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Patrick KS, Gunstad J, Spitznagel MB. Pain in the Context of Virtual Neuropsychological Assessment of Older Adults. Arch Clin Neuropsychol 2024; 39:157-166. [PMID: 37644879 PMCID: PMC10879923 DOI: 10.1093/arclin/acad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. METHOD The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. RESULTS Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. CONCLUSIONS Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.
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Affiliation(s)
- Karlee S Patrick
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Mary B Spitznagel
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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2
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Santella TM, Richebé P, Godin N, Brulotte V. Nociception level index variations in patients with complex regional pain syndrome: a pilot study. J Clin Monit Comput 2022; 36:1851-1858. [PMID: 35260985 DOI: 10.1007/s10877-022-00835-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
The nociception level index (NOL) is a multi-parameter index that incorporates changes in autonomic parameters to evaluate nociception, with more painful stimuli causing more pronounced index variations. How this nociception monitor relates to the pain experience is uncertain, and patients with chronic pain may respond differently to acute pain due to alterations in pain processing. The goal of this pilot study was to evaluate NOL index variations after a painful physiotherapy exercise in patients with upper limb complex regional pain syndrome. Baseline NOL indexes were recorded using a finger probe (PMD-200™ Monitor, Medasense, Israel) and patient reported baseline pain scores using an 11-point numeric rating scale (NRS). Patients then performed a painful physiotherapy exercise and NOL index and pain scores were again recorded. The same procedure and recordings were repeated after a stellate ganglion block. Data were analyzed using a paired Student T test and a P value < 0.05 was considered statistically significant. Twenty patients (12/20 female, 10/20 right-sided) were included in this study. Patients reported moderate baseline pain (4.0 ± 2.7) despite having a low baseline NOL index (7.66 ± 5.76 out of 100). NRS and NOL index scores increased significantly during exercise, both before and after the block. The NOL index increased significantly when patients reported increased pain, indicating that it could eventually be useful in the objective assessment of acute pain in the chronic pain patients. However, NOL index was not able to reflect pain levels at rest, before the painful stimulation, in this chronic pain population. Further studies are needed to better assess NOL index utility at rest and to confirm these findings in this specific chronic pain population.
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Affiliation(s)
- Tanya M Santella
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 boul. L'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 boul. L'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Nadia Godin
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 boul. L'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Véronique Brulotte
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 boul. L'Assomption, Montreal, QC, H1T 2M4, Canada.
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Cui Z, Guo Z, Wei L, Zou X, Zhu Z, Liu Y, Wang J, Chen L, Wang D, Ke Z. Altered pain sensitivity in 5×familial Alzheimer disease mice is associated with dendritic spine loss in anterior cingulate cortex pyramidal neurons. Pain 2022; 163:2138-2153. [PMID: 35384934 PMCID: PMC9578529 DOI: 10.1097/j.pain.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic pain is highly prevalent. Individuals with cognitive disorders such as Alzheimer disease are a susceptible population in which pain is frequently difficult to diagnosis. It is still unclear whether the pathological changes in patients with Alzheimer disease will affect pain processing. Here, we leverage animal behavior, neural activity recording, optogenetics, chemogenetics, and Alzheimer disease modeling to examine the contribution of the anterior cingulate cortex (ACC) neurons to pain response. The 5× familial Alzheimer disease mice show alleviated mechanical allodynia which can be regained by the genetic activation of ACC excitatory neurons. Furthermore, the lower peak neuronal excitation, delayed response initiation, as well as the dendritic spine reduction of ACC pyramidal neurons in 5×familial Alzheimer disease mice can be mimicked by Rac1 or actin polymerization inhibitor in wild-type (WT) mice. These findings indicate that abnormal of pain sensitivity in Alzheimer disease modeling mice is closely related to the variation of neuronal activity and dendritic spine loss in ACC pyramidal neurons, suggesting the crucial role of dendritic spine density in pain processing.
