Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients.
OBJECTIVE
Difficulties in communication and lack of suitable pain scales may lead to undertreatment of pain in cognitively impaired patients. We performed a study in this type of patients and evaluated the usefulness of four simple pain scales.


METHODS
We studied 41 hospitalized elderly (76-95 years) who suffered from pain with an acute component. Cognitive function was assessed with the mini-mental state examination (MMSE) and the degree of depression was assessed on the geriatric depression scale (GDS). Pain intensity was assessed at rest and after a pain-provoking movement three times at 2-week intervals by repeating the test at a 10-min interval at each test session. The pain scales were the 50 cm red wedge scale (RWS), the seven-point faces pain scale (FPS), the 10 cm visual analogue scale (VAS) and the five-point verbal rating scale (VRS).


RESULTS
In group MMSE> or =24, patients were able to use all four scales rather successfully. In the other groups (MMSE 17-23, 11-16 and < or =10), only the use of VRS was successful to a reasonable degree (64-85% on average). GDS scores did not correlate with the pain scores, with the exception of pain scores on FPS during movement (P<0.01). The estimations of intensity and frequency of pain performed by nurses failed to correlate with the patient's own pain intensity estimations.


CONCLUSIONS
Scoring of pain with RWS, FPS and VAS seems to be feasible in elderly patients with a normal cognitive dysfunction. In our study VRS appeared to be applicable in the elderly with a clear cognitive dysfunction, i.e., with MMSE<17.
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. anne.pesonen@hus.fi
A
A
Pesonen
T
T
Kauppila
P
P
Tarkkila
A
A
Sutela
L
L
Niinistö
P H
PH
Rosenberg
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D003071:Cognition / Q000502:physiology; D003704:Dementia / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D009483:Neuropsychological Tests; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000150:complications / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales
D000700:Analgesics; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives