Instruments for assessing pain in persons with severe dementia

Carezzato, Natália Lindemann; Valera, Gabriela Gallego; Vale, Francisco Assis Carvalho; Hortense, Priscilla

doi:10.1590/S1980-57642014DN82000003

ABSTRACT

Through an integrative literature review involving the CINAHL, Cochrane, Embase, LILACS, PsycINFO, PubMed databases, tools available in the literature for assessing pain in individuals with severe dementia were identified along with versions validated for use in Brazil. We found 1501 relevant articles which, after selection of abstracts and full reading, yielded a final sample of 33 articles. The analysis enabled the identification of 12 instruments: ABBEY PAIN SCALE; ADD; CNPI; CPAT; DOLOPLUS-2; MOBID and MOBID-2; MPS; NOPPAIN; PACSLAC; PADE; PAINAD and PAINE. Despite the wide variety of tools for assessing pain in individuals with severe dementia worldwide, it was observed that only four are available in Portuguese, of which two are culturally adapted for Brazilian Portuguese (NOPPAIN and PACSLAC) and two validated for Portuguese of Portugal (DOLOPLUS and PAINAD), pointing to the need for further validation of instruments for use in Brazil.

Key words:
pain; dementia; pain measurement; validation studies

RESUMO

Por meio de revisão integrativa de literatura, realizada nas bases de dados CINAHL, Cochrane, Embase, LILACS, PsycINFO, PubMed, foram identificados os instrumentos disponíveis na literatura que avaliam a dor em pessoas com demência grave e quais desses instrumentos têm versão validada no nosso país. Foram encontrados 1501 artigos, e, após seleção dos resumos e leitura na íntegra, a amostra final constituiu-se de 33 artigos. A análise possibilitou identificar 12 instrumentos: ABBEY PAIN SCALE; ADD; CNPI; CPAT; DOLOPLUS-2; MOBID e MOBID-2; MPS; NOPPAIN; PACSLAC; PADE; PAINAD e PAINE. Apesar de ampla variedade de instrumentos de avaliação de dor em pessoas com demência grave no mundo, observou-se que apenas quatro instrumentos estão disponíveis em português, sendo dois adaptados culturamente para o português brasileiro (NOPPAIN e PACSLAC) e dois instrumentos validados para o português de Portugal (DOLOPLUS e PAINAD), o que sugere a necessidade de validação de mais instrumentos no nosso país.