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Affiliation(s)
- Zhengyu Cui
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Internal Medicine of Traditional Chinese Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhongzhao Guo
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Luyao Wei
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zilu Zhu
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuchen Liu
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Wang
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Deheng Wang
- Department of Physiology, School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zunji Ke
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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4
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Kaufmann L, Moeller K, Marksteiner J. Pain and Associated Neuropsychiatric Symptoms in Patients Suffering from Dementia: Challenges at Different Levels and Proposal of a Conceptual Framework. J Alzheimers Dis 2021; 83:1003-1009. [PMID: 34366340 PMCID: PMC8543251 DOI: 10.3233/jad-210263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Old age is critically associated with multi-morbidity, chronic pain, and high risk for dementia. Recognizing and treating pain is very much dependent on language comprehension and production. Both may be impaired in dementia. Moreover, neuropsychiatric symptoms may interact with pain perception. The main aims of the present article were 1) to identify key areas for future research to elucidate the relation between pain and associated neuropsychiatric symptoms in dementia, and 2) to provide a conceptual framework for ameliorating the clinical process of recognizing, assessing, and managing pain in non-communicating patients with advanced dementia.
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Affiliation(s)
- Liane Kaufmann
- Depatment of Psychology, University of Innsbruck, Austria.,Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
| | - Korbinian Moeller
- School of Science, Centre for Mathematical Cognition, Loughborough University, United Kingdom.,Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Germany
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
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Cantón-Habas V, Carrera-González MDP, Moreno-Casbas MT, Rich-Ruiz M. Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study. BMJ Open 2021; 11:e049211. [PMID: 34158307 PMCID: PMC8220480 DOI: 10.1136/bmjopen-2021-049211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish. DESIGN Cross-sectional observational study. SETTING Two health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia. PARTICIPANTS A total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale. PRIMARY AND SECONDARY OUTCOME MEASURES Psychometric properties including content validity, construct validity and reliability of the scale have been tested. RESULTS The overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55. CONCLUSIONS The Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.
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Affiliation(s)
- Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
| | - María Del Pilar Carrera-González
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Experimental and Clinical Physiopathology Research Group, Department of Health Sciences, University of Jaen Faculty of Experimental Sciences, Jaen, Spain
| | - María Teresa Moreno-Casbas
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Cordoba, Spain
- Ciber Fragility and Healthy Aging (CIBERFES), Madrid, Spain
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
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Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate. J Clin Med 2021; 10:jcm10071424. [PMID: 33915996 PMCID: PMC8037327 DOI: 10.3390/jcm10071424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 01/01/2023] Open
Abstract
The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.
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7
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Montoro-Lorite M, Risco E, Canalias-Reverter M, Rodríguez-Murillo JA, García-Pascual M, Zabalegui A. Integrated Management of Pain in Advanced Dementia. Pain Manag Nurs 2020; 21:331-338. [PMID: 32253093 DOI: 10.1016/j.pmn.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022]
Abstract
AIM Develop and evaluate the implementation of a protocol for comprehensive management of pain in advanced dementia. METHOD Quasi-experimental study carried out between September 2015 and May 2016 in an acute geriatric unit. Following development of the protocol and nurse training, 22 participants were recruited through consecutive sampling to form the intervention group (IG). Pain assessment was performed using the Pain Assessment in Advanced Dementia Spanish version (PAINAD-Sp) instrument and by nurse report-rating using the Numeric Rating Scale (NRS) and control group, with pain assessment through nurse-report using an NRS. Interventions carried out following perception of pain were done according to the actions algorithm created for this purpose. Follow-up was carried out daily during the hospital stay. RESULTS Some 98% of the actions were performed correctly following the protocol. All (100%) of patients had a scheduled prescription for analgesics. Significant differences between mean pain scores at admission and discharge were found through PAINAD-Sp using a Wilcoxon sign test of -2.9543 (p = .004). Analysis of pain perception scores revealed a statistically significant positive correlation between the number of nonpharmacological actions performed and the pain score values obtained in the IG (rho Spearman: 0.617, p < .001) and the control group (rho Spearman: 0.922, p < .001). A high correlation was also observed in the IG between assessments conducted using PAINAD-Sp and NRS (intraclass correlation coefficient: 0.921). CONCLUSIONS The implementation of an agreed-upon, standardized protocol for comprehensive pain management in advanced dementia, including nurse training, leads to systematic application of all the protocol stages, and therefore better pain management.
