Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).
OBJECTIVE
Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting.


METHODS
Sixty severely demented patients (MMSE </=12, language test score </=3) and 42 cognitively intact ones (MMSE >/=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected.


RESULTS
Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients.


CONCLUSIONS
The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.
Ferrari
Renata
R
Hospital Psychology Service, Vicenza Hospital, Via Rodolfi 37, 36100 Vicenza, Italy. renata.ferrari@ulssvicenza.it
Martini
Marilisa
M
Mondini
Sara
S
Novello
Chiara
C
Palomba
Daniela
D
Scacco
Carolina
C
Toffolon
Marta
M
Valerio
Gianni
G
Vescovo
Giorgio
G
Visentin
Marco
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007558:Italy; D007806:Language Disorders / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D008875:Middle Aged; D009043:Motor Activity; D009741:Nursing Staff, Hospital; D010146:Pain / Q000503:physiopathology* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D012648:Self Care; D055815:Young Adult