Wednesday, January 16, 2013

Standardizing Pain Management - Penn Nursing Science

Based on the compelling need to provide a "Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors and their Families," a 22-member task force commissioned by the Office of The Army Surgeon General generated a comprehensive report to address pain among military service members and Veterans.
This report underscored the importance of a consistent way to measure pain across transitions of care within military and Veterans Administration Healthcare (VHA) systems. The Army Pain Management Task Force developed a new integrated pain rating scale – the Defense and Veterans Pain Rating Scale (DVPRS).

Rosemary Polomano, PhD, RN, FAAN, associate professor of pain practice at the University of Pennsylvania School of Nursing, collaborated with Army Pain Management Task Force leaders, COL Chester C. Buckenmaier III, MD (Director of the Defense and Veterans Center for Integrative Pain Management), COL Kevin T. Galloway, BSN, MHA (Office of the Army Surgeon General) and Rollin M. Gallagher, MD, MPH (Philadelphia Veterans Administration Medical Center) to conduct initial psychometric testing of the DVPRS in 350 inpatient and outpatient active duty or retired military service members at the former Walter Reed Army Medical Center, Washington, DC. The sample included patients who were hospitalized across seven units, two medical and five surgical. The study was recently published ahead of print in Pain Medicine, the official journal of the American Academy of Pain Medicine.  

"Preliminary data from the first phase of testing for the DVPRS demonstrated acceptable reliability and validity," said Dr. Polomano. " This scale has important implications for standardizing pain assessment practices throughout military and veteran healthcare settings, improving screening practices to identify risk for pain-related issues and, providing a minimum set of patient-reported outcomes for communication and documentation across transitions of care."

Researchers utilized the standard numeric rating scale (NRS), an 11-point, 0-10 rating system and enhanced it with visual cues and word descriptors. "Traffic light" color coding was added to signify mild (1-4, coded in green), moderate (5-6, coded in yellow), and severe (7-10, coded in red) pain. Word descriptions, such as no pain (0), interrupts some activity (5), and as bad as it could be, nothing else matters (10) were added to promote a standard meaning for each numeric rating of pain. These additions allow more consistent interpretations by healthcare providers and patients. 
Supplemental questions were also added to the DVPRS to gauge the impact of acute and chronic pain on daily life such as: general activity, sleep, mood, and stress levels. The supplemental questions along with the numeric DVPRS scale encourage clinician-patient discussions about pain, its different dimensions and comorbidities, and help guide further evaluation and personalized treatment plans with the patient, researchers noted.  
"Perhaps the most important aspect of the DVPRS and its proposed general adoption by the DoD and VHA in the future is the consistency of data that standardization of "pain questions" brings to integrated electronic health records. A uniform minimum pain data set would allow comparisons and outcomes tracking currently not possible with existing clinical pain assessment practices," said Dr. Polomano. " Additionally, the DVPRS scale as designed contains essential information that is applicable to all patients and healthcare providers across all settings throughout the military and VHA systems, from point of injury or disease throughout rehabilitation and recovery, and into primary and specialty routine care."