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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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Beach PA, Huck JT, Zhu DC, Bozoki AC. Altered Behavioral and Autonomic Pain Responses in Alzheimer's Disease Are Associated with Dysfunctional Affective, Self-Reflective and Salience Network Resting-State Connectivity. Front Aging Neurosci 2017; 9:297. [PMID: 28959201 PMCID: PMC5603705 DOI: 10.3389/fnagi.2017.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/30/2017] [Indexed: 12/25/2022] Open
Abstract
While pain behaviors are increased in Alzheimer's disease (AD) patients compared to healthy seniors (HS) across multiple disease stages, autonomic responses are reduced with advancing AD. To better understand the neural mechanisms underlying these phenomena, we undertook a controlled cross-sectional study examining behavioral (Pain Assessment in Advanced Dementia, PAINAD scores) and autonomic (heart rate, HR) pain responses in 24 HS and 20 AD subjects using acute pressure stimuli. Resting-state fMRI was utilized to investigate how group connectivity differences were related to altered pain responses. Pain behaviors (slope of PAINAD score change and mean PAINAD score) were increased in patients vs. CONTROLS Autonomic measures (HR change intercept and mean HR change) were reduced in severe vs. mildly affected AD patients. Group functional connectivity differences associated with greater pain behavior reactivity in patients included: connectivity within a temporal limbic network (TLN) and between the TLN and ventromedial prefrontal cortex (vmPFC); between default mode network (DMN) subcomponents; between the DMN and ventral salience network (vSN). Reduced HR responses within the AD group were associated with connectivity changes within the DMN and vSN-specifically the precuneus and vmPFC. Discriminant classification indicated HR-related connectivity within the vSN to the vmPFC best distinguished AD severity. Thus, altered behavioral and autonomic pain responses in AD reflects dysfunction of networks and structures subserving affective, self-reflective, salience and autonomic regulation.
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Affiliation(s)
- Paul A Beach
- D.O., Ph.D. Training Program, Michigan State University College of Osteopathic MedicineEast Lansing, MI, United States.,Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States
| | - Jonathan T Huck
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States
| | - David C Zhu
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States.,Department of Radiology, Michigan State UniversityEast Lansing, MI, United States.,Department of Psychology, Michigan State UniversityEast Lansing, MI, United States
| | - Andrea C Bozoki
- Neuroscience Program, Michigan State UniversityEast Lansing, MI, United States.,Department of Neurology & Ophthalmology, Michigan State UniversityEast Lansing, MI, United States
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Affiliation(s)
- Monica Malec
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
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Abstract
Introduction The aim was to investigate whether therapeutic massage was effective in relieving pain in elderly residents with dementia. Methods A randomized controlled study was conducted in an aged care facility. Ten participants with dementia or advanced dementia were allocated to an intervention group or a control group. The intervention group received 10 min of massage (effleurage, kneading, and trigger point therapy) four times per week for 4 weeks. The Pain Assessment in Advanced Dementia scale was used as the outcome measure. Results No significant changes in mean outcome measure scores were found post intervention (Intervention mean = 5.0 ± 3.49; Control mean = 5.2 ± 3.49: t(8) = 0.09, p = 0.93). However, the Intervention Group had a greater magnitude of change (1.200 ± 1.78) when compared to the control group (0.800 ± 2.16). Conclusion Therapeutic massage may provide a useful adjunct to the current pain management plan of patients with dementia.
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Affiliation(s)
- Yamini Kapoor
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Australia
| | - Robin Orr
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Australia
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Beach PA, Huck JT, Miranda MM, Bozoki AC. Autonomic, Behavioral, and Subjective Pain Responses in Alzheimer's Disease. PAIN MEDICINE 2015; 16:1930-42. [DOI: 10.1111/pme.12769] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/11/2015] [Accepted: 03/25/2015] [Indexed: 12/31/2022]
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Pain Assessment Strategies in Home Care and Nursing Homes in Mid-Norway: A Cross-sectional Survey. Pain Manag Nurs 2015; 16:602-8. [PMID: 25982750 DOI: 10.1016/j.pmn.2015.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/22/2022]
Abstract
The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes.
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Guo LL, Li L, Liu YW, Herr K. Evaluation of two observational pain assessment scales during the anaesthesia recovery period in Chinese surgical older adults. J Clin Nurs 2014; 24:212-21. [PMID: 25236497 DOI: 10.1111/jocn.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Li-Li Guo
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Li Li
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Yao-Wei Liu
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Keela Herr
- The University of Iowa College of Nursing; Iowa City IA USA
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Carezzato NL, Valera GG, Vale FAC, Hortense P. Instruments for assessing pain in persons with severe dementia. Dement Neuropsychol 2014; 8:99-106. [PMID: 29213889 PMCID: PMC5619115 DOI: 10.1590/s1980-57642014dn82000003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Through an integrative literature review involving the CINAHL, Cochrane, Embase,
LILACS, PsycINFO, PubMed databases, tools available in the literature for
assessing pain in individuals with severe dementia were identified along with
versions validated for use in Brazil. We found 1501 relevant articles which,
after selection of abstracts and full reading, yielded a final sample of 33
articles. The analysis enabled the identification of 12 instruments: ABBEY PAIN
SCALE; ADD; CNPI; CPAT; DOLOPLUS-2; MOBID and MOBID-2; MPS; NOPPAIN; PACSLAC;
PADE; PAINAD and PAINE. Despite the wide variety of tools for assessing pain in
individuals with severe dementia worldwide, it was observed that only four are
available in Portuguese, of which two are culturally adapted for Brazilian
Portuguese (NOPPAIN and PACSLAC) and two validated for Portuguese of Portugal
(DOLOPLUS and PAINAD), pointing to the need for further validation of
instruments for use in Brazil.
