Multidimensional instruments validated in Brazil for pain evaluation in the elderly: narrative review

Darcton Souza de Aguiar Igor de Matos Pinheiro About the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

Multidimensional instruments for the evaluation of pain in the elderly allows to identify the conditions that involves pain considering the emotional, physical, psychological, social, and economic aspects. They are ancillary tools in the prognosis of diseases, in addition to allowing a better approach to pain considering their assessed dimensions. The objective of this study was to review the literature on multidimensional instruments validated in Brazil for the evaluation of pain in the elderly, identifying instruments aimed at elderly people with neurocognitive disorders.

CONTENTS:

This was a narrative review of the literature with scientific articles searched in the electronic databases Pubmed, LILACS, and Scielo. The following keywords of the Portuguese language defined by the DeCS were used: pain, pain threshold, pain measurement, aging, and the elderly. Scientific articles on instruments validated in Brazil and published in the period from 2000 to 2018 were included. There were 38 articles, of which 33 were excluded, and only 5 articles were included. The validated instruments found for pain assessment in the elderly in Brazil were the McGill Pain Questionnaire, Geriatric Pain Measure, Pain Assessment Checklist for Seniors with Pain Assessment Checklist for Seniors with Limited Ability to Communicate, Non-Communicative Patient´s Pain Assessment Instrument, Pain Assessment in Advanced Dementia.

CONCLUSION:

The five instruments found offer the health professional a range of tools to understand pain better. Of these, three instruments allow the assessment of pain in the elderly with neurocognitive disorders.

Keywords:
Dementia; Elderly; Pain evaluation

RESUMO

JUSTIFICATIVA E OBJETIVOS:

Os instrumentos multidimensionais para avaliação da dor em idosos permitem identificar as condições que envolvem a dor considerando os aspectos emocionais, físicos, psicológicos, sociais e econômicos. Trata-se de ferramentas auxiliares no prognóstico de doenças, que permitem melhor abordagem da dor considerando suas dimensões avaliadas. O objetivo deste estudo foi revisar a literatura sobre os instrumentos multidimensionais validados no Brasil para a avaliação da dor na pessoa idosa, identificando os instrumentos direcionados para idosos com transtornos neurocognitivos.

CONTEÚDO:

Trata-se de uma revisão narrativa da literatura realizada com artigos científicos pesquisados nas bases de dados eletrônicas Pubmed, LILACS e Scielo. Utilizou-se o cruzamento das seguintes palavras-chave da língua portuguesa definidas pelo DeCS: dor, limiar de dor, mensuração da dor, envelhecimento e idoso. Foram incluídos artigos científicos de instrumentos validados no Brasil e que foram publicados no período de 2000 a 2018. Foram encontrados 38 artigos, destes, 33 foram excluídos, sendo incluso apenas 5 artigos. Os instrumentos validados encontrados para a avaliação da dor em idosos no Brasil foram o Brazilian Portuguese McGill Pain Questionnaire, Geriatric Pain Measure, Assessment Checklist for Seniors with Limited Ability to Communicate, Non-Communicative Patient’s Pain Assessment Instrument, Pain Assessment in Advanced Dementia.

CONCLUSÃO:

Os cinco instrumentos encontrados oferecem para o profissional de saúde uma gama de ferramentas para melhor compreensão da dor. Destes, três instrumentos permitem avaliar a dor em idosos com transtornos neurocognitivos.

Descritores:
Avaliação da dor; Demência; Idoso

INTRODUCTION

Aging promotes adaptations in the organic systems and may be associated with chronic degenerative conditions that impact the biopsychosocial components of the elderly’s life11 Fechine BRA, Trompieri N. O processo de envelhecimento: as principais alterações que acontecem com o idoso com o passar dos anos. Rev Cient Int. 2012;20(1):106-94.,22 Dellaroza MS, Pimenta CA, Duarte, YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and Association with functional capacity and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica.2013;29(2):325-34. Portuguese.. Under these conditions, the elderly may be in a favorable state for the occurrence of pain and functional limitations to perform their daily activities11 Fechine BRA, Trompieri N. O processo de envelhecimento: as principais alterações que acontecem com o idoso com o passar dos anos. Rev Cient Int. 2012;20(1):106-94.,33 Cunha LL, Mayrink WC. Influência da dor crônica na qualidade de vida em idosos. Rev Dor. 2011;12(2):120-4.. Socioeconomic conditions, previous diseases, psycho-affective relationships, and cognition are some factors that influence the presence of pain in the elderly11 Fechine BRA, Trompieri N. O processo de envelhecimento: as principais alterações que acontecem com o idoso com o passar dos anos. Rev Cient Int. 2012;20(1):106-94.. Chronic pain (CP) is highly prevalent in the elderly (48 to 55%), with higher intensity in individuals with neurocognitive disorders22 Dellaroza MS, Pimenta CA, Duarte, YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and Association with functional capacity and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica.2013;29(2):325-34. Portuguese.,44 Ashmawi HA. Dor no idoso. Rev Dor. 2015;16(3):161.,55 Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Dor crônica em idosos longevos: prevalência, características, mensurações e correlação com nível sérico de vitamina D. Rev Dor. 2015;16(3):171-5..

