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Pain Threshold: Patients’ Needs May Be Underserved

September 18, 2009
According to a study in the Journal of Clinical Nursing, both nurses and relatives find it hard to accurately assess pain in nursing home residents, especially if the resident has a cognitive impairment, such as dementia, or is unable to speak. Researchers including Dr. Rhodee van Herk of the Pain Expertise Centre at the Erasmus Medical Center in Rotterdam, studied 174 nursing home residents, 124 who had cognitive impairments and 50 did not. They also spoke to 171 nurses and 122 relatives. Six nursing homes took part in the 5-year study. Patients were included if they had a pain rating of more than 4 out of 10, self-assessed if not cognitively impaired or by a staff nurse if they were. The majority of the 110 women and 64 men (average age, 82) experienced pain as a result of musculoskeletal and circulatory problems. "Pain seemed to differ not only on an individual basis, but also in different daily situations. It is clear that pain at rest is a particular issue that needs addressing as residents rated this much higher than caregivers and relatives. Using a simple pain intensity scale, like the 0 to 10 scale employed in our study, is clearly not enough. We would like to see nurses use a combination of the existing pain intensity scale, together with multi-dimensional pain observations scales to judge how much discomfort a patient is experiencing. We are also keen to ensure that relatives receive more information on chronic pain and that both relatives and nurses explore pain relief methods that don’t always rely on drugs. These can include massage, applying warmth, encouraging residents to be more mobile and distractions such as music and storytelling," said Dr. van Herk.