Cultural adaptation and reproducibility validation of the Brazilian Portuguese version of the Pain Assessment in Advanced Dementia (PAINAD-Brazil) scale in non-verbal adult patients.

Marcia Carla Morete Pinto,Ana Carolina Biagioni Lopes,Claudia Regina Laselva,Fabiola Peixoto Minson

doi:10.1590/s1679-45082015ao3036

Marcia Carla Morete Pinto, Ana Carolina Biagioni Lopes + Show 2 more

Open Access

https://doi.org/10.1590/s1679-45082015ao3036

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Abstract

Objective To adapt the Pain Assessment in Advanced Dementia (PAINAD) scale to Brazilian Portuguese with respect to semantic equivalence and cultural aspects, and to evaluate the respective psychometric properties (validity, feasibility, clinical utility and inter-rater agreement).Methods Two-stage descriptive, cross-sectional retrospective study involving cultural and semantic validation of the Brazilian Portuguese version of the scale, and investigation of its psychometric properties (validity, reliability and clinical utility). The sample consisted of 63 inpatients presenting with neurological deficits and unable to self-report pain.Results Semantic and cultural validation of the PAINAD scale was easily achieved. The scale indicators most commonly used by nurses to assess pain were “Facial expression”, “Body language” and “Consolability”. The Brazilian Portuguese version of the scale has proved to be valid and accurate; good levels of inter-rater agreement assured reproducibility.Conclusion The scale has proved to be useful in daily routine care of hospitalized adult and elderly patients in a variety of clinical settings. Short application time, ease of use, clear instructions and the simplicity of training required for application were emphasized. However, interpretation of facial expression and consolability should be given special attention during pain assessment training.

Highlights

According to the definition given by the International Association for the Study of Pain (IASP), pain is an unpleasant sensorial and emotional experience associated with actual or potential tissue damage.[1]
Central nervous system changes associated with dementia interfere with tolerance to pain; judgment, memory and verbal communication impairment in dementia may compromise pain assessment.[12, 13] while patients suffering from dementia may be less capable of perceiving and communicating pain, there is no evidence that such patients physiologically experience less pain.[14]
Pain assessment in this patient population can be extremely challenging; elderly patients, health care providers and specialists agree that self-report alone is less than optimal, and that observation-based pain assessment strategies are required.[15,16] Comprehensive guidelines for evaluation of behavioral indicators of pain were established by the American Geriatrics Society (AGS) in 2002.(17) More recently, the American Pain Society (APS) has implemented a task-force for nursing pain management aimed to assess pain in non-verbal patients; a comprehensive, hierarchical approach integrating selfreport and pain behavior data was recommended.[18]

Summary

Introduction

According to the definition given by the International Association for the Study of Pain (IASP), pain is an unpleasant sensorial and emotional experience associated with actual or potential tissue damage.[1]. Central nervous system changes associated with dementia interfere with tolerance to pain; judgment, memory and verbal communication impairment in dementia may compromise pain assessment.[12, 13] while patients suffering from dementia may be less capable of perceiving and communicating pain, there is no evidence that such patients physiologically experience less pain.[14] Pain assessment in this patient population can be extremely challenging; elderly patients, health care providers and specialists agree that self-report alone is less than optimal, and that observation-based pain assessment strategies are required.[15,16] Comprehensive guidelines for evaluation of behavioral indicators of pain were established by the American Geriatrics Society (AGS) in 2002.(17) More recently, the American Pain Society (APS) has implemented a task-force for nursing pain management aimed to assess pain in non-verbal patients (including dementia patients); a comprehensive, hierarchical approach integrating selfreport and pain behavior data was recommended.[18]. Good inter-rater agreement and internal consistency were reported,(24,19) with lowest associations for the indicator of breathing.[24,25] In the hands of healthcare professionals, PAINAD was reported to be user-friendly and required less than 5 minutes to be completed.[23]

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