Palavras-chave:
dor; demência; medição da dor; estudos de validação

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REFERENCES

¹
IASP. Internacional Association for the Study of Pain (org). Pain definitions. IASP taxonomy 1994. Disponível em: <www.iasp-pain.org>. Acesso em: 28 dez 2012.
» www.iasp-pain.org
²
Horgas AL. Assessing pain in older adults with dementia. New York University, College of Nursing; 2007;2.
³
Maxwell CJ, Dalby DM, Slater M, et al. The prevalence and management of current daily pain among older home care clients. Pain 2008; 138:208-216.
⁴
Horgas AL, Elliott AF, Marsiske M. Pain Assessment in Persons with Dementia: Relationship between Self-report and Behavioral Observation. J Am Geriatr Soc 2009;57:126-132.
⁵
Lorenzet IC, Santos FC, Souza PMR, Gambarro RC, Coelho S, Cendoroglo MS. Avaliação da dor em idosos com demência: tradução e adaptação transcultural do instrumento PACSLAC para a língua portuguesa. Rev Bras Med 2011;68:129-133.
⁶
Rosa TP. Tradução e adaptação transcultural da escala "Pain Assessment Tool in Confused Older Adults-PATCOA". Dissertação. Porto Alegre: Escola de Enfermagem da Universidade Federal do Rio Grande do Sul; 2009.
⁷
Nascimento LA, Kreling MCGD. Avaliação da dor como quinto sinal vital: opinião de profissionais de enfermagem. Acta Paul Enferm 2011;24:50-54.
⁸
Andrade DC, Faria JW, Caramelli P, et al. The assessment and management of pain in the demented and non-demented elderly patient. Arq Neuropsiquiatr 2011;69:387-394.
⁹
Herr K. Pain Assessment Strategies in Older Patients. J Pain 2011; 12:S2-S13.
¹⁰
Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med 2001;17:457-478.
¹¹
Mcauliffe L, Nay R, O'Donnell M, Fetherstonhaugh D. Pain assessment in older people with dementia: literature review. J Adv Nurs 2009;65:2-10.
¹²
Beyea S, Nicoll LH. Writing an integrative review. AORN J 1998;67:877-884.
¹³
Broome ME. Integrative literature reviews for the development of concepts. In: Rodgers BL, Knafl KA. Concept development in nursing: foundations, techniques and applications. Philadelphia: W. B. Saunders; 2000:231-250.
¹⁴
Kovach CR, Weissman DE, Griffie J, Matson S, Muchka S. Assessment and treatment of discomfort for people with late-stage dementia. J Pain Symptom Manage 1999;18:412-419.
¹⁵
Warden V, Hurley AC, Volicer L. Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc 2003;4:9-15.
¹⁶
Villanueva MR, Smith TL, Erickson JS, Lee AC, Singer CM. Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure. J Am Med Dir Assoc 2003;4:1-8.
¹⁷
Fuchs-Lacelle S, Hadjistavropoulos T. Development and Preliminary Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC). Pain Manag Nurs 2004;5:37-49.
¹⁸
Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004;10:6-13.
¹⁹
Holen JC, Saltvedt I, Fayers PM, et al. The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment. Palliat Med 2005;19:411-417.
²⁰
Hutchison RW, Tucker WF Jr, Kim S, Gilder R. Evaluation of a behavioral assessment tool for the individual unable to self-report pain. Am J Hosp Palliat Care 2006;23:328-331.
²¹
Cohen-Mansfield J. Pain Assessment in Noncommunicative Elderly Persons - PAINE. Clin J Pain 2006;22:569-575.
²²
Zwakhalen SMG, Hamers JPH, Berger MPF. The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain 2006;126:210-220.
²³
Leong IY-O, Chong MS, Gibson SJ. The Use of a self-reported pain mesure, a nurse-reported pain measure and the PAINAD in nursing home residents with moderate an severe dementia: a validation study. Age Ageing 2006;35:252-256.
²⁴
Horgas AL, Nichols AL, Schapson CA, Vietes K. Assessing Pain in Persons with Dementia - Relationships Among the Non-communicative Patient's Pain Assessment Instrument, Self-report, and Behavioral Observations. Pain Manag Nurs 2007;8:77-85.
²⁵
Holen JC, Saltvedt I, Fayers PM, et al. Doloplus-2, a valid tool for behavioural pain assessment? BMC Geriatrics 2007;7:29.
²⁶
Zwakhalen SMG, Hamers JPH, Berger MF. Improving the clinical usefulness of a behavioural pain scale for older people with dementia. J Adv Nurs 2007;58:493-502.
²⁷