Pain is an intrinsic and self-reported sensation66 Carvalho MMMJ. O sofrimento da dor em câncer. 1ª ed. São Paulo: Livro Pleno; 2003.

7 Carvalho MMMJ. Introdução à psiconcologia. 1ª ed. São Paulo: Livro Pleno; 2003. 102-18p.
-88 Carvalho MMMJ. Dor - um estudo multidisciplinar. 2ª ed. São Paulo: Summus Editorial; 1999. 41-6p., with abstract signs, which requires validated and adequate assessment instruments to understand better its unidimensional or multidimensional conditions99 Bastos DF, Corrêa da Silva GC, Bastos ID, Teixeira LA, Lustosa MA, Borda MC, et al. Dor. Rev SBPH. 2007;10(1):85-96.. Unidimensional scales only pre-establish data related to pain intensity, while multidimensional instruments address not only the physical aspects but also seek to interpret and understand the painful phenomenon1010 Pimenta CAM. Fundamentos teóricos da dor e de sua avaliação. In: Carvalho JMMM. Dor - um estudo multidisciplinar. 2ª ed. São Paulo: Summus Editorial; 1999. 31-46p.,1111 Melzack R, Casey KL. Sensorial, motivational and central pain control determinants: a new conceptual model in pain. In: Kenshalo DRJ, editor, Skin feels: Proceedings. Springfield, Illinois: Charles C. Thomas. 1968. 63p..

Multidimensional pain assessment instruments in the elderly allow us to identify the conditions that involve pain from the emotional, physical, psychological, social, and economic aspects. They refer to tools that help in establishing the prognosis of diseases, besides allowing a better treatment of pain, considering their assessed dimensions1212 Martinez JE, Grassi DC, Marques LG. Analysis of the applicability of different pain questionnaires in three hospital settings: outpatient clinic, ward and emergency unit. Rev Bras Reumatol. 2011;51(4):299-308. English, Portuguese.. Understanding the dimensions of pain, especially CP, through multidimensional assessment allows a detailed description of the sensory and affective qualities of the painful phenomenon1313 Ekman LL. Neurociência: fundamentos para a reabilitação, 3ª ed. Rio de Janeiro, Editora Elsevier; 2008. 89p.,1414 Nicholson K, Martelli MF. The problem of pain. J Head Trauma Rehabil.2004;19(1):2-9..

This study aimed to review the literature on multidimensional instruments validated in Brazil for pain assessment in the elderly, identifying the instruments aimed at the elderly with preserved cognition and those with neurocognitive disorders.

CONTENTS

This study refers to a narrative literature review performed with scientific articles searched in the electronic databases Pubmed, LILACS, and Scielo. The crossing of the following keywords of the Portuguese language defined by DeCS (Health Sciences Descriptors) was used: pain, pain threshold, pain measurement, aging, and elderly.

Articles that assessed pain in older people (≥60 years old) using instruments validated in Brazil and published from 2000 to 2018 were included. Articles that assessed trauma pain, that were in duplicate in the databases or that used unidimensional pain assessment instruments were excluded. By selecting the articles, it was possible to identify the instruments validated in Brazil and the pain assessment tools in the elderly with neurocognitive disorders.

A total of 38 articles were found, 33 of which were excluded: 5 were duplicates, 12 used unidimensional instruments, 15 did not meet the criteria for pain management, and one for making an association between instruments. Table 1 shows the five articles of this review.

