Pain in Elderly
AN APPLICATION OF PAIN RATING SCALES IN GERIATRIC PATIENTS
I. Bergh. RN, MSc1-3, B. Sjostrom, PhD, RN2., A. Oden, PhD'., B. Steen, MD, PhD'. '
Department of Geriatric Medicine, Goteborg University, Vasa Hospital, SE 411 33 Gothenburg, Sweden.; department of Health Care Pedagogics, Goteborg University, Sweden; 'Department of Health Sciences, University of Skovde, Sweden.
Aim of investigation: To examine the applicability of three different pain rating scales, VAS, GRS and NRS, in geriatric patients.
Methods: Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (M=80.5 yr). Patients rated their current experience of pain twice with a 5 minutes pause in-between on the VAS, GRS and NRS and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms.
Results: The correlation were high and significant both between the ratings of the VAS, GRS and NRS (r=0.78-0.92; p<0.001) (alternative-forms reliability) and between the test and retesting (r=0.75-r=0.83; p<0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient. The probability of agreement between the patients' ratings of pain and the verbal report of PAH tended to decrease with advancing age. Those who verbally denied PAH but reported pain on the scales rated it significant lower (p<0.001) than those who verbally reported PAH and rated the pain as well. Eighteen per cent of those patients who denied pain but rated pain verbally expressed suffering or distress.
Conclusions: The study suggests that the VAS, GRS and NRS can be used in geriatric patients. However, agreement between verbally expressed experience of PAH and the rated pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of pain, ache, hurt, discomfort and distress.
Acknowledgments: This study was supported by grants from the Society of Fellows of Sahlgrenska School of Nursing, Felix Neuberghs Foundation and Hjalmar Svensson Research Foundation.
CHRONIC REFRACTORY PAIN IN THE ELDERLY : TOWARDS A MORE SPECIFIC APPROACH
N Memran *. C Ciais ** F Capriz-Ribiere** * Director, ** Staff Physician Dept d'Evaluation et Traitement de la Douleur CHU Nice, B.P 69 - 06002 Nice - France.
Aim of Investigation: To evaluate the profile of the elderly patients attending a multidisciplinary Pain Centre and its therapeutic implications.
Methods: Patients older than seventy years attending the Centre during a period of twelve months in 1999 were studied from a medical perspective. A questionnaire was used to evaluate biomedical and psychosocial aspects. For taxonomic purposes, the IASP classification of Chronic Pain was adopted with a focus in this specific population regarding regions of pain, systems, temporal characteristics of pain (pattern of occurrence), patient's statement of intensity (time since onset of pain) and aetiology.
Results: One fifth (311) of the total number of patients (1500) over 70 years of age attended in the Centre were studied. 203 (65%) of them presented a single painful region (head, face and mouth: 35%, lower limbs: 18%, thoracic region: 17%, lower back, lumbar spine, sacrum and coccyx:
11%, upper limbs and neck: 10%, pelvis, anal, perineal and genital region: 5%, abdominal region: 4%). 65 patients presented two painful regions, 5 patients presented three painful regions and 38 presented more than three painful regions. In those cases of multiple painful areas, the association of lumbar and lower limbs pain was the most prevalent (60% of cases). The organic system most frequently involved was the nervous system (50% of patients). As for intensity and duration, 60% of patients evaluated their pain as severe and lasting longer than six months. The origin of pain was degenerative in 25% of cases, 12% postherpetic and 15% oncologic.
Conclusions: Besides the multidisciplinary approach for the management of pain, our results stress the importance of various other specialities (neurology, rheumatology, geriatrics) for the global assessment of concurrent diseases in elderly patients.
IMPACT OF SENSORY STATUS AND COGNITION ON EXPERIMENTAL PAIN THRESHOLDS IN THE ELDERLY.
Gisele Pickering. Didier Jourdan, Dominique Morand, Severine Foumet-Fayard, Claude Dubray
Unite de Pharmacologie Clinique, Centre Hospitalier Universitaire,63009 Clermont-Ferrand. France.
Aim of investigation : Research on experimental pain perception in aging has so far produced contradictory results. Most of them have been obtained with psychophysical methods which are highly dependent on psychometric performance. This study investigates the impact of cognition and sensory status on psychophysical tests of experimental pain in the elderly.
Methods : In 21 male and female young (y) and 21 elderly (a), the following tests are determined: mechanical and thermal pain thresholds (MT and TT, kPa); mechanical and thermal tolerance thresholds (MTT and TTT, kPa)(Somedic algometer); choice reaction time (CRT, ms); auditory tolerance threshold (AT, dB); Mini-mental test (MMT);
Auditory (AD) and thermal (TD) discrimination tests (number of right answers).
Results : MTTa is lower than MTTy (680 ± 224 kPa vs 793 ± 228 kPa (p<0,05)) and thermal thresholds are not significantly different in both populations. ATa is lower than ATy (83,2 ± 0,6 dB vs 86,9 ± 0,6 dB (p<0,05)). MTa and MTTa decrease with ATa (p<0,05 and p<0,01) and with MMT (p<0,05). MTa and MTTa decrease when CRTa increases (p<0,01). No relationship exists between thermal and auditory discrimination, and pain thresholds (ADa and TDa / MTa and MTTa)
Conclusions : This study shows that pressure pain sensitivity increases with age and that it is linked to diminished sensory and cognitive functions. Also, our data validate the use of psychophysics for assessing pain sensitivity in the elderly.
EXPERIMENTATION OF SETTING UP A PROGRAMME ABOUT THE QUALITY OF THE PAIN MANAGEMENT IN A GERONTOLOGICAL MEDICAL CARE SERVICE : PROBLEMS-IMPACTS
P. RAT, S. BONIN-GUILLAUME C.H.U. Nord, Marseille
Taking pain into account in gerontological services comes up generally against two problems :
- the lack of systematic screening of the painful state of the patients during their hospitalization ;
- the frequency of the pathologies which are able to modify the possibility of communication and, then, the expression of pain by the older and the oldest
In order to improve the quality of the pain management in a medical service, a programme including several successive stages over a year has been set:
1) making nursing teams aware of the existing dysfunctions and of their consequences on the pain management by a prospective study of prevalence (painful state, frequency and efficiency of the pain treatments. This study confirmed international publications and demonstrated the lack of quality of the pain management (7 patients are painful out of 10, there is no antalgic treatment in 1 case out of 2). The situation is much more critical for non communicative old patients (9/10 painful, 1/4 treated).
2) Training nursing teams to the methods of pain assessment (self-assessment, pain behavioral-assessment) and to the specificities of the antalgic treatments towards aged patients.
3) making a systematic pain assessment sytematic for all the patients (at their admission and during their stay).
4) measuring what the programme allowed to change of medical practising as well toward the assessment than the treatments and evaluating its impact on the results in terms of quality (decreasing pain intensity).
Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 155, 242, 254, 268, 270
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