scholarly journals Pain Assessment in Impaired Cognition (PAIC15) Instrument: Cutoffs Against Three Standards

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 166-166
Author(s):  
Jenny van der Steen ◽  
Margot de Waal ◽  
Wilco Achterberg
Keyword(s):  
Sensitivity And Specificity ◽  
Pain Assessment ◽  
Nursing Home Residents ◽  
Pain Scale ◽  
Self Report ◽  
Evidence Based ◽  
Advanced Dementia ◽  
Pain Scales ◽  
Impaired Cognition ◽  
Based Medicine

Abstract Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□ 0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.

scholarly journals Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards

2021 ◽  
Vol 11 (7) ◽  
pp. 869
Author(s):  
Jenny T. van der Steen ◽  
Andrew Westzaan ◽  
Kimberley Hanemaayer ◽  
Muhamad Muhamad ◽  
Margot W. M. de Waal ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Pain Assessment ◽  
Nursing Home Residents ◽  
Self Report ◽  
Evidence Based ◽  
Pain Scales ◽  
Impaired Cognition ◽  
Based Medicine ◽  
Assessing Sensitivity ◽  
Score Range

Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0–45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.

scholarly journals The Model of Empathic Pain Assessment and Treatment in Persons With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 527-528
Author(s):  
Lauren Starr ◽  
Kristin Corey Magan
Keyword(s):  
Pain Assessment ◽  
The United States ◽  
Care Quality ◽  
Adverse Outcomes ◽  
Self Report ◽  
Evidence Based ◽  
Advanced Dementia ◽  
Model Driven ◽  
Clinical Empathy ◽  
Assessment And Treatment

Abstract There are 5.8 million people with Alzheimer’s dementia in the United States—81% are 75 years or older. Although half of persons with dementia regularly experience pain, their pain is underrecognized and undertreated, partly because clinicians experience challenges assessing pain in persons with dementia who cannot self-report. Evidence suggests clinician empathy is involved in pain assessment and treatment. Conceptual models guiding Alzheimer’s research are lacking in the literature. To create an interdisciplinary, evidence-based model for understanding clinical empathy’s relationship with the assessment and treatment of pain in persons with advanced dementia, we conducted a literature review of relevant manuscripts from 2000-2019 across disciplines and countries, emphasizing dementia studies and research conducted in the last decade. After performing quality appraisal using the Oxford Centre for Evidence-based Medicine’s levels of evidence, we synthesized findings from 38 qualifying studies and developed a new conceptual model driven by observation of behaviors indicating pain in persons with dementia unable to self-report. The model represents the cognitive, affective, ethical, and behavioral components of clinical empathy involved in assessing and treating pain, relevant patient outcomes, and contextual factors influencing empathy and outcomes; and provides a framework for testing clinical empathy interventions to improve adverse outcomes in persons with advanced dementia. Understanding the relationship between clinician empathy and the assessment/treatment of pain in persons with dementia may improve care quality and help reduce pain behaviors in this population. This model may be used to inform pain research in persons with dementia and develop clinical interventions and clinician education programs.

Validation of the Spanish Version of the Pain Assessment in Advanced Dementia Scale (PAINAD-Sp) in Hospitalized Patients with Neurologic Disorders and Oncologic Patients Unable to Self-Report Their Pain

2019 ◽  
Vol 20 (4) ◽  
pp. 323-330 ◽  
Author(s):  
Lucia Muñoz-Narbona ◽  
Sandra Cabrera-Jaime ◽  
Teresa Lluch-Canut ◽  
Natalia Pérez de la Ossa ◽  
Jesús Álvarez Ballano ◽  
...  
Keyword(s):  
Pain Assessment ◽  
Hospitalized Patients ◽  
Self Report ◽  
Spanish Version ◽  
Advanced Dementia ◽  
Neurologic Disorders ◽  
Oncologic Patients

scholarly journals Pain Assessment in People With Dementia: Remaining Controversies

