Wang Wengang: Guan ZhonganShandong University of Traditional Chinese Medicine Ji'nan 250014The Affiliated Hospital of Shandong University of
Wang Wengang: Guan Zhongan
Shandong University of Traditional Chinese Medicine Ji'nan 250014
The Affiliated Hospital of Shandong University of Traditional Chinese Medicine Ji'nan 250014
[Key words] Anorectal Postoperative Pain Assessment
Anorectal Postoperative pain patients each surgery and clinical workers must face the problem, which not only bring different degrees of damage in patients with physical, mental and psychological, but also is the main cause of urinary retention, constipation and other complications caused by postoperative rehabilitation and quality of life in patients with  after surgery. Pain assessment is clinical workers take the necessary steps to effective pain management, only the objective and accurate assessment of pain, in order to guide the clinical take corresponding measures to control pain, relieve the pain of patients, reduce the incidence of postoperative complications. The evaluation method of pain after anorectal operation there is no uniform standard, in recent years the anorectal surgery department and related literature data on postoperative pain assessment are as follows:
1 pain assessment methods
The use of various methods to quantify postoperative pain is a common clinical and scientific research methods.
1.1 pain visual analogue scale (visual analogue scale, VAS)
As a horizontal line or 10cm long vertical line ends were marked "no pain" and "the worst pain", online marked on the most representative of the pain intensity, measuring 0 to mark the distance is the pain intensity score. VAS is a simple and effective method of measurement, but it requires abstract thinking and necessary sensory, motor and perceptual abilities.
1.2 word description scale  (verbal descriptor/rating scale, VDS/VRS)
The pain is divided into several grades by a series of descriptive adjectives, which can be used to assess the degree of pain. VRS is easy to be understood by patients, but the accuracy is not enough, it is difficult for patients to find out the corresponding degree of pain. The method is simple and easy to understand, but it is not suitable for scientific research.
1.2.1 grade four (VRS - 4): Painless (0 points); mild pain (score of 1); moderate pain (score of 2); severe pain (score).
1.2.2 grade five (VRS - 5): mild pain (1 points); moderate pain (score of 2); severe pain (score of 3); severe pain (score of 4); intolerable pain (score).
1.2.3 six grade score (VRS - 6)  (0): painless; slight pain (1 points); moderate pain (2 points); discomfort (3 points); the terrible pain (4 points); unbearable pain (5 points). Or with the following description: Painless (0 points); mild pain, only pay attention to when (1 points); in pain, do not pay attention to the lack of pain; pain (2 points), but normal activities are not limited (3 points); strong pain, can only do simple things, can't concentrate (4 points); very painful, can not do anything (5 points).
1.3 digital pain classification (numerical rating scale, NRS)
The expression method of digital, 0 as painless, 10 is the most severe pain for patients to circle one of the most representative of the pain level number, is a simple and effective evaluation method, the advantages of VAS method is more intuitive, the disadvantage is education more difficult, prone to bias the evaluation results.
1.4 the Changhai pain rating scale evaluation method 
Combined with NRS-10 and VRS-5 to develop a pain assessment method, using VRS to explain and define the scale of NRS. Easy for patients to understand, easy to teach, evaluation results will not appear greater error.
1.5  five fingering
To show with fingers, the little finger (painless); ring finger (mild pain); middle finger (moderate pain); index finger (severe pain); thumb (pain). The assessment of pain assessment Wuzhi pain intensity and is easy to accept patients with fast, wide application range. However, the sample size limit needs further study.