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Affiliation(s)
- Mercedes Montoro-Lorite
- Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Instituto de Hematología y Oncología, Hospital Clínic, Barcelona, Spain.
| | - Ester Risco
- Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Intermediate Care Hospital, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Montserrat Canalias-Reverter
- Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Instituto de Medicina y Dermatología, Hospital Clínic, Barcelona, Spain
| | | | - Marta García-Pascual
- Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Urology Unit, Hospital Clinic, Barcelona, Spain
| | - Adelaida Zabalegui
- Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Hospital Clínic, Barcelona, Spain
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8
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Cantón-Habas V, Carrera-González MDP, Moreno-Casbas MT, Quesada-Gómez JM, Rich-Ruiz M. Correlation between biomarkers of pain in saliva and PAINAD scale in elderly people with cognitive impairment and inability to communicate: descriptive study protocol. BMJ Open 2019; 9:e032927. [PMID: 31712347 PMCID: PMC6858249 DOI: 10.1136/bmjopen-2019-032927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Pain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate. METHODS AND ANALYSIS This is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357-2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.
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Affiliation(s)
- Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
| | - María Del Pilar Carrera-González
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
| | - María Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Manuel Quesada-Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) & Unidad de Gestión Clínica (UGC) de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica (IMIBIC)/ Universidad de Córdoba/ Hospital Universitario Reina Sofía, University of Cordoba, Cordoba, Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
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9
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Rababa M, Al-Rawashdeh S. Nurses’ certainty and pain outcomes of nursing home residents with dementia: the mediating effect of pain assessment. Pain Manag 2019; 9:559-567. [DOI: 10.2217/pmt-2019-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Sami Al-Rawashdeh
- Community & Mental Health Nursing Department, Faculty of Nursing, Hashemite University, Az-Zarqa, Jordan
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10
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Kutschar P, Weichbold M, Osterbrink J. Effects of age and cognitive function on data quality of standardized surveys in nursing home populations. BMC Geriatr 2019; 19:244. [PMID: 31481012 PMCID: PMC6724313 DOI: 10.1186/s12877-019-1258-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Data quality is of special concern when it comes to survey research in nursing homes. Very little is known about specifics of cognitively impaired elderly in responding to survey questions. This study examines effects of cognitive impairment, age, gender, and interview duration on the data quality in a sample of 659 nursing home residents (NHR). Methods Within a cross-sectional design, survey methodology was used to evaluate the pain situation in 13 nursing homes. Residents were stratified into NHR with no/mild (Mini-Mental State Examination MMSE: 18–30) and NHR with moderate (MMSE: 10–17) cognitive impairment. Data quality is measured by item nonresponse (INR). Correlation analyses, ANCOVA, linear and logistic regression models are applied. Results Neither interview duration nor gender have effects on item nonresponse. Age accounts for higher INR (β = 0.12, p < 0.001). Cognitive impairment strongly predicts INR (β = − 0.40, p < 0.001). INR significantly differs between NHR with no/mild (3.98%) and moderate cognitive impairment (11.85%). The likelihood of INR > 5% for residents with moderate cognitive impairment is 3.8-times (p < 0.001) of that for those with no/mild impairment. Conclusions Surveys are adequate for residents with no/mild cognitive impairment but data quality is threatened in residents with moderate impairments. Precision and validity of responses from NHR with progressed cognitive impairment are potentially limited and results may be biased. The results clearly do support the need for a multidisciplinary ‘general theory’ of the question−/answer-process which has to be also inclusive for cognitively impaired elderly persons. Electronic supplementary material The online version of this article (10.1186/s12877-019-1258-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Kutschar
- Paracelsus Medical University, Institute of Nursing Science and Practice, Strubergasse 21, 5020, Salzburg, Austria.
| | - Martin Weichbold
- Department of Sociology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Jürgen Osterbrink
- Paracelsus Medical University, Institute of Nursing Science and Practice, Strubergasse 21, 5020, Salzburg, Austria
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11
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Thiesemann R. [Pain and ageing]. Z Gerontol Geriatr 2018; 51:855-858. [PMID: 30397739 DOI: 10.1007/s00391-018-01472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Thiesemann
- Gemeinschaftspraxis Dr.Thiesemann et al, Akademische Forschungspraxis, Universitätsklinik Hamburg-Eppendorf, Alter Postweg 25, 21075, Hamburg, Deutschland.