2018 ◽  
Vol 10 (5) ◽  
pp. 62 ◽  
Author(s):  
Mohammad Rababa
Keyword(s):  
Pain Assessment ◽  
Gold Standard ◽  
Unmet Needs ◽  
Behavioral Changes ◽  
Self Report ◽  
Advanced Dementia ◽  
Affective Experience ◽  
Pain Experience ◽  
People With Dementia ◽  
Background Pain

BACKGROUND: Pain in people with dementia is under recognized, underestimated, and under-treated due to the complexity of pain assessment in this population.SUMMARY: Self-report tools are the gold standard of pain assessment. However, people with dementia are not always able to clearly and meaningfully self-report their pain. Self-report tools capture the affective experience of pain, which is impaired in people with dementia. Observational pain tools are more useful to assess pain especially in people with advanced dementia who are unable to self-report. Observational pain tools capture the physical component of pain experience, which is unchanged in people with dementia. However, nurses often misunderstand the behavioral changes associated with pain in people with dementia. Also, there is a huge inconsistency in presentation of these behavioral changes associated with pain among people with dementia as behaviors can be due to multiple different unmet needs, pain being one.

Instruments for pain assessment in patients with advanced dementia: A systematic review of the evidence for Latin America

2020 ◽  
Vol 18 (6) ◽  
pp. 741-747
Author(s):  
Silvia Mercedes Coca ◽  
Roberto Ariel Abeldaño Zuñiga
Keyword(s):  
Systematic Review ◽  
Latin American ◽  
Pain Assessment ◽  
Pain Treatment ◽  
Lewy Bodies ◽  
Reliability And Validity ◽  
Pain Scale ◽  
Elderly Persons ◽  
Advanced Dementia ◽  
People With Dementia

AbstractObjectivePain treatment is an essential component of care for elderly patients with advanced dementia. The objective of this study was to identify and analyze the different scales used for pain assessment in elderly persons diagnosed with dementia, in the literature available at the Latin American level.MethodA systematic review was performed on the existing scales for pain assessment in elderly people diagnosed with Alzheimer's disease, vascular dementia, and dementia with Lewy bodies.Results226 articles were retrieved from the PUBMED, BIREME, and Scielo databases, of which a total of 10 articles entered the systematic review. The instruments identified in these publications were PAINAD, Abbey, McGill, and PACSLAC, while the Colored Pain Scale, Faces Pain Scale, and VAS scales were used as the silver standard. In Spanish, the Abbey scale, and in Portuguese, the PACSLAC scale showed the best reliability and validity coefficients.Significance of resultsIt is concluded that there are only two appropriate scales for the assessment of pain in people with dementia in the region of interest of this study. It is recommended to generate more evidence for a more accurate assessment of pain in people with dementia.

Faces scales in paediatric pain assessment

2018 ◽  
Author(s):  
Alison Bliss
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Critical Evaluation ◽  
Pain Scale ◽  
The Self ◽  
Self Report ◽  
Future Research ◽  
Clinical Settings ◽  
Pain Scales ◽  
Pain Rating Scale

The landmark paper discussed in this chapter is a systematic review assessing the commonly used faces pain scales employed to aid children in the self-report of their pain intensity. The review provides a critical evaluation of the Faces Pain Scale, the Faces Pain Scale-Revised (FPS-R), the Oucher pain scale, and the Wong–Baker Faces Pain Rating Scale (WBFPRS). The reviewers found that the psychometric properties of the FPS-R supported its superiority for use in research. Although they found that children, and many staff, expressed a preference for the WBFPRS, the reviewers had major concerns about this scale confounding pain intensity with affect. They also noted the paucity of research in younger children, and concluded that future research should not focus on developing more pain scales for paediatric use but on examining the appropriate application of existing scales in a wider range of clinical settings.

