Magazine article Clinical Psychiatry News

Pain Assessment Difficult in Cognitively Impaired Patients

Magazine article Clinical Psychiatry News

Pain Assessment Difficult in Cognitively Impaired Patients

Article excerpt

SAN FRANCISCO -- Physicians must put on their detective caps to assess pain in cognitively impaired elderly patients, Phillip Wizwer said at a joint conference of the American Society on Aging and the National Council on the Aging.

Patients with sensory and cognitive deficits can't necessarily answer standardized questionnaires or use verbal or visual scales to indicate their pain levels. Reports of pain tend to decrease as cognitive impairment increases, but that doesn't mean the patient is not in pain, said Mr. Wizwer of the Massachusetts College of Pharmacy and Health Sciences, Boston.

To assess cognitively impaired nursing home patients, he developed a tool to quantify behavioral indicators of pain, such as facial grimacing, restless body movement, a change in behavior, moaning, and tense muscles. "The nurses won't use it, though, because it takes 5-10 minutes, which is too long. They want a 1-minute check-off," he said.

He praised the Pain Assessment in Advanced Dementia scale described by other investigators in 2003, which includes a one-page grid on which the assessor rates the patient on five variables with scores of zero to two per variable (J. Am. Med. Dir. Assoc. 4[1]:9-15, 2003). The variables are extent of labored breathing; negative vocalization such as moaning, groaning, or crying; facial expression; body language; and "consolability." Total scores of three or less suggest that no pain intervention is needed, and scores of four or greater demand a plan for pain management.

"That's the kind of scale we need to work toward. …

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