Initial Study for the Definition in Heart Rate Changes in Response to Heat Pressure and Neural Stimulation

Background:

Pain Assessment:

Whereas temperature, pulse, respirations, and blood pressure are all objectively measured, pain is inherently subjective. Given this fundamental difficulty, it is no wonder that failure to properly assess pain is a common cause of its poor control and lack of treatment in patients in different settings (1). Moreover, pain is multidimensional, with "sensory-discriminatory, cognitive-evaluative, and affective-motivational" components (2), or in other words, it affects body, mind, and spirit, and its complexity makes it hard to measure (1). Since pain has been recognized as an important modality, influencing recovery and quality of life in patients, it has been termed "the fifth vital sign" and is now being evaluated and registered in the patients' charts during routine checkups. Pain itself is repeatedly rated by the patients and the caregivers or the medical personnel, it is followed and treated.

For routine standardization, pain is charted on a scale of 0(no pain) to 10 (worst pain possible). At pain intensities of 0 to 4 patients describe the interference with function as mild (as reflected in daily activities and mood), at 5 to 6 it is described as moderate, and at 7 to 10 as severe (2). For standard scaling, different assessment tools were developed. One-dimensional pain scales, in which the patient is asked to describe the intensity of pain, are the most used tool today (1). These are the VAS- Visual analog Score (e.g., the patient places a mark on a 10-cm line to indicate the intensity of pain; one end of the line is labeled "no pain" and the other "the worst possible pain"), the Numeric ("please rate the intensity of pain on a scale of 1 to 10") and the Categorical ("please rate the pain as none, mild, moderate, or severe"). These scales are reliable and valid and can be used in conjunction with the World Health Organization (WHO) analgesic ladder guideline. (3)

The one-dimensional intensity scales can be modified to produce a pain relief scale, a patient pain satisfaction scale, or a pain management index (4). Moreover, comprehensive multidimensional pain assessment tools such as the Brief Pain Inventory were developed to help pain management specialist's measure and assess the effect of pain on mood, activities, and quality of life-which one-dimensional tools cannot do. (2) These tools are more difficult for the patients and the medical personnel to complete and are usually not used in daily practice (1).