Table 1
Multidimensional instruments validated in Brazil for pain assessment in the elderly

DISCUSSION

In this literature review, the following multidimensional pain assessment instruments for elderly people validated in Brazil were found: Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain Assessment in Advanced Dementia (PAINAD), Non-Communicative Patient’s Pain Assessment Instrument (NOPPAIN), Geriatric Pain Measure (GPM), Brazilian McGill Pain Questionnaire (Br-MPQ). Of these, the first three instruments are indicated for application in the elderly with neurocognitive disorders.

The pain in the elderly must be viewed in several aspects, beyond the physical domain. The emotional and psychosocial conditions that surround the elderly should also be investigated during pain assessment. Pain assessed and inadequately addressed can have negative consequences on the emotional component, body functions, and social aspects2020 Silva JA, Pinto N. A dor como um problema psicofísico. Rev Dor. 2011;12(2):138-51.,2121 Barbosa MH, Araújo NF, Silva JA, Corrêa TB, Moreira TM, Andrade EV. Avaliação da intensidade da dor e analgesia em pacientes no período pós-operatório de cirurgias ortopédicas. Esc Ana Nery Rev Enferm. 2014;18(1):143-7..

Pain has specific conditions in each individual because it is self-reported, subjective, and abstract2222 Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-99.

23 Marquez JO. A dor e os seus aspectos multidimensionais. Ciência e Cultura. 2011;63(2):28-32.
-2424 Costa ED. Síndromes de amplificação dolorosa. Einstein. 2008;6 (Suppl 1):S151-8.. Multidimensional instruments portray these conditions by assessing the various dimensions involved in the life of the elderly, differing from each other according to the approach method. There are common domains among the instruments such as pain intensity, location, and duration, but there are specific domains in some scales such as mood assessment, pain during activities, and social aspects.

Pain intensity is a measure of assessment widely used in unidimensional instruments, being also components of multidimensional tools. The McGill pain questionnaire, developed by Melzack in 19752222 Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-99., aimed to assess the qualitative dimensions of pain such as sensory, affective, temporal regarding duration, spatial distribution, and pain intensity1818 Motta TS, Gambaro RC, Santos FC. Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure Portuguese version. Rev Dor. 2015;16(2):136-41.,2525 Santos KA, Cendoroglo MS, Santos FC. Anxiety disorder in elderly persons with chronic pain: frequency and associations. Rev Bras Geriatr Gerontol. 2017;20(1):91-8.,2626 Ferrell BA, Stein WM, Beck JC. The Geriatric Pain Measure: validity, reliability and factor analysis. J Am Geriatr Soc. 2000;48(12):1669-73.. The domains of this instrument are divided into 20 subgroups of words, from 1 to 10, referring to the sensitive questions, 11 to 15 affective questions, 16 general experiences of the individual, and 17 to 20 miscellaneous2121 Barbosa MH, Araújo NF, Silva JA, Corrêa TB, Moreira TM, Andrade EV. Avaliação da intensidade da dor e analgesia em pacientes no período pós-operatório de cirurgias ortopédicas. Esc Ana Nery Rev Enferm. 2014;18(1):143-7.,2727 Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191-7.. The evaluative measures adopted in this instrument are related to the experience of the elderly facing the painful condition, in addition to the neurophysiological aspects involved in pain perception1818 Motta TS, Gambaro RC, Santos FC. Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure Portuguese version. Rev Dor. 2015;16(2):136-41.,2121 Barbosa MH, Araújo NF, Silva JA, Corrêa TB, Moreira TM, Andrade EV. Avaliação da intensidade da dor e analgesia em pacientes no período pós-operatório de cirurgias ortopédicas. Esc Ana Nery Rev Enferm. 2014;18(1):143-7.,2525 Santos KA, Cendoroglo MS, Santos FC. Anxiety disorder in elderly persons with chronic pain: frequency and associations. Rev Bras Geriatr Gerontol. 2017;20(1):91-8..

Corroborating the Br-MPQ, the GPM instrument consists in assessing intensity (five items), disengagement (five items), walking (two items), vigorous activities (two items), other activities (three items), and these items are distribute at random at the time of the assessment2424 Costa ED. Síndromes de amplificação dolorosa. Einstein. 2008;6 (Suppl 1):S151-8.,2828 Gagliese L, Melzack R. Chronicpain in elderly people. Pain. 1997;70(1):3-14.. The GPM was designed to broaden and facilitate the assessment of pain in the elderly, but the elderly must have preserved cognition so the assessment will not present divergence of results2828 Gagliese L, Melzack R. Chronicpain in elderly people. Pain. 1997;70(1):3-14..

