergency department in 53% of the cases. Only in 4.6% of the cases were the symptoms judged to be caused by myocardial ischaemia on both occasions. At the initial visit 36.0% of the patients were judged to have uncertain cause of the symptoms. This proportion was lowered to 26.4% at reevaluation. The exercise electrocardiogram at reevaluation revealed clinical and electrocardiographic signs indicating definite myocardial ischaemia in 2.6% of the cases. Early follow-up of patients discharged from the emergency department after acute myocardial infarction was ruled out revealed that a low proportion showed signs of myocardial ischaemia. In about half of the cases the judgement differed from that being made in the emergency department.European Journal of Emergency Medicine 07/1997; 4(2):72-80. · 1.02 Impact Factor