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Affiliation(s)
- Natália Lindemann Carezzato
- Resident Nurse in Nursing in Health of Adults and Elderly - UNICAMP, Campinas SP, Brazil. Bachelor and Licentiate degree in Nursing from the Federal University of São Carlos, Center for Biological Science and Health/Department of Nursing, São Carlos SP, Brazil
| | - Gabriela Gallego Valera
- Nurse, Master's in Nursing. Center for Biological Science and Health/Department of Nursing - Federal University of São Carlos, São Carlos SP, Brazil
| | - Francisco Assis Carvalho Vale
- Medical Doctor, PhD in Neurology/Neurosciences, Associate Professor. Center for Biological Science and Health/Department of Medicine - Federal University of São Carlos, São Carlos SP, Brazil
| | - Priscilla Hortense
- Nurse, PhD in Nursing, Associate Professor. Center for Biological Science and Health/Department of Nursing - Federal University of São Carlos, São Carlos SP, Brazil
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Apinis C, Tousignant M, Arcand M, Tousignant-Laflamme Y. Can Adding a Standardized Observational Tool to Interdisciplinary Evaluation Enhance the Detection of Pain in Older Adults with Cognitive Impairments? PAIN MEDICINE 2014; 15:32-41. [DOI: 10.1111/pme.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brinkkemper T, van Norel AM, Szadek KM, Loer SA, Zuurmond WWA, Perez RSGM. The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: a systematic review. Palliat Med 2013; 27:54-67. [PMID: 22045725 DOI: 10.1177/0269216311425421] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative sedation is the intentional lowering of consciousness of a patient in the last phase of life to relieve suffering from refractory symptoms such as pain, delirium and dyspnoea. AIM In this systematic review, we evaluated the use of monitoring scales to assess the degree of control of refractory symptoms and/or the depth of the sedation. DESIGN A database search of PubMed and Embase was performed up to January 2010 using the search terms 'palliative sedation' OR 'terminal sedation'. DATA SOURCES Retro- and prospective studies as well as reviews and guidelines containing information about monitoring of palliative sedation, written in the English, German or Dutch language were included. RESULTS The search yielded 264 articles of which 30 were considered relevant. Most studies focused on monitoring refractory symptoms (pain, fatigue or delirium) or the level of awareness to control the level of sedation. Four prospective and one retrospective study used scales validated in other settings: the Numeric Pain Rating Scale, the Visual Analogue Scale, the Memorial Delirium Assessment Scale, the Communication Capacity Scale and Agitation Distress Scale. Only the Community Capacity Scale was partially validated for use in a palliative sedation setting. One guideline described the use of a scale validated in another setting. CONCLUSIONS A minority of studies reported the use of observational scales to monitor the effect of palliative sedation. Future studies should be focused on establishing proper instruments, most adequate frequency and timing of assessment, and interdisciplinary evaluation of sedation depth and symptom control for palliative sedation.
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Affiliation(s)
- Tijn Brinkkemper
- Department of Anaesthesiology, VU University Medical Centre, Amsterdam, The Netherlands.
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Zwakhalen SMG, van der Steen JT, Najim MD. Which score most likely represents pain on the observational PAINAD pain scale for patients with dementia? J Am Med Dir Assoc 2012; 13:384-9. [PMID: 21640656 DOI: 10.1016/j.jamda.2011.04.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We sought to determine a cutoff score for the observational Pain Assessment in Advanced Dementia (PAINAD), to adequately assess pain in clinical nursing home practice and research. DESIGN AND SETTING We used data from multiple sources. We performed a literature review on PAINAD, performed secondary data analysis of a study examining psychometric properties of PAINAD in nursing home patients with dementia, and performed another study in nursing home patients with dementia specifically aimed at determining a cutoff score for PAINAD. PARTICIPANTS Patients with dementia in long term care facilities. MEASUREMENTS We related PAINAD scores (range 0 to 10) to (1) self-reported and proxy-reported pain by global clinical judgment and (2) scores on another pain assessment instrument (DOLOPLUS-2), and (3) we compared scores between painful and supposedly less painful conditions. RESULTS Findings from this study showed that a cutoff value of 2 should serve as a trigger for a trial with pain treatment. Although the majority of patients scoring 1 or 0 were not in pain, pain could be ruled out. CONCLUSION Based on the findings of multiple available data sources, we recommend that a PAINAD score of 2 or more can be used as an indicator of probable pain. A score of 1 is a sign to be attentive to possible pain. Future work may focus on cutoff scores for the presence of pain and severe pain in other frequently used pain tools, and on further development of methodology to assess cutoff scores.