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12
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Pain assessment in advanced dementia. Validity of the German PAINAD—a prospective double-blind randomised placebo-controlled trial. Pain 2018; 160:742-753. [DOI: 10.1097/j.pain.0000000000001430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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13
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Lin PC, Li CH, Chou PL, Chen YM, Lin LC. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res 2018; 11:1589-1598. [PMID: 30214270 PMCID: PMC6126483 DOI: 10.2147/jpr.s172875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purposes To investigate the prevalence of pain-related diagnoses in patients with dementia and evaluate the association of pain-related diagnoses with demographic characteristics and dementia subtypes. Patients and methods In this population-based retrospective cohort study, participants were recruited from a cohort of 2 million people randomly sampled from the general population in the National Health Insurance Research Database of Taiwan from 2000 to 2013. The index year was defined as the period of 1 year from the date of the first diagnosis of dementia. Results The study group comprised 28,450 patients with the dementia subtypes of vascular dementia, Alzheimer’s disease, or other dementia subtypes. The mean age of patients with dementia was 76.75 years. Of all patients with dementia, 49.07% had at least one pain-related diagnosis documented in their outpatient or inpatient claim records within the index year. The top three pain-related diagnoses were osteoarthritis (29.27%), headache (12.53%), and osteoporosis (11.43%). Musculoskeletal diagnosis was more likely in female patients with vascular dementia. Although patients with vascular dementia had a significantly lower prevalence of pain-related diagnosis, they had a significantly higher risk of 1-year mortality than patients with other dementia subtypes. Conclusion During the index year, 49.07% of patients with dementia had at least one pain-related diagnosis. To investigate the differences of the use of pain medication in patients with different dementia subtypes and the difference of pain-related diagnosis and treatment in patients with and without dementia, future studies are recommended.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Mei Chen
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,International Medical Service Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan,
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14
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Montoro-Lorite M, Canalias-Reverter M. Protocolos de gestión del dolor en demencia avanzada. ENFERMERIA CLINICA 2018; 28:194-204. [DOI: 10.1016/j.enfcli.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022]
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15
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Schofield P. The Assessment of Pain in Older People: UK National Guidelines. Age Ageing 2018; 47:i1-i22. [PMID: 29579142 PMCID: PMC5888957 DOI: 10.1093/ageing/afx192] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pat Schofield
- Positive Ageing Research Institute Anglia Ruskin University Chelmsford, Cambridge
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Pain as a Predictor of Disability in Elderly Population. Anesthesiology 2017; 127:1038-1039. [DOI: 10.1097/aln.0000000000001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Quality assurance of pain care in Austria : Classification of management facilities]. Wien Med Wochenschr 2017; 167:349-358. [PMID: 28424996 DOI: 10.1007/s10354-017-0563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
In Austria there is no nationwide coverage of pain management, which meets even approximately international criteria. At present there are about 30 interdisciplinary pain management offices and clinics providing care according to a concept of the Austrian Pain Society (ÖSG), about 10 other outpatient pain clinics are located in district and country hospitals. A few years ago, there still were about 50 pain clinics. Yet closure of outpatient clinics and cost-cutting measures in the health sector jeopardize adequate pain relief for patients with chronic pain conditions.Hence, the supply of care for approx. 1.8 mio. Austrians with chronic pain is not guaranteed due to lack of a comprehensive demand planning of pain care facilities. Furthermore, existing structures such as specialized clinics or emergency services in hospitals are primarily based on the personal commitment of individuals. At present, the various centres for pain management in Austria are run with very different operating times, so that for 74% of the chronic pain patients the desired requirements for outpatient pain management are not met and about 50 full-time pain clinics are missing.Under the patronage of the Austrian Pain Society, various national specialist societies have defined the structure and quality criteria for pain management centres in Austria, include, among others, proof of training, cooperation in interdisciplinary teams or minimum number of new patients per year, depending on the classification of the institution.This stepwise concept of care provision for pain patients is intended as first step to help improve the care of pain patients in Austria!
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Münter KH, Clemmesen CG, Foss NB, Palm H, Kristensen MT. Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery. Disabil Rehabil 2017; 40:1808-1816. [DOI: 10.1080/09638288.2017.1314556] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kristine H. Münter
- Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Nicolai B. Foss
- Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Henrik Palm
- Hip Fracture Unit, Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
| | - Morten T. Kristensen
- Hip Fracture Unit, Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark
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Kutschar P, Bauer Z, Gnass I, Osterbrink J. Does item overlap render measured relationships between pain and challenging behaviour trivial? Results from a multicentre cross-sectional study in 13 German nursing homes. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Patrick Kutschar
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Zsuzsa Bauer
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
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Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation. Pain Res Manag 2016; 2016:6493463. [PMID: 27445619 PMCID: PMC4904616 DOI: 10.1155/2016/6493463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
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Fry M, Chenoweth L, Arendts G. Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study. Int Emerg Nurs 2016; 24:54-60. [DOI: 10.1016/j.ienj.2015.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/01/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
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Baeta-Corral R, Defrin R, Pick CG, Giménez-Llort L. Tail-flick test response in 3×Tg-AD mice at early and advanced stages of disease. Neurosci Lett 2015; 600:158-63. [DOI: 10.1016/j.neulet.2015.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 12/15/2022]
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Lee KH, McConnell ES, Knafl GJ, Algase DL. Pain and psychological well-being among people with dementia in long-term care. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:1083-9. [PMID: 25800276 PMCID: PMC4478238 DOI: 10.1111/pme.12739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the relationship between self-reported pain and psychological well-being of people with dementia (PWD) living in residential long-term care as indicated by displays of observed emotional expression over the daytime period. DESIGN Secondary analysis using repeated measures of self-report and observational data. SETTING AND SUBJECTS A total of 177 PWD were included from 17 nursing homes and six assisted living facilities in Michigan and Pennsylvania. METHODS Negative emotional expression was used as an indicator of reduced psychological well-being. Pain was assessed through PWD's response to a question about presence of pain obtained at each observation. Cognitive impairment was assessed using the Mini-Mental Status Examination. Linear mixed models were used that accounted for correlation of negative emotional expression measurements over time for each participant and between participants within the same facility. RESULTS Among 171 participants who were able to express their pain, 44% of PWD reported pain once or more during the daytime period. Severity of cognitive impairment was related to expression of negative emotion. PWD with pain displayed more negative emotional expression than PWD without pain. CONCLUSIONS Routine pain assessment is feasible among PWD with moderate to severe dementia and positive report of pain is associated with greater observed negative emotional expression, an indicator of reduced psychological well-being. Improving pain management holds potential for enhancing psychological well-being among PWD living in residential long-term care.
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Affiliation(s)
- Kyung Hee Lee
- Boston College, Connell School of Nursing, Chestnut Hill, MA, USA
| | - Eleanor S McConnell
- Duke University, School of Nursing, Clinical Nurse Researcher, Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - George J Knafl
- University of North Carolina, Chapel Hill, School of Nursing, Chapel Hill, NC, USA
| | - Donna L Algase
- University of Michigan, School of Nursing, Ann Arbor, MI, USA
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Abstract
Systematic reviews of psychosocial assessment and effectiveness of psychotherapy for chronic pain syndromes in older patients are rare. However, it is of particular importance to consider the psychosocial aspects of elderly people with chronic pain. This narrative review describes recommended German-language assessments of the psychosocial dimensions of pain and summarizes existing studies of psychological therapy approaches for chronic pain in old age. Effective psychometric instruments are available for the assessment of cognitive function, pain-specific attitudes, depression, fear of falling, interpersonal processes and social activities, pain management, pain acceptance, disability, psychological well-being, and quality of life. Further experience with the use of these instruments with cognitively impaired or geriatric patients is required. The efficacy of age-adapted cognitive behavioral therapy and multimodal therapy for older patients has been documented. However, there is often a lack of supporting documentation about important result parameters (e.g., quality of life, functioning in everyday life, or pain acceptance). Overall, chronic pain in elderly people requires a biopsychosocial-spiritual model of pain. More attention should be given in research and daily practice to religiosity/spirituality as a possible means of coping, while mindfulness- and acceptance-based therapies should be further explored.
