Validity of pain behaviors in persons with mild to moderate cognitive impairment.
OBJECTIVE
To evaluate the validity of traditional pain behaviors (guarding, bracing, rubbing, grimacing, and sighing) in persons with and without cognitive impairment and chronic low back pain (CLBP).


METHODS
Prospective observational study.


METHODS
Outpatient clinics.


METHODS
Thirty-seven cognitively intact and 40 cognitively impaired participants with and without CLBP.


METHODS
Frequency of traditional pain behaviors.


RESULTS
Forty-six of the participants were pain free, and 31 had CLBP. The internal consistency reliability coefficient of the five pain behaviors was 0.32, suggesting that a unidimensional scale did not exist. Multivariate analysis of variance analysis according to the independent variables pain status (pain free vs CLBP) and cognitive status (intact vs impaired) with the dependent variable frequency of pain behaviors found significant differences according to pain status (F[5,61]=3.06, P=.02) and cognitive status (F[5,61]=5.41, P<.001) but without evidence of an interaction (F[5,61]=1.14, P=.35). Participants with CLBP exhibited significantly higher levels of grimacing (P<.001) and guarding (P=.02) than pain-free participants. Intact subjects exhibited fewer guarding (P=.02) and rubbing behaviors (P<.001) but a higher number of bracing behaviors (P=.03) than cognitively impaired participants.


CONCLUSIONS
These results support the utility of facial grimacing in assessing pain in patients with mild to moderate cognitive impairment and call into question the validity of guarding and rubbing in assessing pain in persons with mild to moderate cognitive impairment.
Shega
Joseph W
JW
Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, Illinois 60611, USA. shega@northwestern.edu
Rudy
Thomas
T
Keefe
Francis J
FJ
Perri
Lisa Caitlin
LC
Mengin
Olga Telgarska
OT
Weiner
Debra K
DK
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D003072:Cognition Disorders / Q000523:psychology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D055809:Illness Behavior; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009633:Nonverbal Communication; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods* / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results