This article is taken from the whitepaper “Modern Pain Assessment in Aged Care”. Download the full whitepaper
Findings from Painaustralia suggest that as many as 80% of aged care residents are living with chronic pain, ranging from common arthritis, bone and joint disorders, cancer, and other long-term illnesses.
What’s even more worrying is that pain is often poorly identified and managed in older adults living in residential aged care facilities. This is especially the case for those who are unable to verbalise their pain.
To prevent such misdiagnoses of pain from happening, clinicians must use the right assessment methods to get the most accurate picture of the resident’s experience of pain.
In this article, we review the latest pain assessment tools to guide a best-practice approach to pain management. These are classified according to whether they cater to those who can reliably verbalise their own pain levels or those who are unable to self-report pain.
Pain assessment for those who cannot self-report pain
For those who are unable to self-report, strategies that infer their level of pain must be used to inform intervention. For instance, the American Society for Pain Management Nursing (ASPMN) recommends a hierarchy of pain assessment techniques for those with advanced dementia, including:
-
- Be aware of the potential causes of pain in older persons. Common causes of pain include arthritis, lower back pain, musculoskeletal disorders, or neurological disorders. They should be given consideration during the assessment.
- Attempt to self-report (even with limited communication). These could include a simple yes/no, vocalisations, or gestures such as a hand grasp, head nod, or eye blink.
- Observe the individual’s behaviours. Look for pain-related facial expressions (like grimacing) and vocalisations (like moaning).
- Ask a proxy to report pain and behavioural or activity changes. A credible proxy reporter should be someone who knows the patient well — such as a close family member, spouse, or personal care assistant in a long-term care setting.
- Attempt analgesic trial. Initiate this only if behavioural scores indicate the presence of pain. The goal is to establish whether or not pain is the cause of the behaviours, and all treatments should be monitored closely.
Paper-based pain assessment methods for those unable to self-report
In addition to this, there are formal paper-based tools for assessing pain in those who are not able to self-report. They involve a nurse or carer assessing the patient and providing ratings based on their observations. Commonly used methods include:
-
- Abbey Pain Scale. Users observe the resident in six key areas: vocalisation, facial expression, change in body language, behavioural change, physiological change, and physical changes. For each area, a rating is given between 0-3.
- Checklist of Non-verbal Pain Indicators (CNPI). There are six items on the CNPI checklist: vocal complaints, non-verbal expression of pain, facial grimaces and winces, bracing restlessness, rubbing, and verbal expression of pain using words. Each item is scored at movement and at rest. The higher the score, the greater the likelihood that the resident is in pain.
- Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC and PACSLAC-ii). PACSLAC is the most comprehensive of all manual, paper-based observational tools, and includes a checklist of 60 items in five subscales. PACSLAC-ii is an abridged version of the checklist with 31 items and six subscales: facial expressions, verbalisations and vocalisations, body movements, changes in personal interactions, changes in activity patterns, and mental state changes. Carers observe and score these behaviours with higher scores implying more pain.
- Pain Assessment in Advanced Dementia Scale (PAINAD). PAINAD is designed to detect pain in those with advanced dementia. The carer observes the resident during activity (with movement) for 3-5 minutes before scoring behaviours on a scale of 0 to 2 in five domains: negative vocalisations, body language, breathing (independent of vocalisation), facial expression, and consolability.
Pain assessment for those that can self-report
In the most ideal situation where the person is able to verbalise or express pain, self-reporting remains the best choice.
For such cases, the British Geriatrics Society and Royal Australian College of General Practitioners (RACGP) both recommend the use of a Numeric Rating Scale (NRS) or Verbal Rating Scale (VRS).
The NRS is regarded as the gold standard of pain assessment in those who can self-report pain. The patient rates the intensity of their pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable.
Assess pain frequently for accurate results
Another crucial aspect of effectively assessing pain is to do it regularly. When specialised pain assessment tools are administered on a consistent and frequent schedule, it has been shown to help with pain reduction and improved pain management practices.
Although there is no universally accepted number of pain assessments that should be conducted amongst aged care residents, the RACGP recommends aged care residents are assessed for pain at the following points:
-
- During admission.
- Every 8 hours for older adults with behavioural symptoms that suggest pain.
- Every time there is a change in pain status.
- One hour after any pain intervention.
- Quarterly, for older adults residing in long-term healthcare settings.
These assessments should also include input from various sources such as the patient, family, facility staff, and carers.
PainChek®: Creating a new standard for pain assessment
To further advance the accuracy and efficiency of current assessment tools, innovators are combining these current tried and tested frameworks with the latest technology.
For example, PainChek’s digital pain assessment solution uses AI and facial recognition on a smart device to analyse facial movement, vocalisations, and other pain indicators.
These digitally-measured inputs can also be taken together with self-reports, which are captured through the NRS that’s integrated into the app.
This enables best-practice pain management for both verbal and non-verbal adult patients across a range of clinical settings.
To find out more about the latest pain assessment insights, download our whitepaper “Modern Pain Assessment in Aged Care” and register for our free upcoming webinar here.
