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Assessing pain for people living with cognitive impairments presents challenges for their care providers due to difficulties in communicating, or self-reporting their pain.

To assist caregivers in addressing these challenges, there are several pain assessment tools available, each offering unique strengths and weaknesses.. In this blog, we will explore the different types of assessment tools and what methods of pain assessment that can be utilised effectively in health and social care settings.

Pain Assessment Methods

There are many different forms of pain assessment tools available, all of which have different strengths and limitations. Among the tools available to health care providers, the following types of assessment methods may be implemented in different ways.

Behavioural Observation

Noticing changes in an individual’s typical behaviour through observation is a reliable indicator of pain. This approach has been effectively employed in multiple pain assessment tools, including PainChek®, the Abbey Pain Scale, and the Behavioural Pain Scale (BPS). Signs such as body part guarding, frustration, confusion, and distress can all signify the presence of pain. Therefore, caregivers who are familiar with a person’s usual behaviour can effectively identify potential pain even when the individual is unable to self-report..

Pain Assessment Scales

The Numeric Rating Scale (NRS) and the Visual Analogue Scales (VAS) are examples of Pain Assessment Scales. These rely on the person being able to indicate the level of pain they are experiencing themselves. People who live with a cognitive impairment may experience limitations in their ability to self-report which may also fluctuate over time.

Caregiver Reports

Caregiver reports are dependent on the caregiver maintaining a record of an individual’s regular activities and behaviours to detect any changes that could indicate the presence of pain. This approach can be an invaluable supplementary tool in pain assessment. However, its reliability relies on consistent and uninterrupted care, making it challenging to achieve if there are changes in the caregiver or if the individual is attended to by a rotating roster of caregivers.

Pain Diaries

A pain diary can be an effective tool for people with mild cognitive impairment who still have the ability to document their pain. This can also be donet by a loved one or caregiver to maintain an ongoing log of the severity and frequency of pain experiences.

Multidimensional Assessments

Multidimensional assessment has now become standard practice for assessing pain, providing a comprehensive understanding. Multidimensional assessments such as PainChek® examine various areas or ‘domains’, including the face, voice, movement, activity, behaviour, and body..

With a better understanding of the basis for different pain assessment tools, we can explore the different tools that are available and commonly used across aged care to determine their benefits and limitations. It is important to note that the correct tool will depend on how well an individual can self-report their pain. A person’s ability to self-report the presence and severity of pain is essential to managing pain; however, as their cognitive impairments progress, this ability becomes weakened, sometimes to the point where they become nonverbal, so the right tool should be carefully selected.

A common limitation of pain assessment tools in aged care is their subjective nature. When individuals are unable to communicate their pain levels, the assessment process relies on the judgment of a third party who makes observations and utilises a validated tool to reach a conclusion. However, this approach is subject to human error, as different individuals may have varying assessment outcomes. It can also be difficult to distinguish between pain behaviours and BPSD – a challenge explored in this whitepaper ‘Pain and Dementia: Common Challenges for Care Managers’.

Common Pain Assessment Tools

A number of pain assessment tools are available, however here we have focused on the most commonly used models: Numeric Rating Scale (NRS), Abbey Pain Scale, CNPI, PACSLAC & PACSLAC-ii, and PAINAD.

Limitations of Existing Paper-Based Pain Assessment Tools

Limitations table
1Brown, D. (2011). ‘Pain Assessment with Cognitively Impaired Older People in the Acute Hospital Setting’. Reviews in Pain. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591671 [online]. (Accessed 5 May 2021).

Neville, C., Ostini, R. (2014). ‘A psychometric evaluation of three pain rating scales for people with moderate to severe dementia’, Pain Management Nursing, 2014 Dec;15(4), p10. Available at: https://pubmed.ncbi.nlm.nih.gov/24144573/ [online].
(Accessed 5 May 2021).

Schofield, P., Abdulla, A. (2018). ‘Pain assessment in the older population: what the literature says’ Age and Ageing 2018; 47: 324–327. Available at: https://pubmed.ncbi.nlm.nih.gov/29584807/ [online]. (Accessed 5 May 2021).

Pain assessment in the older population: what theiLi literature says.

Moving away from paper-based tools, PainChek’s® multidimensional pain assessment tool aims to reduce the subjectivity often associated with traditional assessments on paper. By facilitating pain assessments at the point of care, PainChek enhances the accuracy and efficiency of pain evaluations.
PainChek® is the world’s first regulatory-cleared medical device for the assessment of pain, enabling best-practice pain management for people living with pain in any environment, including those who cannot reliably self-report their pain, those who can, and those who fluctuate between the two.

The PainChek® app combines PainChek’s AI pain assessment tool, which intelligently automates the multidimensional pain assessment process, with the Numerical Rating Scale (NRS). This hybrid functionality allows accurate, consistent pain assessment at the point of care, whether a resident or patient can or cannot self-report their pain.

Modern Pain Assessment in Aged Care

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