The importance of pain assessment tools in aged care.
With an aging population, the issue of effective pain management in aged care is in the interest of every Australian. A core responsibility of all aged care facilities, measuring pain and subsequent pain management is key to ensuring the very best quality of life for aged care residents. There are a variety of common assessment tools utilised by care professionals that are designed to quantify and provide an improved understanding of residents’ experience of pain.
Chronic pain in aged care residents
Chronic or persistent pain is a common health concern for aged care residents. Described as pain that persists beyond a normal healing time of 3 months, persistent pain is estimated to affect up to 80% of aged care residents. This carries huge implications in terms of resident quality of life; symptoms can be severely exacerbated if untreated or poorly managed, extending beyond physical ramifications, affecting a resident emotionally and psychologically.
The pain assessment tools most commonly used in residential aged care facilities can be divided into self-report tools, observational behavioral tools, and sensory testing tools.
What is a pain scale?
Pain scales are used in health care to assess and manage patients’ pain levels and treatment. Their purpose is to provide critical pain-related information to form tailored treatment plans.
A pain scale is a way of measuring pain’s intensity, frequency, duration, and impact on an individual.
There are at least ten pain scales in common use, which can be divided into three categories:
- Numerical Rating Scales use numbers to rate pain.
- Visual analog scales require a patient to mark a place on a scale that they feel best aligns with their level of pain.
- Categorical scales use verbal or visual descriptors, such as words, numbers, or colors, for individuals to communicate their level of pain. An individual may use a verbal pain intensity scale, using adjectives such as “mild”, “moderate” or “severe” to describe their pain. For others, a visual pain intensity scale with a variety of expressions to choose from (for example a face with a big smile or a downturned grimace) may be a more appropriate way to communicate pain.
The Numerical Rating Scale
The Numerical Rating Scale is a commonly used pain assessment tool in healthcare and residential aged care.
Patients choose a number from 0 to 10 that they feel best corresponds to their experience of pain, with a 0 being “no pain” and 10 being “worst pain imaginable”.
Whilst the Numerical Rating Scale is a simple and commonly used system, it does hold disadvantages. One of these disadvantages is if a person has chosen a value of “10” and the pain worsens, then there is no way to officially document this. This is described as a “ceiling effect”. The Numerical Rating Scale will also not be an effective way of measuring pain if a resident is unable to, or has a fluctuating ability to verbalise or self-report.
Wong-Baker FACES Pain Scale
The Wong-Baker FACES Pain Scale was developed by Donna Wong and Connie Baker. This pain assessment tool was born out of a concern for the void of adequate tools to help children communicate about their pain. This resulted in pain in children often being under-reported or poorly managed. Wong and Baker embarked on years of research, resulting in the Wong-Baker FACES Pain Rating Scale. The scale is used for children as young as three years old but is also used in aged care.
The scale consists of six faces that range from no pain at all to the worst pain imaginable, depicted in a happy face to a crying face. It is an inexpensive way of understanding pain levels, and is a particularly useful Pain Scale for children who may be embarrassed to voice their experience, and may be more comfortable with matching their level of pain to a face on the scale.
The McGill Pain Questionnaire
Consisting of 78 words that describe pain, the McGill Pain Questionnaire pain assessment tool is useful for those aged care residents that have full cognitive ability and can self-report. This pain scale can be used for patients with several diagnoses and assesses both the quality and intensity of subjective pain.
Featuring descriptors such as ‘sharp’, ‘shooting’ and ‘tingling’, The McGill Pain Questionnaire requires the resident to choose the seven adjectives that best describe their pain. Each pain descriptor holds a different numerical value, based on its associated severity. Once the resident has rated their pain, a numerical score with a maximum of 78 is assigned.
This pain assessment tool offers a wide breadth of descriptions and provides cognitive aged care residents optimum opportunity to communicate their symptoms. However, the McGill Pain Questionnaire is only useful for those who can self-report.
Brief Pain Inventory
The Brief Pain Inventory is a self-administered assessment tool used in pain management. The Brief Pain Inventory aims to assess the severity of pain and the impact of pain on a resident’s everyday functioning of life.
There are two forms of the Brief Pain Inventory pain assessment tool, which vary in length and detail. The short form, which includes prompts such as “what treatments or medications are you receiving for your pain?”, takes approximately five minutes for a patient to complete. However, this does not signal the end of an assessment. The clinician or carer will then need to extract and analyse the data provided.
The Brief Pain Inventory also utilises numerical rating scales, which require a resident to answer, on a scale of 0 to 10, how pain impacts their everyday life. A 0 is the lowest possible rating and represents no impact, whereas a 10 is representative of pain that severely impacts a residents’ life.
PainChek Ltd®
PainChek is a popular choice of pain assessment and management for Aged Care providers. To date, 60% of the Australian aged care bed market is using PainChek for its accurate and efficient pain assessment benefits.
Unlike other forms of pain assessment, PainChek can be used to quantify pain levels in all residents, as opposed to only serving those who can self-report.
The PainChek app uses a smartphone camera to look at a person’s face and, using AI technology, automatically recognises and records facial muscle movements indicative of pain. This enables carers and clinicians to accurately assess and manage the pain of those who cannot verbalise. The caregiver is also given the option to add their own observations of residents’ pain-related behaviours into the app. PainChek then calculates an overall pain score and stores the result. The outcome forms the evidence base for pain management interventions.
For those who can self-report, or have a fluctuating ability to do so, PainChek also incorporates the traditional Numerical Rating Scale. The assessor simply asks the person a guided question regarding their pain and documents their response. The app also stores pivotal information such as the time and date of the assessment and the activity status of the resident.
A common challenge of pain assessment in aged care is that it is rarely done at the point of care, alongside the resident. Often, critical information regarding a resident’s symptoms are completed at the nurses station in bulk and from memory. This is where PainChek has a key advantage over paper-based tools. PainChek is built around an open API, which integrates seamlessly into residential aged care integration systems. This means that there is no duplication of effort for carers and clinicians, with no manual handling of data. PainChek is a true point of care assessment tool.
