Clinical Meaning of Visual Analog Scales(VAS) for Teenage Pediatric Patients Undergoing Laparoscopic Surgical Procedures
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Observational

Summary: 
      The purpose of this study is to find a more accurate postoperative pain assessment for
      teenager patients. This is important because a patient should not have a very strong pain
      medication such as morphine if the pain is just mild.
    

Detailed description: 
      Pain is a sensory and emotional experience, modified by multiple factors, including meaning,
      context, previous pain experience, culture, gender, expectation, anxiety, depression, fear,
      family and social factors. Hospitalized teenager patients (11-18 years) admitted to surgical
      services experience high prevalence of moderate and severe pain.1 The VAS (Visual Analog
      Scale, 0 mm "no pain", to 100 mm," the worst pain possible ") is used to assess postoperative
      pain for teenager patients. The reliability and validity of this scale was proven but
      clinical significance of VAS pain score is not clear. 2 There is an increased focus on very
      good pain control and is a common practice that patients with moderate or severe pain scores
      (numeric rating score, more than 4) to receive opioid pain medication 3, regardless of pain
      behavior or health care providers' input , and this can result in various side effects.
      Pediatric nurses administer more pain medications to the children who vocalize their pain. 4
      Numerous clinical trials of postoperative pain treatment in teenager use only VAS pain scores
      to assess the effectiveness of a studied pain medication.

      Although the treatment of pain may be a basic human right, that does not mean that all
      teenager patients require opioids administration if they report high pain scores. It is our
      observation that teenager's pain behavior does not always correlate with the magnitude of
      reported pain scores by the patient and different caregivers. Concomitant parental and nurse
      observation of teenager's pain behavior can provide additional information about pain
      severity. Minimal correlation between VAS pain scores reported by teenager and caregivers
      does not mean that pain severity is "unreal". Perioperative teenager's pain catastrophizing
      thoughts about pain, anxiety, and mood level can influence teenager's postoperative pain
      scores.

      The authors aim is to develop a multi-modal assessment of postoperative pain for the teenager
      patient, using VAS pain scores reported by the teenager, nurse, and parent in association
      with the teenager's postoperative pain behavior, pain catastrophizing thinking, anxiety, and
      mood level. The subjects included in this study will be 206 teenager patients (11-17 years
      old) undergoing any laparoscopic surgical procedures. On postoperative day 1, the teenager
      will complete the following questionnaires: Visual Analog Scale from teenager (VAS teen),
      State-Trait Anxiety Inventory for Children (STAIC S - Anxiety), Pain Catastrophizing Scale
      for Children (PCS-C) and Brief Mood Introspection Scale (BMIS). The nurse taking care of the
      patient and one parent, preferable the mother, will complete the following questionnaires:
      Visual Analog Scale from parent (VAS p), Visual Analog Scale from nurse (VAS n), and
      Adolescent Pain Behavior Questionnaire from parent (APBQ-p), Adolescent Pain Behavior
      Questionnaire from nurse (APBQ-n). The main goal is to determine if VAS score reported by the
      teenager correlates with VAS scores reported by the parent and nurse, and with pain behavior
      scores reported by the nurse and family. Expected correlation is minimal (0.23-0.29) to
      moderate (0.3-0.49). Our second goal is to determine whether postoperative pain is associated
      with psychosocial factors such as teenager catastrophizing attention to pain, anxiety, and
      mood level. Expected correlation between postoperative VAS teen and teenager catastrophizing
      attention to pain, anxiety, and mood level is moderate (0.3-0.49) to high (>/=0.5).

      To our knowledge, this is the first study to investigate all these variables together to
      assess postoperative pain for a teenager patient. The findings of this study may influence
      the medical decisions regarding administration of pain medication, allow for a safer and more
      effective use of opioids in postoperative period and would be very helpful for clinical and
      research practice.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        The participants will be selected based on medical records review and medical interview on
        the day of surgery: we plan to enroll 206 teenager patients (11-17 years old) with
        anticipated postoperative pain after any laparoscopic procedure and their parents and
        nurses.
      
Keywords: laparoscopic surgery; teenager