Abstracts The Journal of Pain S5

(116) Pain intensity in hospitalized children in CanadaB Stevens, J Yamada, J Stinson, and C Team; In Children’s Pain, Hospital for SickChildren Toronto, Ontario, Canada

Pain assessment is routinelymandated using validatedmeasures by pain guide-lines for hospitalized children as a basis for pain prevention and management.However, the overall pain intensity of hospitalized children is unknown. Thegoal was to determine pain intensity across pediatric hospital settings in Can-ada. Pain intensity scores were collected during a 24-hour period by chart re-view from 3822 children aged 0-18 years hospitalized on 32 inpatient units in8 pediatric hospitals. Pain was assessed at least once within the 24 hours for2615/3822 (68.4%) of children; however, only 28% had pain assessed usinga validated pain measure. The mean standardized pain intensity score was2.56/10 (SD 2.78) representing mild pain intensity; 42% (n= 455) had no pain(0 out of 10), 25% (n = 263) had mild pain (1 to 3 out of 10), 22% (n=238)had moderate pain (4 to 6 out of 10) and 11% (n=116) had severe pain (7 to10 out of 10). Similar results were foundwhen the unit of analysis was the num-ber of pain assessments documented: 41% (n = 2041) of pain assessment scoresindicated no pain (0 out of 10), 23 %(n=1140) of pain assessment scores werewithin the mild range (1 to 3 out of 10), 22 % (n=1105) within the moderaterange (4 to 6 out of 10) and 14 % (n=677) within the severe range (7 to 10out of 10). Despite the advances in the development of validated pain assess-ment measures and pain guidelines, two thirds of hospitalized children experi-ence pain, with one third having moderate or severe pain. Novel knowledgetranslation strategies are needed to reduce pain in hospitalized children. Sup-ported by the Canadian Institutes for Health Research (CIHR). (CTP-79854 andMOP-86605) .

(117) Attitudes and analgesic administration for children’spostoperative pain in English- and Spanish-speaking par-ents

M Fortier, S Gomez, E Maurer, S Zolghadr, and Z Kain; University ofCalifornia-Irvine, Orange, CA

Parents provide suboptimal analgesia following children’s surgery, often re-lated to misconceptions regarding analgesia. However, data regarding therole of ethnicity and language in this relationship are lacking. The purposeof this studywas to examine attitudes and analgesic administration in 3 groupsof parents: English-speaking White (ESW), English-speaking Hispanic (ESH),and Spanish-speaking Hispanic (SSH). A total of 288 parents of children ages0-18undergoingoutpatient surgeryparticipated. Parents completedameasureof attitudes regarding analgesic use for children and documented pain and an-algesic administration on postoperative days 1, 3, and 7. Analysis of variance(ANOVA) revealed demographic differences in income, and parent age and ed-ucation, which were controlled for in subsequent analyses. ANOVA demon-strated significant group differences in medication attitudes; SSH parentsreported more misconceptions than ESW (p = .001) and ESH (p = .001) parents.Hierarchical regressionmodels significantly predictedmedication doses admin-istered on days 1 (F(11,75)=3.55, p=.0005; R2=.34), 3 (F(11,85)=2.81, p=.004;R2=.27), and 7 (F(11,79)=4.09, p=.0001; R2=.36). In each model, SSH parents ad-ministered fewer doses of medication compared to ESH parents. In addition,there was a significant interaction between ethnicity/language and parentalattitudes on analgesia administered. Specifically, for ESH parents, fewer anal-gesic misconceptions were related to more doses and this relationship wasstronger for ESH parents than SSH parents. These findings illustrate not onlythat children whose parents endorse misconceptions regarding analgesic useare at risk for inadequate painmanagement at home but that children of Span-ish-speaking parents may be at even greater risk for under treatment of pain.

(118) A retrospective review of acupuncture use for the treat-ment of pain in sickle cell disease patients: a single insti-tution analysis

K Lu, M Cheng, A Berger, and M Caterina; National Institutes of Health,Bethesda, MD

Patients with sickle cell disease are frequently faced with acute and chronicpain as part of their illness. Often, opioidmedications are used as the sole treat-ment modality. There has been growing interest in the use of acupuncture fortreatment of a variety of pain disorders, and there are on- going clinical trialsevaluating its effectiveness. The usefulness of acupuncture for the treatment ofpain in the sickle cell population has been poorly described in the literature.This study reviews the use of acupuncture for sickle cell patients and describesseveral documented pain related outcomes. Between January, 2005 and Sep-tember, 2011, 48 sickle cell patients (39.5% male, median age 36 years) wereretrospectively identified for acupuncture treatment at the National Institutesof Health. The types of pain (acute or chronic), their sites of pain, self reportedpain score, and the use of pain medications pre- and post acupuncture treat-ment were analyzed. Description of whether acupuncture was ‘‘helpful’’ wasalso assessed in some of the patients. To our knowledge, this is the largest ret-rospective review of acupuncture use in the sickle cell population. This analysiscalls for the need formore systematic way of evaluating pain in this group. Fur-ther randomized control trials are needed to assess the effectiveness of acu-puncture for treatment of pain and whether the use of acupuncture may beefficacious in conjunction with pharmacological interventions or as an alterna-tive therapy for pain in the sickle cell population.

(119) Assessing the stability of self-report and physical exami-nation measures in chronic pain over 8 weeks

C Kemp, B Theodore, H Wilson, J Robinson, and D Turk; University ofWashington, Seattle, WA

Pain, mood, and physical function are routinely used as outcomes to evaluatethe efficacy of treatments for chronic pain. The stability of instruments used toassess these outcomes is essential as lack of consistency of the measure will in-hibit ability to attribute any changes observed to the treatment. There is no settime for the assessment of test-retest reliability of self-report measures, al-though this is most frequently measured between 1 day and 6 weeks apart.However, clinical trials are typically conducted between 6- 12 weeks. Knowl-edge of the stability of outcome measures over extended periods of time com-mensurate with the duration of a clinical trial will provide informationregarding spontaneous fluctuation in these measures attributable to randomerror. The purpose of this study was to assess the stability of several well-estab-lished instruments used in chronic pain trials over 8-weeks, namely, Multidi-mensional Pain Inventory Pain Severity Scale(MPI), Oswestry DisabilityIndex(ODI), Center for Epidemiological Studies Depression Scale(CESD), PainAnxiety Symptom Scale(PASS), State-Trait Anxiety Inventory(STAI), HospitalAnxiety and Depression Index(HADS), Pain Catastrophizing Scale(PCS), anda measure of self-efficacy pain, for a sample of fibromyalgia patients awaitingtreatment. Paired t-tests indicated allmeasureswere stable over the 8-weekpe-riod (all p values >0.05). The most stable measure was the ODI (r=0.92). In addi-tion, all psychosocial measures had large and significant test-retestcorrelations: HADS (r=0.81), PASS (r=0.76), PCS (r=0.76), CESD (r=0.72), STAI(r=0.68), and Self-Efficacy (r=0.63). Although highly correlated, pain severityshowed the lowest stability (r=0.61). The stability of themeasures over 8 weeksdemonstrates that fibromyalgia patients’ levels of pain, physical functioning,mood, and self-efficacy are relatively enduring. Moreover, the results supportthe use of these measures as outcomes in clinical trials of up to 2 months inlength.