1.6 behavioral assessment
A method for quantitative assessment of behavioral changes in pain and pain. Is the six common behavior score (BRS - 6) : the pain is divided into 6 levels: no pain (1 points); there is pain but often overlooked (2 points); the pain can not be ignored, do not interfere with daily life (3 points); the pain can not be ignored, distract (4 points); have pain, can not be ignored, all daily activities are affected, but can meet the basic physiological needs, such as eating and defecation (5 points); there is severe pain, can not be ignored, all daily activities are affected by the need to rest, and rest in bed (6 points). This method is used to express the intensity of pain, including pain intensity and pain caused by behavioral changes, there is a certain degree of objectivity, easy to understand, suitable for comparative study and follow-up work. The other is , which can only be used for quantitative determination of the behavior changes caused by pain, which can be used as a reference index for the evaluation of pain. This scoring method is based on the degree of pain behavior and the time to do three grades: No 0, 1/2 occasionally, the number of 1. The total score of the behavioral indicators of the patients was the score of pain behavior. There are 6 main aspects: the reflection of pain behavior; the spontaneous reaction; the functional limitations and dysfunction; attitude and frequency of medication patients; the hope to arouse the attention of the act; the changes in sleep habits.
1.7 facial expression scale
It is a series of progressive facial expressions of pain, and the subjects have a good reliability and validity. This method is suitable for any age, there is no specific cultural background or gender requirements, easy to grasp, acute pain, children, the elderly, the loss of language skills are particularly applicable. The most commonly used include:
1.7.1 facial pain scale (face pain scale, FPS) : using facial expressions to show varying degrees of pain, patients were selected from the level of pain consistent with their expression to assess the degree of pain. FPS can be made up of 6, 7 and 9 facial expressions. The revised version of the facial expression scale (faces, FPS-R) and FPS (McGrath) facial expressions composed of 9 facial expressions are commonly used in the present study, consisting of 6 facial expressions.
1.7.2 Wong-Baker facial pain rating scale (Wong-Baker faces pain rating scale ): very happy, no pain (0 points); a little pain (1 points); slight pain (2 points); obvious pain (3 points); severe pain (4 points); severe pain, but not a cry (5 points).
1.8 questionnaire evaluation
Ignoring the assessment of the patient's physiology, action and function will lead to the lack of assessment of pain in patients with . Therefore, the majority of researchers tend to use a variety of evaluation methods together with the questionnaire evaluation method, can be relatively accurate and comprehensive assessment of postoperative pain and pain. But this kind of assessment form is relatively complex, and it requires a high level of assessment and patients. Common there:
1.8.1 McGill pain questionnaire (McGill pain question-naire, MPQ) : to assess the emotional and sensory aspects of pain and pain of the site, intensity, time characteristics, etc.. In addition to the pain profile, it also includes the assessment of the spatial distribution of pain distribution and the measurement of PPI (present pain intensity). The pain intensity measurement is a kind of from 0 to 5, followed by the use of painless or mild discomfort, pain, fear and pain of the words to describe the pain scale.
1.8.2 simplified McGill pain questionnaire (Short-from of McGill pain Questionnaire, SF-MPQ):  is based on MPQ to simplify. To know the pain of patients with valuation table, it will pain said with visual intuitive pain scale, pain and pain of the recording portion of time, nature, and measures to relieve pain pain on the patient's appetite, sleep, attention, emotional and social activities influence.
1.8.3 pain questionnaire (the brief pain simple inventory, BPI) : the expression of pain intensity in the patients with NRS-10, 7 patients with pain interference problem description mood, work and life; the treatment degree of remission expressed as a percentage; with the graphical representation of the corresponding pain etc..
1.8.4 Memorial card (the Me-morial pain assessment, MPAC) : is a simple pain assessment card, not only to assess the intensity of pain, but also to assess the impact of emotional pain and treatment. There are 4 scales for assessing pain in the assessment card, the 1 one is the language description scale, and the other is the visual scale to assess the degree of pain, the degree of remission and the emotional state of the 3.
2 object evaluation method of pain 
Medical staff according to the patient's main narrative, facial expression, the evaluation of their own experience of pain, the degree of pain may be reached by various diseases to determine the degree of pain. The general description of the text, there is no relative range of the intensity of the pain, with the bias of the evaluators, the lack of accuracy, scientific, and can not quantify the intensity of pain.
