Validation of three pain scales among adult postoperative patients in Ghana

Lydia Aziato, Florence Dedey, Kissinger Marfo, James Avoka Asamani, Joe Nat A. Clegg-Lamptey

Pain assessment is an important component of pain management and health professionals require valid tools to assess pain to guide their pain management decisions. The study sought to select, develop, and validate context-appropriate unidimensional pain scales for pain assessment among adult post-operative patients. A mixed methods design was adopted. The study was conducted at two hospitals in Accra, Ghana. The qualitative phase involved 17 patients and 25 nurses, and the quantitative phase involved 150 post-operative patients. Qualitative data was collected iteratively through individual interviews and focus groups. Two existing pain scales (0-10 Numeric Rating Scale [NRS] and Wong-Baker FACES [FPS] scales) and one new pain scale (Colour-Circle Pain Scale-[CCPS]) were validated. The psychometric properties of the three scales were assessed when patients had fully recovered from anesthesia. The CCPS had higher scale preference than NRS and FPS. Convergent validity was very good and significant (0.70-0.75). Inter-rater reliability was high (0.923-0.928) and all the scales were sensitive to change in the intensity or level of pain experienced before and after analgesia such as paracetamol and diclofenac suppositories, injectable pethidine, and oral tramadol had been administered. Using a valid tool for pain assessment gives the clinician an objective criterion for pain management. Due to the subjective nature of pain, consideration of socio-cultural factors for the particular context ensures that the appropriate tool is used.