Adoption of a Pain Assessment Tool in Older Homebound Patients With Dementia in a Housecall Practice: A Dissemination Study

2012 ◽  
Vol 5 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Jean-Claude K. Provost
Keyword(s):  
Older Adults ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Selection Process ◽  
Pain Scale ◽  
Assessment Tools ◽  
Advanced Dementia ◽  
Pain Diagnosis

This article describes the steps of a pilot dissemination study toward adopting a pain assessment tool for older homebound adults with dementia. The chosen practice site had not previously used adequate pain assessment tools for older adults with dementia. After the selection process by a pain assessment tool committee, providers (N = 20) were asked to choose between three tools: pain assessment in advanced dementia (PAINAD), the Abbey Pain Scale, and DOLOPLUS-2/ DOLOSHORT. Providers voted to use the PAINAD (54%) for the following 2 weeks. A preintervention audit showed that without the use of a pain assessment tool, 97.7% of the charts did not have any documentation of a pain diagnosis nor an intervention. Postintervention using PAINAD, 91.3% of the charts had both (χ2[1] = 18.645, p < .001). The feedback obtained from providers (n = 10) after 2 weeks of testing the tool was unanimously positive. Many providers reported increased confidence in identifying pain and some changed their practice by placing pain assessment in the forefront of their encounter with their older clients with dementia. PAINAD was adopted as the pain assessment tool for this practice.

scholarly journals Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP)

Animals ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 354 ◽  
Author(s):  
Machteld C. van Dierendonck ◽  
Faith A. Burden ◽  
Karen Rickards ◽  
Johannes P.A.M. van Loon
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pain Scale ◽  
Follow Up Study ◽  
Observer Reliability ◽  
Pain Scales ◽  
Different Types ◽  
Good For

Objective pain assessment in donkeys is of vital importance for improving welfare in a species that is considered stoic. This study presents the construction and testing of two pain scales, the Equine Utrecht University Scale for Donkey Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP), in donkeys with acute pain. A cohort follow-up study using 264 adult donkeys (n = 12 acute colic, n = 25 acute orthopaedic pain, n = 18 acute head-related pain, n = 24 postoperative pain, and n = 185 controls) was performed. Both pain scales showed differences between donkeys with different types of pain and their control animals (p < 0.001). The EQUUS-DONKEY-COMPASS and EQUUS-DONKEY-FAP showed high inter-observer reliability (Cronbach’s alpha = 0.97 and 0.94, respectively, both p < 0.001). Sensitivity of the EQUUS-DONKEY-COMPASS was good for colic and orthopaedic pain (83% and 88%, respectively), but poor for head-related and postoperative pain (17% and 21%, respectively). Sensitivity of the EQUUS-DONKEY-FAP was good for colic and head-related pain (75% and 78%, respectively), but moderate for orthopaedic and postoperative pain (40% and 50%, respectively). Specificity was good for all types of pain with both scales (91%–99%). Different types of acute pain in donkeys can be validly assessed by either a composite or a facial expression-based pain scale.

Nurses’ certainty and pain outcomes of nursing home residents with dementia: the mediating effect of pain assessment

2019 ◽  
Vol 9 (6) ◽  
pp. 559-567
Author(s):  
Mohammad Rababa ◽  
Sami Al-Rawashdeh
Keyword(s):  
Nursing Home ◽  
Patient Outcomes ◽  
Pain Assessment ◽  
Nursing Home Residents ◽  
Mediating Effect ◽  
Self Report ◽  
Convenience Sample ◽  
Correlational Design ◽  
Pain Outcomes ◽  
Severity Of Dementia

Aim: This study aims to examine the associations of pain assessment scope, nurses’ certainty, patient outcomes, and cognitive and verbal characteristics of nursing home (NH) residents. Methods: This study used a descriptive correlational design and a convenience sample of 78 NH residents with dementia. Results: There are significant associations between the severity of dementia and the ability to self report symptoms in NH residents and nurses’ certainty of pain. Also, pain assessment scope does not mediate the relationship between nurses’ certainty and patient outcomes. Conclusion: Pain assessment in NH residents with dementia is very challenging for nurses due to multiple complex factors. Improved understanding of pain assessment in those residents and how it relates to certainty of pain and patient outcomes are crucial.

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