Paramedic assessment of pain in the cognitively impaired adult patient

Bill Lord

doi:10.1186/1471-227x-9-20

Abstract

BackgroundParamedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. The primary objective of this study was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics.MethodsA systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults.ResultsTwo systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use.ConclusionThe reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to evaluate the effectiveness of paramedic pain management practice in older adults to ensure that the care of all patients is unaffected by age or disability.

Highlights

Paramedics are often a first point of contact for people experiencing pain in the community
As tools currently used by paramedics to assess pain may be unreliable in the presence of cognitive impairment this paper aims to identify tools that may assist paramedics to assess these challenging cohorts of patients in order to ensure that their pain is recognised, thereby enabling interventions aimed at relieving their pain
The primary objective of this review was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics

Summary

Introduction

Paramedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. Pain is a commonly encountered complaint in prehospital and emergency medicine settings, evidence of inadequate analgesia has been widely documented. Even when pain assessment is encouraged or required, patients may be unable to communicate their experience to carers, or be reluctant to report pain due to concerns about treatment side effects or the possibility that they will be viewed as a complaining or difficult patient, a belief that has been documented in settings that include oncology [7] and aged care[8,9]

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