UF nurse searching for better ways to assess pain

“Ouch! It hurts!” That is perhaps our most common response to pain. And, how we express our pain is a major factor in how health-care providers diagnose and treat our various injuries and illnesses. But what if you can’t clearly express what hurts and doesn’t hurt?

With a new $523,636 grant from the National Institute of Nursing Research, one University of Florida nurse researcher wants to find a better way to assess pain in older patients who may have difficulty expressing their discomfort.

“There are more than 1.5 million people in nursing homes today and about 80 percent of them have painful diseases,” said Ann Horgas, R.N., Ph.D., an associate professor at the UF College of Nursing and UF Institute on Aging. “About half of those patients have significant cognitive impairment and we know that these patients tend to verbally report less pain than those patients without such problems.”

On the other hand, no evidence exists to indicate that people with cognitive impairment, as found in patients with Alzheimer’s disease or other dementia, feel less pain, said Horgas.

Most prior research in this area has relied solely on the patients’ verbal reports of their pain, which may be biased because cognitively-impaired patients have dementia-related memory and language deficits, said Horgas. As such, standard measures using observation are greatly needed to detect pain in this vulnerable population.

“Before health-care providers can effectively manage pain among elderly adults, they must be able to accurately assess it, especially in those patients who are less able to verbally report pain,” said Horgas.

How pain is assessed and treated has taken on a new level of importance in recent years. Since January, caregivers are now required to monitor and document pain as one of the key vital signs along with blood pressure, pulse, respiration and temperature, according to the Joint Commission on Accreditation of Health Care Organizations. In early June, a California jury awarded $1.5 million to the family of an 85-year-old man who accused his doctor of not prescribing enough pain medication during the patient’s final days.

Horgas will use the new federal grant to videotape 200 nursing home residents as they participate in a variety of activities. She will monitor behaviors and facial expressions that may be indicators of pain, examine the relationship between the pain that patients report and the pain behaviors observed, then evaluate whether such relationships vary among patients with and without dementia.

“There is no blood test for pain and people respond very differently to it,” said Horgas. “The primary caregiver, who works most closely with residents helping them do all the activities of daily living, must be able to identify when someone is in pain. But if that first line of detection is inaccurate, there is a breakdown in the entire system of pain management. That can have serious consequences for the physical and mental health of older adults.”