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American Pain Society
4700 W Lake Ave
Glenview, IL 60025
| For immediate release March 15, 2011 |
Contact: Chuck Weber (847) 705-1802 |
GLENVIEW, Ill., March 15, 2011 -- One of the most challenging problems in long-term geriatric care is providing adequate pain management for patients with dementia who are unable to communicate verbally. For these individuals, facial expressions, involuntary movements and other cues should enable relatives and other informal caregivers to gauge pain intensity levels. However, a new study in The Journal of Pain, published by the American Pain Society, reports that informal caregivers, even though they may spend a lot of time with the loved one, frequently misinterpret nonverbal communications and, as a result, often fail to intervene for pain treatment.
Researchers at the Centre on Aging and Health at the University of Regina (Canada) sought to determine the extent to which informal caregivers of dementia patients understand nonverbal expressions for evaluating pain intensity. In previous studies with nonverbal infants and children, it has been shown there are high correlations between children’s and parents’ ratings of post-surgical pain. It is believed that insufficient pain management in dementia patients, therefore, often is caused by failure to correctly interpret nonverbal cues.
The Canadian researchers hypothesized that caregiver ratings of pain would be predicted by nonverbal pain behaviors displayed by patients and self reports (where available) would be correlated with caregiver pain ratings and personal characteristics, such as age, sex and overall empathy. Also, the researchers explored if caregiver depression interfered with recognizing nonverbal pain expressions.
For the study, long term care facility residents were videotaped during potentially painful routine daily activities, such as transfers, walking, dressing, as well as at rest. A large majority of the participating residents had moderate-to-severe cognitive impairment. Immediately following the activities, participating residents were asked, using a Colored Analogue Scale (CAS), to indicate how much pain they experienced. Just one in four residents was able to complete the CAS. Caregivers were asked to complete measurements of depression and empathy.
In the segment of patients able to self report their pain, there was a significant relationship between caregiver and patient ratings of pain. However, for the remaining 60 percent who communicated their pain with nonverbal cues, none of the pain behaviors displayed were considered pain cues by the caregivers. Also, caregiver characteristics such as empathy, depression, age, sex were not determined to be predictors of pain ratings.
The researchers concluded that the surprising weak relationships they discovered between nonverbal patient behaviors and caregiver assessments of pain intensity show that interventions designed to help informal caregivers recognize pain cues from dementia patients are essential for effective pain management. They also noted that very often caregivers are not aware that behavioral disturbances, such as aggression, can indicate increased pain in dementia patients. Further, some have argued that as cognitive functions deteriorate caregivers can develop perceptions of personhood erosion and, therefore, communication with the loved one tends to be one-sided and patient responses are disregarded.
The finding that nonverbal pain behaviors are not predictive of caregiver pain ratings in dementia patients helps explain the well documented under treatment of pain in this population, according to the authors. They concluded that interventions designed to help caregivers become more attentive to specific pain cues will be valuable and could lead to better pain management for dementia patients.
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.