The pain assessment in the elderly with a neurocognitive disorder is a challenge for health professionals because of the difficulty in applying the instruments that allow the understanding of the painful phenomenon in these patients1919 Santos CC, Pereira LS, Resende MA, Magno F, Aguiar A. Aplicação da versão brasileira do questionário de dor McGill em idosos com dor crônica. Acta Fisiatr. 2006;13(2):75-82.,2929 Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9.. Proper reporting of painful experience requires preservation of cognition. Given the symptom, a self-report is required for the analysis of the phenomenon, verbal expression or perception skills, and interaction may be compromised due to cognitive decline, but sensory perception may be maintained. However, pain duration, intensity, and location can only be identified through some assessment instrument2424 Costa ED. Síndromes de amplificação dolorosa. Einstein. 2008;6 (Suppl 1):S151-8.. Cole et al.3030 Cole LJ, Ferrelll MJ, Duff EP, Barber JB, Egan GF, Gibson SJ. Pain sensitivity and fMRI pain-related brain activity in Alzheimer'sdisease. Brain. 2006;129(Pt 11):2957-65. investigated the brain areas responsible for pain perception in dementia patients to identify activation zones through functional nuclear magnetic resonance, which resulted in significant data on pain perception and emotional reactions. Thus, it has been shown that there are brain activation and excitability regarding painful stimulation in the elderly with cognitive disorders.

Thé et al.1515 Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LA, Nardes EM, et. al. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. Einstein. 2016;14(2):152-7. observed the need for an instrument to assess pain in older people with neurocognitive disorders and developed PACSLAC. It is an instrument composed of 60 observational items, separated by domains comprised of facial expressions, movement and body activities, sociability, personality/mood, and others1919 Santos CC, Pereira LS, Resende MA, Magno F, Aguiar A. Aplicação da versão brasileira do questionário de dor McGill em idosos com dor crônica. Acta Fisiatr. 2006;13(2):75-82.,3131 Gambaro RC, Santos FC, Thé KB, Castro LA, Cendoroglo MS. Avaliação de dor no idoso: proposta de adaptação do Geriatric Pain Measure para a língua portuguesa. Rev Bras Med. 2009;66(3):62-5. www.moreirajr.com.br/revistas.asp?id_materia=3992&fase=imprime
www.moreirajr.com.br/revistas.asp?id_mat...

32 Araújo LG, Lima DM, Sampaio RF, Pereira LS. Escala de Locus de controle da dor: adaptação e confiabilidade para idosos. Rev Bras Fisioter. 2010;14(5):438-45.
-3333 Zwakhalen SM, Hamers JP, Berger MP. The psychometric quality and clinical use fulness of three pain assessment tools for elderly people with dementia. Pain. 2006;126(1-3):210-20.. PACSLAC has been validated for countries other than Brazil, but it still lacks studies that reaffirm its use in our population. The PACSLAC was elaborated through the need observed by the American Geriatrics Society (AGS) to assess the pain of patients with communication difficulties, integrating self-report, hierarchical measures and behavioral and mood changes during the assessments3131 Gambaro RC, Santos FC, Thé KB, Castro LA, Cendoroglo MS. Avaliação de dor no idoso: proposta de adaptação do Geriatric Pain Measure para a língua portuguesa. Rev Bras Med. 2009;66(3):62-5. www.moreirajr.com.br/revistas.asp?id_materia=3992&fase=imprime
www.moreirajr.com.br/revistas.asp?id_mat...
,3333 Zwakhalen SM, Hamers JP, Berger MP. The psychometric quality and clinical use fulness of three pain assessment tools for elderly people with dementia. Pain. 2006;126(1-3):210-20..

The PAINAD is a multidimensional instrument with similar applicability to PACSLAC. It is based on philosophical (abstract) assessment and behaviors of the painful condition, corresponding to the domains of breathing, negative vocalization, facial expression, body language, and comforting. PAINAD quantifies its domains with quantitative variation from zero to 10 points, based on pain patterns. Scores of 1 to 3 points are considered mild pain, 4 to 6 reflect moderate pain, and 7 to 10 points are considered severe pain conditions1515 Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LA, Nardes EM, et. al. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. Einstein. 2016;14(2):152-7.,3434 Lorenzet IC, Santos FC, Souza PM, 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(4):129-33.

