Pain Assessment Guidelines and Frameworks

Pain is common in residential aged care, with up to 80% of residents experiencing pain at some point in time, while at least 50% of those with dementia have pain on a regular basis. Despite the prevalence of pain amongst those living with moderate to severe dementia, the inability of these patients to self-report means it often goes undetected and untreated.

In this article, we explore the implications of untreated pain in patients living with dementia, and how the PainChek® digital pain assessment tool offers a reliable and accurate means of assessing pain in those who are unable to self-report.

The consequences of unidentified and untreated pain

A recent article by Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, and Associate Professor of Psychiatry, Monash University, looks at the way behaviours of dementia are managed in residential care.

Common behaviours displayed by those living with advanced dementia include “agitation, anxiety, attempts to leave care, aggression, apathy, sleep disturbance, aimless pacing, psychosis and aggression”.

According to Macfarlane, one of the leading causes of these behaviours is unidentified or untreated pain. He notes:

“This is relevant in over 50% of the cases we see. Earlier research on pain management in the setting of advanced dementia has shown those with a dementia diagnosis who are admitted to hospital with hip fractures tend to be prescribed only a fraction of the analgesia given to those without dementia.”

The most effective method of addressing these behaviours is to mitigate key contributing factors such as undiagnosed or mismanaged pain. As Macfarlane explains:

“The best way to manage most behavioural changes is to prevent the circumstances that lead to their development in the first place. Prevention is always better than cure.

Once behaviours are occurring, there is no single correct way to de-escalate them. The appropriate de-escalation strategies will always be specific to what has caused the altered behaviour in the first place.”

Assessing pain in non-verbal patients with dementia

We know effective pain management is vital to minimising behavioural disturbances in patients with dementia and other forms of cognitive impairment.

Historically, however, pain amongst these cohorts has been difficult to assess due to traditional pain assessment tools’ reliance on the patient’s ability to articulate their own pain levels. Indeed, in those that can verbalise their pain and those with mild to moderate dementia, self-reporting remains the gold standard.

For patients who are unable to self-report, other strategies must be used to assess pain and evaluate the need for intervention. Facial expressions are non-verbal pain-related behaviours that have been included in observational pain scales.

The Facial Action Coding System (FACS) is an anatomical catalogue of facial movements regarded as the gold standard for evaluating facial expressions, including those related to pain. However, manual facial analysis using tools such as FACS is time-consuming, subjective, and requires significant training, making it unrealistic for clinical practice.

The advancement of technologies, including smartphones and artificial intelligence, is helping overcome these challenges by enabling fast, objective pain assessment even in those who are unable to verbalise their pain levels.

PainChek® is a clinically validated pain assessment tool that supports accurate and rapid pain assessment at the point of care. The app combines PainChek®’s AI pain assessment tool, which intelligently automates the multidimensional pain assessment process, with the Numerical Rating Scale (NRS).

PainChek® as a reliable point-of-care pain assessment solution

An observational study published in the Journal of Alzheimer’s Disease assessed the validity of PainChek® compared to the Abbey Pain Scale (APS), which has been the standard pain assessment tool used for people who cannot verbalise in Australia and overseas since 2004.

The study found that PainChek®’s digital pain assessment tool “offers a valid and reliable new method to assess pain in people with moderate to severe dementia who can no longer self-report their pain.”

The study’s authors note that “it [removes] the subjectivity associated with the assessment of the features of pain and provides an objective and reproducible assessment of pain facial expression for each individual.”

“It has proven validity and reliability compared to APS [Abbey Pain Scale], which is the current gold standard for pain assessment in people with dementia who cannot self-report pain in Australia. We believe it offers a significant advantage in that the facial expression assessment is automated, providing an objective and reproducible evidence of the presence of pain, in conjunction with non-facial features.”

In addition to enabling reliable, objective pain assessment for dementia patients, PainChek® offers a number of significant benefits in residential aged care settings, including:

  • Centralised data: All pain assessment data is stored securely and centrally in PainChek®’s detailed reporting suite, PainChek® Analytics.
  • Interoperability: PainChek® is fully interoperable with leading care management systems, enabling seamless and secure data sharing.
  • Reduced risk: No duplication of effort or the need for paper handling reduces the risk of human error and inaccuracies.
  • Improved quality of care: PainChek® has been shown to instigate a reduction in the inappropriate use of psychotropic medication.
  • Accessibility: A fast and objective tool, PainChek® empowers staff to accurately and consistently monitor pain, saving time and costs.
  • Digital transformation: PainChek® helps facilities digitise their process and become technology leaders.
  • Ongoing support: PainChek®’s expert team is on hand to support day-to-day and strategic decisions relating to pain assessment.
  • Reputability: PainChek® has government backing and a strong, credible reputation with clients and the industry.

To find out more about the clinical validity of PainChek® and how it can enable best-practice pain assessment protocols for those living with dementia, book a one-on-one session with a PainChek expert.

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