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Lukas A, Mayer B, Onder G, Bernabei R, Denkinger M. Schmerztherapie in deutschen Pflegeeinrichtungen im europäischen Vergleich. Schmerz 2015; 29:411-21. [DOI: 10.1007/s00482-015-0004-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cowen R, Stasiowska MK, Laycock H, Bantel C. Assessing pain objectively: the use of physiological markers. Anaesthesia 2015; 70:828-47. [PMID: 25772783 DOI: 10.1111/anae.13018] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2015] [Indexed: 12/14/2022]
Abstract
Pain diagnosis and management would benefit from the development of objective markers of nociception and pain. Current research addressing this issue has focused on five main strategies, each with its own advantages and disadvantages. These encompass: (i) monitoring changes in the autonomic nervous system; (ii) biopotentials; (iii) neuroimaging; (iv) biological (bio-) markers; and (v) composite algorithms. Although each strategy has shown areas of promise, there are currently no validated objective markers of nociception or pain that can be recommended for clinical use. This article introduces the most important developments in the field and highlights shortcomings, with the aim of allowing the reader to make informed decisions about what trends to watch in the future.
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Affiliation(s)
- R Cowen
- Chelsea and Westminster NHS Foundation Trust, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - M K Stasiowska
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - H Laycock
- Chelsea and Westminster NHS Foundation Trust, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - C Bantel
- Chelsea and Westminster NHS Foundation Trust, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Wolrich J, Poots AJ, Kuehler BM, Rice ASC, Rahman A, Bantel C. Is number sense impaired in chronic pain patients? Br J Anaesth 2014; 113:1024-31. [PMID: 25082664 PMCID: PMC4235572 DOI: 10.1093/bja/aeu255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. Methods First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. Results Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research.
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Affiliation(s)
- J Wolrich
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - A J Poots
- NIHR CLAHRC for NWL, Department of Medicine, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - B M Kuehler
- Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - A Rahman
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK
| | - C Bantel
- Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London SW10 9NH, UK Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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Lukas A, Niederecker T, Günther I, Mayer B, Nikolaus T. Self- and proxy report for the assessment of pain in patients with and without cognitive impairment: experiences gained in a geriatric hospital. Z Gerontol Geriatr 2013; 46:214-21. [PMID: 23474866 DOI: 10.1007/s00391-013-0475-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain assessment is a complex procedure in patients with different degrees of cognitive impairment. The challenge is to determine whether self-reporting tools are adequate and to identify the cases in which proxy ratings are necessary. PATIENTS AND METHODS As part of an open, prospective observational study, 178 patients underwent a comprehensive pain assessment consisting of the Numeric Rating Scale (NRS), the Verbal Rating Scale with four and five items (VRS4 and VRS5) and the Pain Assessment in Advanced Dementia Scale (PAINAD). RESULTS Even without prior knowledge of a patient's cognitive impairment, this toolkit can be used to reliably identify cases where self-rating is appropriate and where proxy rating becomes necessary. Inter-rater reliability: "good" agreement [Cohen's κ = 74.2% (p < 0.001) (95%CI, 54.6-93.8%)], test-retest reliability: "moderate" agreement [κ = 55.3% (p < 0.001) (95%CI, 28.5-82.1%)]. Furthermore, movement resulted in a higher correlation between the selected assessments. Self-report assessments are appropriate up to a mini-mental state examination (MMSE) value greater than ten. In comparison to NRS, VRS4 and VRS5 remain more stable as the degree of cognitive impairment increases. CONCLUSIONS In the majority of the cases, our approach enables reliable appropriate pain assessment without the strict prerequisite of an upstream cognitive assessment.
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Affiliation(s)
- A Lukas
- Agaplesion Bethesda Clinic, Competence Center of Geriatrics and Aging Research, Stipendiat Forschungskolleg Geriatrie, Robert Bosch Stiftung, University of Ulm, Akademisches Krankenhaus Universität Ulm, Zollernring 26-28, 89073, Ulm, Germany.