35 Valera GG, Carezzato NL, Vale FA, Hortense P. Adaptação cultural para o Brasil da escala Pain Assessment in Advanced Dementia (PAINAD). Rev Esc Enferm USP. 2014;48(3):462-8.
-3636 Batalha LM, Duarte CI, Rosário RA, Pereira da Costa MF, Pereira VJ, Morgado TM. Adaptação cultural e propriedades psicométricas da versão portuguesa da escala Pain Assessment in Advanced Dementia. Rev Enf Ref. 2012;8(III Série):7-16..

In the literature reviewed for this study, a simplified instrument, NOPPAIN1717 Araujo RS, Pereira LV. [Brazilian version of the Non-communicative Patient's Pain Assessment Instrument (NOPPAIN): conceptual, item, and semantic equivalence]. Cad Saude Publica. 2012;28(10):1985-92. Portuguese. was found. This tool consists of four assessment sessions involving nine daily care pictures. Six refer to pain-related behaviors, and a unidimensional figure numbered from zero to 10 to assess pain intensity, another session related to activities with pain responses yes or no, observing if the professional performed the activity or if the patient performed alone, and a numerical scale to quantify the pain intensity. The fourth session consists of the sum of the previous sessions formalizing a total score of the instrument. The literature does not provide detailed descriptions of its use, nor does it report the psychometric measures of this instrument for the Brazilian population.

This study allowed us to know the multidimensional instruments validated in Brazil for multidimensional pain assessment in the elderly. The presented tools provide a range of instruments for the healthcare professional to be able to select the most appropriate one according to the profile of their patients. Cognitive condition is a determining factor for choosing the most appropriate instrument for each patient. Although it was not the object of study, in this review, no scientific studies were identified that used the instruments for pain assessment in the elderly, except for the GPM and the Br-MPQ.

CONCLUSION

The five multidimensional instruments validated in Brazil to assess pain in the elderly presented in this review offer health professionals a range of tools for better understanding of pain. Of these, three instruments allow the assessment of pain in the elderly with neurocognitive disorders. It was observed that the variability of domains present in the instruments helps in the identification and assessment of the painful condition in the elderly with preserved cognition or neurocognitive disorders, regardless of the degree of impairment.

