Pain assessment in the cognitively impaired and unimpaired elderly.
ABSTRACT The purpose of this study was to determine the self-report pain rating scale(s) that can be used to quantify pain in elderly persons across cognitive functioning levels. Randomly selected elderly subjects (N = 100) completed the Short Portable Mental Status Questionnaire to categorize their level of cognitive impairment: intact (n = 36), mild (n = 9), moderate (n = 15), and severe (n = 40). Pain was measured with the Memorial Pain Assessment Card verbal subscale, FACES, COOP pain subscale, a numeric rating scale, and the Present Pain Intensity subscale of the McGill Pain Questionnaire. Receiver operator characteristic curves indicated that participants categorized with moderate to no cognitive impairment were able to complete 1 or more of the pain assessment tools. Of the severely impaired, 30% were able to complete 1 or more pain assessment tools. Intraclass correlations showed a high degree of consistency among all pairs of tools (intraclass correlation > 0.74). We conclude that most elderly, with normal to moderately impaired cognitive functioning, as well as some severely impaired elderly, are capable of using self-report tools to rate their pain.
Article: Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: implications for research and practice.[show abstract] [hide abstract]
ABSTRACT: Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have resulted in a growing number of seriously injured soldiers who are evacuated to the United States for comprehensive medical care. Trauma-related pain is an almost universal problem among these war-injured soldiers, and several military and Department of Veterans Affairs initiatives have been implemented to enhance pain care across the continuum of medical services. This article describes several innovative approaches for improving the pain care provided to OEF and OIF military personnel during acute stabilization, transport, medical-surgical treatment, and rehabilitation and presents summary data characterizing the soldiers, pain management services provided, and associated outcomes. We also identify some of the pain assessment, classification, and treatment challenges emerging from work with this population and provide recommendations for future research and practice priorities.The Journal of Rehabilitation Research and Development 02/2007; 44(2):179-94. · 1.78 Impact Factor
Article: Factors associated with self- and caregiver report of pain among community-dwelling persons with dementia.[show abstract] [hide abstract]
ABSTRACT: Among cognitively intact patients, self- and caregiver report of patient pain has been associated with worse psychological health for both the patient and caregiver. Little existing research examines factors associated with patient self-report of pain and caregiver report of patient pain among community-dwelling persons with dementia. To identify patient and caregiver factors associated with self- and caregiver report of patient pain among community-dwelling persons with dementia. Cross-sectional analysis of a longitudinal study using structured interviews with dementia patients and their family caregivers. Urban outpatient geriatrics clinics affiliated with a university hospital. Dyads composed of dementia patients and their family caregivers were approached prior to routine clinic visits to participate in the study. Relevant patient measurements included self-report of pain; cognitive, functional, and comorbidity assessments; a screen for depression; and demographic information. Relevant caregiver measurements included their report of patient pain and agitation, screens for depression and strain, and demographic information. Of 115 dyads, 37 patients (32%) and 57 caregivers (53%) reported the patient to be in pain. No patient or caregiver factors were significantly associated with patient self-report of pain. In the univariate analysis, caregiver reports of patient pain were associated with the patient not being depressed (p = .036), caregiver reports of patient agitation (p = .038), higher level of education in the caregiver (p = .029), and caregiver depression (p = .019). In multivariate logistic regression analyses, caregiver depression and patient agitation remained significantly associated with caregiver report of patient pain. In community-dwelling persons with dementia, self-report of pain was not associated with any other variables measured, suggesting that pain should be assessed through direct self-report and treated accordingly. Caregiver report of patient pain was associated with both caregiver report of patient agitation and caregiver depression. These findings suggest that clinicians may need to routinely assess patient pain, patient agitation, and caregiver depression. More research is needed to understand the relationship between these conditions.Journal of Palliative Medicine 07/2005; 8(3):567-75. · 1.85 Impact Factor
Article: Pressure ulcer pain: a systematic literature review and national pressure ulcer advisory panel white paper.[show abstract] [hide abstract]
ABSTRACT: Pain is an ever-present problem in patients with pressure ulcers. As an advocate for persons with pressure ulcers, the National Pressure Ulcer Advisory Panel (NPUAP) is concerned about pain. To synthesize available pressure ulcer pain literature, a systematic review was performed of English language literature, specific to human research, 1992 to April 2008, using PubMed and the Cumulative Index in Nursing and Allied Health Literature. Fifteen relevant papers were found; they examined pain assessment tools, topical analgesia for pain management, and/or descriptions of persons with pressure ulcer pain. Studies had small sample sizes and included only adults. The literature established that 1) pressure ulcers cause pain; 2) pain assessment was typically found to be self-reported using different versions of the McGill Pain Questionnaire, Faces Rating Scale, or Visual Analog Scale; 3) pain assessment instruments should be appropriate to patient cognitive level and medical challenges; 4) in some cases, topical medications can ease pain and although information on systemic medication is limited, pain medications have been found to negatively affect appetite; and 5) wound treatment is painful, particularly dressing changes. Research gaps include the prevention and treatment of pressure ulcer pain, the impact of pain on nutrition, and pressure ulcer pain considerations for special groups (eg, children, end-of-life patients, and bariatric patients). The NPUAP presents this white paper as the current scientific know-ledge base on the topic. Research regarding the multidimensional aspects of pressure ulcer pain is strongly recommended.Ostomy/wound management 03/2009; 55(2):16-31. · 1.08 Impact Factor