Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

Pain Assessment

Pain is common in older people but typically under-recognised and under-treated.

This may be partly due to cultural expectations of aging, with older people frequently ‘expecting’ pain or accepting it as normal.

Assessment of pain is even more challenging in people with cognitive impairment or communication difficulties, and can be a cause of delirium or behavioural disturbance in dementia.

Pain is, however, typically treatable, by addressing the underlying cause and careful use of analgesia and non-drug therapies.

Pain Scale

Numeric scale, Verbal scale, Facial scale, Activity tolerance scale, for the rating of pain

3 min.

Initial Pain Assessment Record

Objective and subjective description of pain, including mapping.

5 min.

FLACC Pain Scale

Evaluation of severity of pain in individuals who are unable to communicate

5 - 10 min.

Non Verbal Pain Scale - revised

Evaluation of severity of pain in individuals who are unable to communicate

5 - 10 min.

Abbey Pain Scale

Assessment of pain in patients who are unable to clearly articulate their needs

x min. : variable

DOLOPLUS-2 Pain Scale

Behavioural pain assessment in cognitively impaired patients.

x min. : variable

Assessment

Pain assessment is an important and challenging task.

Acute pain can be reliably assessed, both at rest (important for comfort) and during movement (important for function), with one-dimensional tools such as the Pain Numeric Scale and the Initial Pain Assessment Rrecord.

Patients with chronic non-cancer pain report even worse quality of life than dying cancer patients. This is a dramatic illustration of the major impact of chronic pain conditions on the quality of life of persons with long-lasting pain (Fredheim OH, 2008).

Chronic pain has a major impact on physical, emotional, and cognitive function, on social and family life, and on the ability to work and secure an income (Breivik H, 2006).

Algorithm for the assessment of pain in older people (RCP, 2007)

Key components of an assessment of pain (RCP National Guidelines, 2007)

1.  Direct enquiry about the presence of pain

Including the use of alternative words to describe pain

2.  Observation for signs of pain

Especially in older people with cognitive/ communication impairment

3.  Description of pain to include

Sensory dimension

- the nature of the pain (eg sharp, dull, burning etc)

- pain location and radiation (by patients pointing to the pain on themselves or by using a pain map)                   

- intensity, using a standardised pain assessment scale

Affective dimension

- emotional response to pain (eg fear, anxiety, depression)

Impact

- disabling effects of pain at the levels of

- functional activities (eg activities of daily living)

- participation (eg work, social activities, relationships)

4.  Measurement of pain

Using standardised scales in a format that is accessible to the individual

5.  Cause of pain    

Examination and investigation to establish the cause of pain

Observational changes associated with pain.

 *Guarding = abnormal stiff, rigid, or interrupted movement while changing position

**Bracing = a stationary position in which a fully extended limb maintains and supports an abnormal weight distribution for at least three seconds.

Factors to consider when selecting a pain assessment tool

The Pain Assessment is one of 5 sub-domains of the

Medical Assessment

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The Medical Assessment is one of 8 domains of the

 Comprehensive Geriatric Assessment (CGA)

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