Abstract
Facial expression is a key aspect in observational scales developed to improve pain assessment in individuals with cognitive impairments. Although these scales are used internationally in individuals with different types of cognitive impairments, it is not known whether observing facial expressions of pain might differ between regions or between different types of cognitive impairments. In a pilot study, facial responses to standardized experimental pressure pain were assessed among individuals with different types of cognitive impairments (dementia, mild cognitive impairment, Huntington’s disease, and intellectual disability) from different countries (Denmark, Germany, Italy, Israel, and Spain) and were analyzed using facial descriptors from the PAIC scale (Pain Assessment in Impaired Cognition). We found high inter-rater reliability between observers from different countries. Moreover, facial responses to pain did not differ between individuals with dementia from different countries (Denmark, Germany, and Spain). However, the type of cognitive impairment had a significant impact; with individuals with intellectual disability (all being from Israel) showing the strongest facial responses. Our pilot data suggest that the country of origin does not strongly affect how pain is facially expressed or how facial responses are being scored. However, the type of cognitive impairment showed a clear effect in our pilot study, with elevated facial responses in individuals with intellectual disability.
Highlights
Assessing pain in individuals with cognitive impairments can be quite challenging, given that the ability to provide a valid self-report of pain can be limited and deteriorates across the course of cognitive decline [1,2,3]
The scores of the remaining facial descriptors were summed up to form a SUM-score of facial responses
[2], worldwide across different differentregions regionsand andacross acrossdifferent different types cognitive impairments little is known about how these factors might impact observational pain assessment
Summary
Assessing pain in individuals with cognitive impairments can be quite challenging, given that the ability to provide a valid self-report of pain can be limited and deteriorates across the course of cognitive decline [1,2,3]. Pain is often overlooked in individuals with cognitive impairments and, remains undertreated [4]. To improve this situation, observational pain scales that rely on non-verbal indicators, such as facial expression, to assess pain have been developed [2,5,6]. Observational pain scales that rely on non-verbal indicators, such as facial expression, to assess pain have been developed [2,5,6] One of these scales is the PAIC scale (“Pain Assessment in Individuals with Cognitive impairment”), which was recently developed under international consensus out of an EU-COST collaboration between researchers from different disciplines (e.g., medicine, nursing, physiotherapy, psychology, and neuroscience) and from different European regions with different languages, ethnicity, and culture [7,8,9]. Within the category of facial responses (facial responses are the most prominent non-verbal pain behaviors), 15 facial descriptors were identified that had been frequently used to assess pain states in individuals with cognitive impairments [9,10]
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