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, Snow AL, Ljunggren AE. Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): Development and Validation of a Nurse-Administered Pain Assessment Tool for Use in Dementia. J Pain Symptom Manager 2007;34:67-80.
²⁸
Schuler MS, Becker S, Kaspar R, Nikolaus T, Kruse A, Basler HD. Psychometric Properties of the German "Pain Assessment in Advanced Dementia Scale" (PAINAD-G) in Nursing Home Residents. J Am Med Dir Assoc 2007;8:388-395.
²⁹
Costardi D, Rozzini L, Costanzi C, et al. The Italian version of the pain assessment in advanced dementia (PAINAD) scale. Arch Gerontol Geriatr 2007;44:175-180.
³⁰
Cervo FA, Raggi RP, Bright-Long LE, et al. Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in Nursing Home Residents With Dementia. Am J Alzheimers Dis Other Demen 2007;22:112-119.
³¹
Mahoney AE, Peters L. The Mahoney Pain Scale: examining pain and agitation in advanced dementia. Am J Alzheimers Dis Other Demen 2008;23:250-261.
³²
Ferrari R, Martini M, Mondini S, et al. Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN). Aging Clin Exp Res 2009;21:298-306.
³³
Cervo FA, Bruckenthal P, Chen JJ, et al. Pain Assessment in Nursing Home Residents with Dementia Psychometric Properties and Clinical Utility of the CNA Pain Assessment Tool (CPAT). J Am Med Dir Assoc 2009;10:505-510.
³⁴
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, LJunggren AE. Pain behavior and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 2009;23:180-189.
³⁵
Pickering G, Gibson SJ, Sebouti S, et al. Reliability study in five languages of the translation of the pain behavioural scale Doloplus. Eur J Pain 2010;14:545.e1-e10.
³⁶
Takai Y, Yamamoto-Mitani N, Chiba Y, Nishikawa Y, Hayashi K, Sugai Y. Abbey Pain Scale: Development and validation of the Japanese version. Geriatr Gerontol Int 2010;10:145-153.
³⁷
Lin PC, Lin LC, Shyu YIL, Hua MS. Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. J Adv Nurs 2010;66:2360-2368.
³⁸
Ersek M, Herr K, Neradilek MB, Buck HG, Black B. Comparing the Psychometric Properties of the Checklist of nonverbal Pain behaviors (CNPI) and the Pain Assesment in Advanced Dementia (PAIN-AD) Instruments. Pain Med 2010;11:395-404.
³⁹
Ando C, Hishinuma M. Development of the Japanese DOLOPLUS-2: A pain assessment scale for elderly with Alzheimer's disease. Psychogeriatrics 2010;10:131-137.
⁴⁰
Chen Y-H, Lin LC, Watson R. Evaluation of the psychometric properties and the clinical feasibility of a Chinese version of the Doloplus-2 scale among cognitively impaired older people with communication difficulty. Int J Nurs Stud 2010;47:78-88.
⁴¹
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, LJunggren AE. Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scand J Caring Sci 2010;24:380-391.
⁴²
Lints-Martindale AC, Hadjistavropoulos T, Lix LM, Thorpe L. A Comparative Investigation of Observational Pain Assessment Tools for Older Adults With Dementia. Clin J Pain 2012;28:226-237.
⁴³
Batalha LMC, Duarte CIA, Rosário RAF, Costa MFSP, Pereira VJR, Morgado TMM. Adaptação cultural e propriedades psicométricas da versão portuguesa da escala Pain Assessment in Advanced Dementia. Rev Enferm Ref 2012;3:7-16.
⁴⁴
Zwakhalen SM, van't Hof CE, Hamers JP. Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. J Clin Nurs 2012;21:3009-3017.
⁴⁵
De Araújo RS, Pereira LV. Versão brasileira do Instrumento de Avaliação da Dor em Paciente Não Comunicativo (NOPPAIN): equivalência conceitual, de itens e semântica. Cad Saúde Pública 2012;28:1985-1992.
⁴⁶
Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 2000;1:13-21.
⁴⁷
Lefebvre-Chapiro S. The Doloplus-2 scale - evaluating pain in the elderly. Eur J Palliat Care 2001;8:191-194.
⁴⁸
Wary B, Serbouti S, Doloplus Collectif. Validation d'une échele d'evaluation comportamentale de la douleur chez la personne âgée. Douleurs 2001;2:35-38.
⁴⁹
Snow AL, Webwe JB, O'Malley KJ, et al. NOPPAIN: A nursing assistant-administered pain assessment instrument for use in dementia. Dement Geriatr Cogn Disord 2004;17:240-246.
⁵⁰
American Geriatrics Society. Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002;6(Suppl):S205-224.