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Affiliation(s)
- Sandra M G Zwakhalen
- Maastricht University, School for Public Health and Primary Care (Caphri), Maastricht, the Netherlands.
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A Comparative Investigation of Observational Pain Assessment Tools for Older Adults With Dementia. Clin J Pain 2012; 28:226-37. [DOI: 10.1097/ajp.0b013e3182290d90] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Support for Traumatic Brain Injury Patients’ Family Members in Neurosurgical Nursing. J Neurosci Nurs 2011; 43:337-48. [DOI: 10.1097/jnn.0b013e318234ea0b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jordan A, Hughes J, Pakresi M, Hepburn S, O'Brien JT. The utility of PAINAD in assessing pain in a UK population with severe dementia. Int J Geriatr Psychiatry 2011; 26:118-26. [PMID: 20652872 DOI: 10.1002/gps.2489] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Studies suggest that pain is under-recognized and under-treated in those with severe dementia. Identifying pain is the first step in its effective management. Few studies have investigated the utility of behavioural pain tools in those with advanced dementia. METHODS Participants were nursing home residents with advanced dementia who were observed on three occasions using a pain assessment tool (PAINAD). Following further assessment, an appropriate management plan was formulated for those thought to be in pain. Participants who scored above the cutoff (two) on the PAINAD scale, but were felt not to be in pain, formed the false positive group. The pain and false positive groups were reassessed at 1 and 3 months. RESULTS Seventy-nine participants completed the study, with 39 participants scoring above two on the PAINAD. Of these, only 13 were assessed as being in pain. The other 26 participants who scored above the cutoff on PAINAD were not felt to be in pain. Instead, their behaviour had a psychosocial explanation, often to do with a lack of understanding as to what was happening to them. The sensitivity of PAINAD was 92%. In those with pain, a significant decrease was demonstrated in the PAINAD scores on intervention following treatment for pain (p=0.008). CONCLUSIONS PAINAD is a sensitive tool for detecting pain in people with advanced dementia, but has a high false positive rate, frequently detecting psychosocial distress rather than pain. PAINAD can be used to assess whether pain management strategies have been successful.
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Affiliation(s)
- Alice Jordan
- Northumbria Healthcare NHS Foundation Trust, UK.
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Paulson-Conger M, Leske J, Maidl C, Hanson A, Dziadulewicz L. Comparison of two pain assessment tools in nonverbal critical care patients. Pain Manag Nurs 2010; 12:218-24. [PMID: 22117753 DOI: 10.1016/j.pmn.2010.05.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/12/2010] [Accepted: 05/26/2010] [Indexed: 11/19/2022]
Abstract
It is recommended that patient's self-report of pain should be obtained as often as possible as the "gold standard." Unfortunately in critical care, many factors can alter verbal communication with patients, making pain assessment more difficult. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have improved pain management strategies. However, pain assessment for nonverbal patients in critical care continues to present a challenge for clinicians and researchers. The purpose of this study was to compare the Pain Assessment in Advanced Dementia (PAINAD) and the Critical-Care Pain Observation Tool (CPOT) scores for assessment in nonverbal critical care patients. A descriptive, comparative, prospective design was used in this study. A convenience sample of 100 critical care, nonverbal, adult patients of varying medical diagnoses who required pain evaluation were assessed with the PAINAD and CPOT scales. Data were collected over a 6-month period in all critical care areas. Observations of pain assessments for nonverbal patients who required pain evaluation were recorded on the PAINAD and the CPOT successively. Internal consistency reliability for the PAINAD was 0.80 and for the CPOT 0.72. Limits of agreement indicated that there was no difference in PAINAD and CPOT scores for assessing pain in nonverbal patients in critical care. Further research in the area of pain assessment for nonverbal patients in critical care is needed.
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Ersek M, Herr K, Neradilek MB, Buck HG, Black B. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. PAIN MEDICINE (MALDEN, MASS.) 2010; 11:395-404. [PMID: 20088854 PMCID: PMC2866060 DOI: 10.1111/j.1526-4637.2009.00787.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. DESIGN In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. SETTING Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. MEASURES Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment.
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Affiliation(s)
- Mary Ersek
- School of Nursing, University of Pennsylvania, Room 329, 418 Curie Bld, Philadelphia, PA 19104-6096, USA.
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Herr K, Bursch H, Ersek M, Miller LL, Swafford K. Use of Pain-Behavioral Assessment Tools in the Nursing Home: Expert Consensus Recommendations for Practice. J Gerontol Nurs 2010; 36:3-4. [DOI: 10.3928/00989134-20100108-04] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 10/05/2009] [Indexed: 01/08/2023]
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Do We Need Another Dementia Pain Scale? J Am Med Dir Assoc 2009; 10:450-2. [DOI: 10.1016/j.jamda.2009.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
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