ANA ASLAN INTERNATIONAL ACADEMY OF AGING ANA ASLAN INTERNATIONALFOUNDATION 1 PAIN QUANTIFICATION IN...

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PAIN QUANTIFICATION IN SEVERE ALZHEIMER’S DISEASE: ADVANTAGES AND DISADVANTAGES

OF PAIN ASSESSMENT SCALES

Ioana Ioancio, MD, PhD Ana Aslan International Academy of Aging,

“Elias” University Emergency Hospital, Bucharest, Romania

Ileana Turcu, , PhDAna Aslan International Academy of Aging,

Bucharest, Romania

Luiza Spiru, MD, PhDHead of the Day Hospital of Memory Diseases,

President of Ana Aslan International FoundationVice-President of Ana Aslan International

Academy of Aging, Professor of Geriatric Dept. ”Carol Davila” University of Medicine and Pharmacy,

“Elias” University Emergency Hospital, Bucharest, Romania

26th International Conference of Alzheimer Disease International ADI 2011

26-29 March 2011Toronto, CanadaToronto, Canada

26th International Conference of Alzheimer Disease International ADI 2011

26-29 March 2011Toronto, CanadaToronto, Canada

All rights reserved. No part of these slides can be reproduced, stocked or transmitted in no other form and through no other electronic, mechanic, or photocopy way, without the approval of “Ana Aslan” International Academy of Aging®© “Ana Aslan” International Foundation ®© Brain Aging International Journal ®©.

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Content

Background ‘Alzheimer’s Crisis’Personality changes in dementias

Our studyAimsSubjectsMethodsResultsDiscussionsConclusions

To do in the management of behavioral symptoms

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Background

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50-85% of the geriatric patients have pain

32-53% of the patients with dementia have pain daily

Dementia is associated with SNC changes that alter pain tolerance, but not pain thresholds.

Horgas AL et al., 2009. Pain assessment in Persons with Dementia: Relationship

Between Self Report and Behavioral Observation. J Am Geriatr Soc 57:126-132


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Horgas AL et al., 2009. Pain assessment in Persons with Dementia: Relationship

Between Self Report and Behavioral Observation. J Am Geriatr Soc 57:126-132

PAIN SELF REPORT a standard criterion of pain assessment , but INSUFFICIENT ! often underestimates patient’s pain.

Pain Self-Report contains: pain presence disclosed by Structured Pain Interview pain intensity pain duration pain location


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Catananti C, Gambassi G, 2010. Pain

assessment in the elderly. Surgical

Oncology, 9:140-148.

Pain reporting depends of :

Biology Age older people experience less pain the perception that pain is an inevitable part of

aging

Culture pain is something to be endured pain means weakness Religion Ethnicity Cognitive impairment


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Linda Mc Auliffe et al., 2008. Pain assessment in older people with dementia:

Literature review. Journal of Advanced Nursing.

Barriers in pain recognition:

’no - pain’ subset of people with dementia,

stoical attitudes.


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Quantitative Assessment of Pain :

1. Visual Analogue Scale (VAS)2. The faces pain scale3. The verbal rating scale4. The numerical rating scale.

1.Catananti C, Gambassi G, 2010. Pain assessment in the elderly.

Surgical Oncology, 9:140-148.

Pain measurementthe most adequate assessment.


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Quantitative Assessment of Pain :

Involves:

Localisation and referral pattern of pain + complete functional physical examination

Characteristics of pain McGill Pain Questionnaire (emotional, sensory and evaluative dimensions of pain)

Quantification of response to analgesic therapies. Patient’s current level of functioning (ADL,IADL, Barthel

Score) Consideration of:

Affective disorders (anxiety, anger) the Geriatric Depression Scale

Cognitive impairment , delirium and behaviour disturbances

Sleep disorders

Frequent re-evaluation is an essential part of effective management 1.Catananti C, Gambassi G, 2010. Pain assessment in

the elderly.Surgical Oncology, 9:140-148.


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Dementia a major impediment in the evaluation and management of pain.

Cross-sectional studies less analgesics were administrated in Alzheimer’s patients than in non-cognitively impaired old people.

Cognitive impairment may be aggravated by uncontrolled pain.

In clinical practice the ability to remember, interpret and respond to pain can be altered in patients with dementia.

1.Catananti C, Gambassi G, 2010. Pain assessment in the elderly.

Surgical Oncology, 9:140-148.

Pain assessment in Dementia


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The Pain Assessment in Advanced Dementia (PAINAD) includes:

assesses breathing, negative vocalisation, facial expression, body language .

The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) -60 items organized in 4 groups:

facial expression, activity/body movement, social/personality/mood indicators physiological needs

Cf. Catananti C, Gambassi G, 2010. Pain assessment in the

elderly. Surgical Oncology, 9:140-148.


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Dolophus 2: 5 somatic items: somatic complaints, protective body posture adopted at rest, protection of sore areas, facial expression and gaze, sleep pattern),

2 psychomotor items:based on observation of washing and/or dressing and mobility3 psychosocial items: communication, social interaction, behaviour)

The Elderly Pain Caring Assessment -2(EPCA-2)8 item behavioural scale to rate the intensity of pain in non-verbally communicating older patients.Cf. Catananti C, Gambassi G, 2010. Pain

assessment in theelderly. Surgical Oncology, 9:140-148.


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Our study

The aim:

Quantitative estimation of pain intensity using various pain scales,

Detection of different scales power

on patients referred to our Ana Aslan Memory Clinic from Bucharest, Romania.

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Methods

Patients:

510 patients diagnosed with severe Alzheimer dementia 398 females 112 males mean age 73.5 years

Assessment tools:

Visual Analog Scale, Graphic Scale, Verbal Scale, Word Descriptor ScaleScales for Evaluation of Functional Performance (ADL, IADL).

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For an accurate assessment of pain we had to identify the type of pain, the characteristics and severity of pain .

The pain was quantified : at the first visit periodically afterwards.

Only 10% (n=51) of all patients could be assessed using all 5 scales.

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Results

Scale Percent of compliant patients (assessment

scale completion)Graphic Scale 81% (n=413)Word Descriptor Scale 52.9% (n=270)Evaluation of Functional Performance Scale

89.6% (n=457)

Visual Analog Scale 33% (n=168)Verbal Scale 26.8% (n=137)

15% of patients’ assessments were deemed

as ambiguous (contradictory results)


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Conclusions

Because our patients have: severe memory impairment difficulty integrating pain experiences over time,

A single pain quantification scale: is far to reflect the involvement of pain in the patient’s

situation to offer sufficient information for his/her management

As much as possible scales must be applied They must be correlated with:

the severity of cognitive impairments (psychometric scales scores)

the outcomes of analgesic medication Information provided by the caregiver.


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Only then we can adjust: timing dosage

of different drugs administration (either for the

disease per se or analgesics),

or we can react by suggesting nondrugtherapies for more physical,

psychological,social and spiritual comfort.

ANA ASLANINTERNATIONAL

ACADEMY OF AGING

ANA ASLANINTERNATIONALFOUNDATION

Thank you for

attention

and feedback

HealthyBrain Aging

Healthy Aging

Ioana Ioancio, MD, [email protected]

Ileana Turcu, [email protected]

Luiza Spiru, MD, [email protected]

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