Publication Dates

Publication in this collection
Apr-Jun 2014

History

Received
26 Mar 2014
Accepted
27 May 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
IASP. Internacional Association for the Study of Pain (org). Pain definitions. IASP taxonomy 1994. Disponível em: <www.iasp-pain.org>. Acesso em: 28 dez 2012.
» www.iasp-pain.org

[2] ²
Horgas AL. Assessing pain in older adults with dementia. New York University, College of Nursing; 2007;2.

[3] ³
Maxwell CJ, Dalby DM, Slater M, et al. The prevalence and management of current daily pain among older home care clients. Pain 2008; 138:208-216.

[4] ⁴
Horgas AL, Elliott AF, Marsiske M. Pain Assessment in Persons with Dementia: Relationship between Self-report and Behavioral Observation. J Am Geriatr Soc 2009;57:126-132.

[5] ⁵
Lorenzet IC, Santos FC, Souza PMR, Gambarro RC, Coelho S, Cendoroglo MS. Avaliação da dor em idosos com demência: tradução e adaptação transcultural do instrumento PACSLAC para a língua portuguesa. Rev Bras Med 2011;68:129-133.

[6] ⁶
Rosa TP. Tradução e adaptação transcultural da escala "Pain Assessment Tool in Confused Older Adults-PATCOA". Dissertação. Porto Alegre: Escola de Enfermagem da Universidade Federal do Rio Grande do Sul; 2009.

[7] ⁷
Nascimento LA, Kreling MCGD. Avaliação da dor como quinto sinal vital: opinião de profissionais de enfermagem. Acta Paul Enferm 2011;24:50-54.

[8] ⁸
Andrade DC, Faria JW, Caramelli P, et al. The assessment and management of pain in the demented and non-demented elderly patient. Arq Neuropsiquiatr 2011;69:387-394.

[9] ⁹
Herr K. Pain Assessment Strategies in Older Patients. J Pain 2011; 12:S2-S13.

[10] ¹⁰
Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med 2001;17:457-478.

[11] ¹¹
Mcauliffe L, Nay R, O'Donnell M, Fetherstonhaugh D. Pain assessment in older people with dementia: literature review. J Adv Nurs 2009;65:2-10.

[12] ¹²
Beyea S, Nicoll LH. Writing an integrative review. AORN J 1998;67:877-884.

[13] ¹³
Broome ME. Integrative literature reviews for the development of concepts. In: Rodgers BL, Knafl KA. Concept development in nursing: foundations, techniques and applications. Philadelphia: W. B. Saunders; 2000:231-250.

[14] ¹⁴
Kovach CR, Weissman DE, Griffie J, Matson S, Muchka S. Assessment and treatment of discomfort for people with late-stage dementia. J Pain Symptom Manage 1999;18:412-419.

[15] ¹⁵
Warden V, Hurley AC, Volicer L. Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc 2003;4:9-15.

[16] ¹⁶
Villanueva MR, Smith TL, Erickson JS, Lee AC, Singer CM. Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure. J Am Med Dir Assoc 2003;4:1-8.

[17] ¹⁷
Fuchs-Lacelle S, Hadjistavropoulos T. Development and Preliminary Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC). Pain Manag Nurs 2004;5:37-49.

[18] ¹⁸
Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004;10:6-13.

[19] ¹⁹
Holen JC, Saltvedt I, Fayers PM, et al. The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment. Palliat Med 2005;19:411-417.

[20] ²⁰
Hutchison RW, Tucker WF Jr, Kim S, Gilder R. Evaluation of a behavioral assessment tool for the individual unable to self-report pain. Am J Hosp Palliat Care 2006;23:328-331.

[21] ²¹
Cohen-Mansfield J. Pain Assessment in Noncommunicative Elderly Persons - PAINE. Clin J Pain 2006;22:569-575.

[22] ²²
Zwakhalen SMG, Hamers JPH, Berger MPF. The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain 2006;126:210-220.

[23] ²³
Leong IY-O, Chong MS, Gibson SJ. The Use of a self-reported pain mesure, a nurse-reported pain measure and the PAINAD in nursing home residents with moderate an severe dementia: a validation study. Age Ageing 2006;35:252-256.

[24] ²⁴
Horgas AL, Nichols AL, Schapson CA, Vietes K. Assessing Pain in Persons with Dementia - Relationships Among the Non-communicative Patient's Pain Assessment Instrument, Self-report, and Behavioral Observations. Pain Manag Nurs 2007;8:77-85.

[25] ²⁵
Holen JC, Saltvedt I, Fayers PM, et al. Doloplus-2, a valid tool for behavioural pain assessment? BMC Geriatrics 2007;7:29.

[26] ²⁶
Zwakhalen SMG, Hamers JPH, Berger MF. Improving the clinical usefulness of a behavioural pain scale for older people with dementia. J Adv Nurs 2007;58:493-502.

[27] ²⁷
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, Snow AL, Ljunggren AE. Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): Development and Validation of a Nurse-Administered Pain Assessment Tool for Use in Dementia. J Pain Symptom Manager 2007;34:67-80.

[28] ²⁸
Schuler MS, Becker S, Kaspar R, Nikolaus T, Kruse A, Basler HD. Psychometric Properties of the German "Pain Assessment in Advanced Dementia Scale" (PAINAD-G) in Nursing Home Residents. J Am Med Dir Assoc 2007;8:388-395.

[29] ²⁹
Costardi D, Rozzini L, Costanzi C, et al. The Italian version of the pain assessment in advanced dementia (PAINAD) scale. Arch Gerontol Geriatr 2007;44:175-180.

