Pain
Carole K. H. Bartoo
1.Poorly relieved pain is an important cause of functional impairment in any age group (Schofield, 2007).
2.Cognitive impairment can make assessment and diagnosis of pain more difficult.
3.Pain is commonly underreported in older adults. In one project (Schofield, 2007), the data obtained from resident interviews in nursing facilities grouped reasons for underreporting into four themes as follows (Schofield, 2006):
a.A reluctance to report pain/acceptance that pain is normal and low expectations of help from medical interventions.
b.Fear of chemical or pharmacological interventions.
c.Age-related perceptions of pain.
d.Lack of awareness of potential pain-relieving strategies.
The older adults in this project did take an interest in controlling pain on their own, reporting techniques like taking a hot bath or shower when the pain was bad, or rubbing the affected area.
But generally, the residents were unaware of approaches such as relaxation, massage, or distraction.
4.Assessing pain: Many well-described techniques are available, including the following:
a.Pain scale 1-10, or 0-to-10.
b.Wong-Baker Faces
pain rating scale.
For chronic pain sufferers, assess interference with the patient’s life:
a.Brief Pain Inventory (short form; www.npcrc.org/files/news/briefpain_short.pdf ).
5.For dementia or noncommunicative patients: The American Medical Directors Association has endorsed the Pain Assessment in Advanced Dementia (PAINAD) Scale and scores the following items:
a.Breathing: Examples include normal, labored, hyperventilation.
b.Negative vocalization: Examples include moaning, negative language, crying.
c.Facial expression: Examples include smiling, frowning, grimacing.
d.Body language: Examples include relaxed, tense, rigid, or striking out.
e.Consolability: Examples include extent to which a caregiver is able to console, distract, or reassure (dementiapathways.ie/_filecache/04a/ddd/98-painad.pdf ).