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Lukas A, Barber JB, Johnson P, Gibson SJ. Observer-rated pain assessment instruments improve both the detection of pain and the evaluation of pain intensity in people with dementia. Eur J Pain 2013; 17:1558-68. [PMID: 23737457 DOI: 10.1002/j.1532-2149.2013.00336.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Observer-rated pain assessment instruments for people with dementia have proliferated in recent years and are mainly effective in identifying the presence of pain. The objective of this study was to determine whether these tools can also be used to evaluate intensity of pain. METHOD Quasi-experimental design. Cognitively intact [Mini Mental State Examination (MMSE) ≥ 24, n = 60] and impaired people (MMSE < 20, n = 65) in nursing home facilities took part in the study. Participants were observed at rest and during a movement protocol. Directly afterwards, the observer, blinded to cognitive status, completed three behavioural pain assessment instruments (Abbey Pain Scale, Pain Assessment in Advanced Dementia Scale (PAINAD), Non-communicative Patient's Pain Assessment Instrument (NOPPAIN) ], before interviewing the resident about pain self-report. RESULTS Significant correlations were found between observer-rated and self-rated measures of pain and were stronger in persons with dementia than in cognitively intact adults. Discriminant function analysis (DFA) revealed: (1) that the use of observer-rated instruments improved recognition of the presence or absence of pain by up to 25.4% (in dementia) and 28.3% (in cognitively intact adults) above chance; and (2) the same instruments improved the classification of residents into the correct self-reported level of pain intensity by up to 42.5% (in dementia) and 34.1% (in cognitively intact adults) above chance. However, DFA also reveals a considerable rate of 'false alarms' for pain in cognitively intact and 'misses' in cognitively impaired people. CONCLUSIONS The use of the Abbey Pain Scale, PAINAD or NOPPAIN improves both the recognition of pain presence/absence as well as rating pain severity in older people with impaired cognition.
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Affiliation(s)
- A Lukas
- National Ageing Research Institute, Parkville, Australia; AGAPLESION Bethesda Clinic Ulm, University of Ulm, Germany
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Albrecht JS, Gruber-Baldini AL, Fromme EK, McGregor JC, Lee DSH, Furuno JP. Quality of hospice care for individuals with dementia. J Am Geriatr Soc 2013; 61:1060-5. [PMID: 23710597 DOI: 10.1111/jgs.12316] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with dementia constitute an increasing proportion of hospice enrollees, yet little is known about the quality of hospice care for this population. The aim of this study was to quantify differences in quality of care measures between hospice patients with and without dementia. DESIGN Cross-sectional analysis of data. SETTING 2007 National Home and Hospice Care Survey. PARTICIPANTS Four thousand seven hundred eleven discharges from hospice care. MEASUREMENTS A primary diagnosis of dementia at discharge was defined according to International Classification of Diseases, Ninth Revision, codes (290.0-290.4x, 294.0, 294.1, 294.8, 331.0-331.2, 331.7, and 331.8). Quality-of-care measures included enrollment in hospice in the last 3 days of life, receiving tube feeding, depression, receiving antibiotics, lack of advanced directive or do not resuscitate order, Stage II or greater pressure ulcers, emergency care, lack of continuity of residence, and a report of pain at last assessment. RESULTS Four hundred fifty (9.5%) individuals were discharged with a primary diagnosis of dementia. In multivariable analysis, individuals with dementia were more likely to receive tube feeding (odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.4-4.5) and to have greater continuity of residence (OR = 1.8, 95% CI = 1.1-3.0) than other individuals in hospice and less likely to have a report of pain at last assessment (OR = 0.6, 95% CI = 0.3-0.9). CONCLUSIONS The majority of quality-of-care measures examined did not differ between individuals in hospice with and without dementia. Use of tube feeding in hospice care and methods of pain assessment and treatment in individuals with dementia should be considered as potential quality-of-care measures.
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Affiliation(s)
- Jennifer S Albrecht
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
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Lorenzl S, Nübling G, Perrar KM, Voltz R. Palliative treatment of chronic neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:133-9. [DOI: 10.1016/b978-0-444-53501-6.00010-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ferrocene tripeptide Gly-Pro-Arg conjugates: Synthesis and inhibitory effects on Alzheimer’s Aβ1–42 fibrillogenesis and Aβ-induced cytotoxicity in vitro. Bioorg Med Chem 2013; 21:395-402. [DOI: 10.1016/j.bmc.2012.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022]
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