3 reference indicators in pain assessment
3.1 physiological assessment
The degree of pain was assessed by changes in the physiological function of pain caused by non - autonomy. Pain often causes heart rate, pulse, blood pressure, respiratory rate, sweating, electrical activity of the skin, electromyography, neuroendocrine and other physiological changes , which can be based on the assessment of pain. However, there are too many factors, no specificity, often not accurate enough, can be used as a reference index to determine the degree of pain in patients with .
3.2 pain threshold assessment 
The pain threshold is different because of individual differences, the assessment of pain for the determination of the threshold can be. Pain threshold measurement includes the determination of pain threshold and pain tolerance threshold. Any noxious stimuli can cause pain, can use a variety of different stimuli such as determination of pain threshold, mechanical stimulation, electrical stimulation and thermal stimulation. Study on the anorectal postoperative pain related pain assessment is still blank. Should know to accurately grasp the patient's pain threshold assessment process pain in anorectal surgery, a measure repeatedly applied to the assessment, contribute to the assessment of pain intensity objectively and accurately and quickly determine the intensity of pain, is an important reference index.
In summary, the anorectal postoperative pain assessment of the various methods have advantages and disadvantages, from the nature of pain after anorectal operation, pain assessment of the subject method is the preferred method for most clinical workers. Anorectal Postoperative pain is influenced by many factors, the main purpose is to understand the pain assessment in patients with the degree of pain, so as to develop effective measures to alleviate the pain. Methods of pain assessment still focuses on the subjective feelings of the patients, its accuracy is influenced by the impact of the patients, how to find a more objective, reliable and effective assessment method, repeated use is still facing clinical and scientific research tasks. In the assessment of pain in the comprehensive consideration of all aspects of the factors is necessary, the assessment of pain intensity and pain threshold of individual links, fully used in clinical and scientific research, to make an objective assessment of the dynamic before and after anorectal surgery for treatment of pain intensity, a research direction for Anorectal Postoperative Pain assessment the.
1 Li Licheng, Liu Ying. Evaluation of postoperative pain and analgesia nursing. Journal of Shenyang Medical College, 2010,12 (1): 57
2 Wu Yun, Lin Mei. Clinical evaluation of the degree of pain. International Journal of Stomatology, 2008,35:147
3 Tang Ke. Methods of measurement and evaluation of patient pain. Contemporary nurses, 2008,9:8
4 Zhao Cunfeng, Zhang Tingting, Lu Xiaoying, et al. Application of "Changhai pain scale" in pain assessment. Journal of nursing, 2003,20 (4): 6-7
5 Zhang Juying, Zou Ruifang, ye Wei. Application of Wuzhi method in pain intensity assessment. Chinese Journal of nursing, 2005,40 (6): 409
6 sun Fen. Assessment and nursing care of patients with postoperative pain. Journal of Bethune Military Medical College, 2010,8 (6): 466
7 Shen Ping, Shi Yi. With facial scale assessment of pain. Foreign medical nursing: 1998,17 (3): 127
8 Cui Jing, Zhang Yuanju, Zhao Jijun. Research progress on the evaluation of pain in others and the deviation of actual pain in patients. Shanghai nursing, 2009, 9 (): 67-68
The 9 generation Yuee, Interfax Bing, Liu Hui. Progress in pain assessment and treatment of the elderly. Huaxi Medical 2009,24 (2): 518
10. Research progress of Zhao Jijun to Li Guo, pain assessment. Journal of nursing, 2008,15 (12): 9
11 Gu Xin, Tong Fang, Li Jingping, et al. Pain assessment. Modern rehabilitation, 2000,4 (1): 86
12 Zhao Ying. Methods of measurement and evaluation of pain. Chinese Journal of clinical rehabilitation, 2002,6 (16): 2348
13 Jin. Factors influencing postoperative pain assessment and countermeasures. Modern nursing, 2002, (10): 783