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NTIS 바로가기Annales françaises d'anesthésie et de réanimation, v.17 no.6, 1998년, pp.555 - 572
Benhamou, D
AbstractPain is a subjective feeling; its assessment is therefore difficult, and no “gold standard” method exists for humans. Major improvements have, however, been made in the last decade by widespread acceptation of the concept of pain evaluation and widespread use on surgical ward...
RésuméBien que la mesure de la douleur, phénomène subjectif, soit difficile et qu'il n'existe pas de méthode clinique de référence, des progrès majeurs ont été réalisés au cours des dernières années par l'acceptation, dans de nombreux établissements de soins, du concept de mesure en routine de la douleur postopératoire. L'auto-évaluation par le patient lui-même est la règle chaque fois que possible, car l'hétéro-évaluation par le personnel soignant conduit à une sous-estimation. Cette sous-estimation existe également lorsque l'hétéro-évaluation utilise une échelle systématisée, telle que l'échelle comportementale développée par Boureau. Il est théoriquement souhaitable d'évaluer non seulement l'intensité de la douleur, mais également les autres composantes telles que la localisation, le retentissement affectif et émotionnel, le type de douleur. En pratique, les échelles permettant d'évaluer ces différentes composantes sont trop complexes pour une mise en ˦uvre chez tous les opérés et plusieurs fois par jour. Ainsi, le Mac Gill Pain Questionnaire ne peut-il être utilisé dans le contexte postopératoire en dehors de la recherche clinique. Par ailleurs, sa validation scientifique, bien que considérée comme obtenue par de nombreux auteurs, est en réalité soutenue par peu de preuves méthodologiques. Ainsi, seules les méthodes décrivant uniquement l'intensité de la douleur sont-elles utilisées en pratique clinique. L'échelle verbale simple (EVS), l'échelle numérique simple (ENS) et l'échelle visuelle analogique (EVA) sont préférées par un nombre croissant d'auteurs. Malgré la difficulté de la validation scientifique, il semble que l'EVA soit la plus sensible et la plus reproductible. La mesure de l'intensité de la douleur postopératoire doit être réalisée plusieurs fois par jour, au repos et en conditions dynamiques (toux, mouvement) et doit concerner plutôt la douleur du moment présent que celle des heures précédentes.
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