REFERENCES

  • 1
    Fechine BRA, Trompieri N. O processo de envelhecimento: as principais alterações que acontecem com o idoso com o passar dos anos. Rev Cient Int. 2012;20(1):106-94.
  • 2
    Dellaroza MS, Pimenta CA, Duarte, YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and Association with functional capacity and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica.2013;29(2):325-34. Portuguese.
  • 3
    Cunha LL, Mayrink WC. Influência da dor crônica na qualidade de vida em idosos. Rev Dor. 2011;12(2):120-4.
  • 4
    Ashmawi HA. Dor no idoso. Rev Dor. 2015;16(3):161.
  • 5
    Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Dor crônica em idosos longevos: prevalência, características, mensurações e correlação com nível sérico de vitamina D. Rev Dor. 2015;16(3):171-5.
  • 6
    Carvalho MMMJ. O sofrimento da dor em câncer. 1ª ed. São Paulo: Livro Pleno; 2003.
  • 7
    Carvalho MMMJ. Introdução à psiconcologia. 1ª ed. São Paulo: Livro Pleno; 2003. 102-18p.
  • 8
    Carvalho MMMJ. Dor - um estudo multidisciplinar. 2ª ed. São Paulo: Summus Editorial; 1999. 41-6p.
  • 9
    Bastos DF, Corrêa da Silva GC, Bastos ID, Teixeira LA, Lustosa MA, Borda MC, et al. Dor. Rev SBPH. 2007;10(1):85-96.
  • 10
    Pimenta CAM. Fundamentos teóricos da dor e de sua avaliação. In: Carvalho JMMM. Dor - um estudo multidisciplinar. 2ª ed. São Paulo: Summus Editorial; 1999. 31-46p.
  • 11
    Melzack R, Casey KL. Sensorial, motivational and central pain control determinants: a new conceptual model in pain. In: Kenshalo DRJ, editor, Skin feels: Proceedings. Springfield, Illinois: Charles C. Thomas. 1968. 63p.
  • 12
    Martinez JE, Grassi DC, Marques LG. Analysis of the applicability of different pain questionnaires in three hospital settings: outpatient clinic, ward and emergency unit. Rev Bras Reumatol. 2011;51(4):299-308. English, Portuguese.
  • 13
    Ekman LL. Neurociência: fundamentos para a reabilitação, 3ª ed. Rio de Janeiro, Editora Elsevier; 2008. 89p.
  • 14
    Nicholson K, Martelli MF. The problem of pain. J Head Trauma Rehabil.2004;19(1):2-9.
  • 15
    Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LA, Nardes EM, et. al. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. Einstein. 2016;14(2):152-7.
  • 16
    Pinto MC, Minson FP, Lopes AC, Laselva CR. 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. Einstein. 2015;13(1):14-9.
  • 17
    Araujo RS, Pereira LV. [Brazilian version of the Non-communicative Patient's Pain Assessment Instrument (NOPPAIN): conceptual, item, and semantic equivalence]. Cad Saude Publica. 2012;28(10):1985-92. Portuguese.
  • 18
    Motta TS, Gambaro RC, Santos FC. Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure Portuguese version. Rev Dor. 2015;16(2):136-41.
  • 19
    Santos CC, Pereira LS, Resende MA, Magno F, Aguiar A. Aplicação da versão brasileira do questionário de dor McGill em idosos com dor crônica. Acta Fisiatr. 2006;13(2):75-82.
  • 20
    Silva JA, Pinto N. A dor como um problema psicofísico. Rev Dor. 2011;12(2):138-51.
  • 21
    Barbosa MH, Araújo NF, Silva JA, Corrêa TB, Moreira TM, Andrade EV. Avaliação da intensidade da dor e analgesia em pacientes no período pós-operatório de cirurgias ortopédicas. Esc Ana Nery Rev Enferm. 2014;18(1):143-7.
  • 22
    Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-99.
  • 23
    Marquez JO. A dor e os seus aspectos multidimensionais. Ciência e Cultura. 2011;63(2):28-32.
  • 24
    Costa ED. Síndromes de amplificação dolorosa. Einstein. 2008;6 (Suppl 1):S151-8.
  • 25
    Santos KA, Cendoroglo MS, Santos FC. Anxiety disorder in elderly persons with chronic pain: frequency and associations. Rev Bras Geriatr Gerontol. 2017;20(1):91-8.
  • 26
    Ferrell BA, Stein WM, Beck JC. The Geriatric Pain Measure: validity, reliability and factor analysis. J Am Geriatr Soc. 2000;48(12):1669-73.
  • 27
    Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191-7.
  • 28
    Gagliese L, Melzack R. Chronicpain in elderly people. Pain. 1997;70(1):3-14.
  • 29
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9.
  • 30
    Cole LJ, Ferrelll MJ, Duff EP, Barber JB, Egan GF, Gibson SJ. Pain sensitivity and fMRI pain-related brain activity in Alzheimer'sdisease. Brain. 2006;129(Pt 11):2957-65.
  • 31
    Gambaro RC, Santos FC, Thé KB, Castro LA, Cendoroglo MS. Avaliação de dor no idoso: proposta de adaptação do Geriatric Pain Measure para a língua portuguesa. Rev Bras Med. 2009;66(3):62-5. www.moreirajr.com.br/revistas.asp?id_materia=3992&fase=imprime
    » www.moreirajr.com.br/revistas.asp?id_materia=3992&fase=imprime
  • 32
    Araújo LG, Lima DM, Sampaio RF, Pereira LS. Escala de Locus de controle da dor: adaptação e confiabilidade para idosos. Rev Bras Fisioter. 2010;14(5):438-45.
  • 33
    Zwakhalen SM, Hamers JP, Berger MP. The psychometric quality and clinical use fulness of three pain assessment tools for elderly people with dementia. Pain. 2006;126(1-3):210-20.
  • 34
    Lorenzet IC, Santos FC, Souza PM, 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(4):129-33.
  • 35
    Valera GG, Carezzato NL, Vale FA, Hortense P. Adaptação cultural para o Brasil da escala Pain Assessment in Advanced Dementia (PAINAD). Rev Esc Enferm USP. 2014;48(3):462-8.
  • 36
    Batalha LM, Duarte CI, Rosário RA, Pereira da Costa MF, Pereira VJ, Morgado TM. Adaptação cultural e propriedades psicométricas da versão portuguesa da escala Pain Assessment in Advanced Dementia. Rev Enf Ref. 2012;8(III Série):7-16.

Publication Dates

  • Publication in this collection
    23 Sept 2019
  • Date of issue
    Jul-Sep 2019

History

  • Received
    07 Aug 2018
  • Accepted
    07 Jan 2019
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