[30] ³⁰
Cervo FA, Raggi RP, Bright-Long LE, et al. Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in Nursing Home Residents With Dementia. Am J Alzheimers Dis Other Demen 2007;22:112-119.

[31] ³¹
Mahoney AE, Peters L. The Mahoney Pain Scale: examining pain and agitation in advanced dementia. Am J Alzheimers Dis Other Demen 2008;23:250-261.

[32] ³²
Ferrari R, Martini M, Mondini S, et al. Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN). Aging Clin Exp Res 2009;21:298-306.

[33] ³³
Cervo FA, Bruckenthal P, Chen JJ, et al. Pain Assessment in Nursing Home Residents with Dementia Psychometric Properties and Clinical Utility of the CNA Pain Assessment Tool (CPAT). J Am Med Dir Assoc 2009;10:505-510.

[34] ³⁴
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, LJunggren AE. Pain behavior and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 2009;23:180-189.

[35] ³⁵
Pickering G, Gibson SJ, Sebouti S, et al. Reliability study in five languages of the translation of the pain behavioural scale Doloplus. Eur J Pain 2010;14:545.e1-e10.

[36] ³⁶
Takai Y, Yamamoto-Mitani N, Chiba Y, Nishikawa Y, Hayashi K, Sugai Y. Abbey Pain Scale: Development and validation of the Japanese version. Geriatr Gerontol Int 2010;10:145-153.

[37] ³⁷
Lin PC, Lin LC, Shyu YIL, Hua MS. Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. J Adv Nurs 2010;66:2360-2368.

[38] ³⁸
Ersek M, Herr K, Neradilek MB, Buck HG, Black B. Comparing the Psychometric Properties of the Checklist of nonverbal Pain behaviors (CNPI) and the Pain Assesment in Advanced Dementia (PAIN-AD) Instruments. Pain Med 2010;11:395-404.

[39] ³⁹
Ando C, Hishinuma M. Development of the Japanese DOLOPLUS-2: A pain assessment scale for elderly with Alzheimer's disease. Psychogeriatrics 2010;10:131-137.

[40] ⁴⁰
Chen Y-H, Lin LC, Watson R. Evaluation of the psychometric properties and the clinical feasibility of a Chinese version of the Doloplus-2 scale among cognitively impaired older people with communication difficulty. Int J Nurs Stud 2010;47:78-88.

[41] ⁴¹
Husebo BS, Strand LI, Moe-Nilssen R, Husebo SB, LJunggren AE. Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting. Scand J Caring Sci 2010;24:380-391.

[42] ⁴²
Lints-Martindale AC, Hadjistavropoulos T, Lix LM, Thorpe L. A Comparative Investigation of Observational Pain Assessment Tools for Older Adults With Dementia. Clin J Pain 2012;28:226-237.

[43] ⁴³
Batalha LMC, Duarte CIA, Rosário RAF, Costa MFSP, Pereira VJR, Morgado TMM. Adaptação cultural e propriedades psicométricas da versão portuguesa da escala Pain Assessment in Advanced Dementia. Rev Enferm Ref 2012;3:7-16.

[44] ⁴⁴
Zwakhalen SM, van't Hof CE, Hamers JP. Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. J Clin Nurs 2012;21:3009-3017.

[45] ⁴⁵
De Araújo RS, Pereira LV. Versão brasileira do Instrumento de Avaliação da Dor em Paciente Não Comunicativo (NOPPAIN): equivalência conceitual, de itens e semântica. Cad Saúde Pública 2012;28:1985-1992.

[46] ⁴⁶
Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 2000;1:13-21.

[47] ⁴⁷
Lefebvre-Chapiro S. The Doloplus-2 scale - evaluating pain in the elderly. Eur J Palliat Care 2001;8:191-194.

[48] ⁴⁸
Wary B, Serbouti S, Doloplus Collectif. Validation d'une échele d'evaluation comportamentale de la douleur chez la personne âgée. Douleurs 2001;2:35-38.

[49] ⁴⁹
Snow AL, Webwe JB, O'Malley KJ, et al. NOPPAIN: A nursing assistant-administered pain assessment instrument for use in dementia. Dement Geriatr Cogn Disord 2004;17:240-246.

[50] ⁵⁰
American Geriatrics Society. Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002;6(Suppl):S205-224.

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