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THE ANGLE LABOR PAIN QUESTIONNAIRE: RELIABILITY OF PAIN RECALL FOLLOWING INITIATION OF EPIDURAL ANALGESIA
Abstract Number: T-29
Abstract Type: Original Research
INTRODUCTION: Severe pain is extremely difficult to assess during labor, making it desirable to conduct assessments after women have received pain relief. The reliability of retrospective pain assessments following epidural drug administration, however, is unknown. This study assessed the reliability of pain recall using the Angle Labor Pain Questionnaire (A-LPQ) following initiation of labor epidural analgesia.
METHODS: After REB approval and written informed consent, 44 women in early active labor were recruited. Women were fluent in English, >18 years of age, ≤6cm cervical dilatation and contracting ≥3 minutes apart without pain relief. The same trained interviewer administered the A-LPQ in mixed versus standard question order format during 2 test sessions. Test session 1 was administered just prior to epidural insertion; Test session 2 was initiated 20 minutes following the epidural test dose. Overall changes in pain were assessed using the Patient Global Impression of Change Scale (PGICS). Concurrent validity was assessed with overall pain intensity ratings based on an 11-point Numeric Rating Scale (NRS) and a Verbal Rating Scale (VRS) and for coping using the Pain Mastery Scale (PMS) for both test sessions.
RESULTS: Forty women were analysed; the majority (90%) reported moderate (21/39) or severe (14/39) pain at baseline. Most women (73%, 29/40) reported very much improved pain following epidural drug administration during Test 2. Recall reliability for A-LPQ summary scores was excellent (ICC 0.98, 95% CI 0.97, 0.99) and very good to excellent for subscales (Table 1). Cronbach’s alphas were ≥0.95 for A-LPQ summary scores and ranged from 0.72 to 0.95 subscales. Paired t-tests were insignificant for all comparisons except for The Enormity of the Pain subscale (p=0.03). Intraclass correlation coefficients (ICC) were high (>0.95) for this subscale regardless of parity. Correlations between A-LPQ summary and subscale scores with overall pain intensity scores on the NRS and VRS and with the PMS for pain coping supported concurrent and construct validity.
CONCLUSION: The study demonstrated that recall reliability of prior pain experiences is high in women of mixed parity during early active labor. Findings suggest that the A-LPQ can be used to asses severe or extreme labor pain in women after epidural analgesia has been established.