Having a Feel for Others’ Pain

Pain is a phenomenon so common that almost all individuals become familiar with this sensation at some point in life. Some consider it as unavoidable and others as a challenge that has to be defeated. During the second part of the last century researchers became interested in the neurobiological source and regulation of pain, the use of assessment instruments to “objectify” pain, and treatment options for distinct patient groups and types of pain. Meanwhile we have become aware of the negative impact of pain on quality of life, recovery from surgery and survival, as well as the risk of acute pain turning into chronic pain. Babies and intellectually disabled individuals of all ages have often been excluded from pain studies; for long it was believed that they were unable to experience pain. For infants and young children this belief was not specifically based on a scientific rationale but more on a lack of knowledge about the status of the myelinisation process of the nerves in neonates, the individual variability in drug disposition and fear of harmful side effects of analgesics and narcotics. Intellectually disabled individuals have always been considered to be unable to experience or suffer from pain. This misconception was partly based on absence of visible emotion during potentially painful situations, like continuing to walk with a broken hip or leg. Such observations seemed more important than the knowledge that a condition is known to be (extremely) painful in individuals that are not intellectually disabled. Fortunately enough we have done away with these misconceptions. A landmark publication of Anand and Hickey in 1987 reported huge circulatory and metabolic complications in (prematurely born) neonates after ligation of a patent ductus arteriosus without fentanyl compared to children that received fentanyl. Since then it was acknowledged that babies are capable to feel pain and require treatment just like in older patients

The Rotterdam Elderly Pain Observation Scale (REPOS) is reliable and valid for non-communicative end-of-life patients

__Background:__ In palliative care, administration of opioids is often indispensable for pain treatment. Pain assessment may help recognize pain and guide treatment in non-communicative patients. In the Netherlands the Rotterdam Elderly Pain Observation Scale (REPOS) is recommended to this aim, but not yet validated. Therefore the objective of this study was to validate the REPOS in non-communicative or unconscious end-of-life patients. __Methods:__ In this observational study, the primary researcher applied the REPOS, while both the researcher and a nurse applied the Numeric Rating Scale (NRS). If possible, the patient in question applied the NRS as well. The NRS scores were compared with the REPOS scores to determine concurrent validity. REPOS scores obtained before and after a pain-reducing intervention were analysed to establish the scale's sensitivity to change. __Results:__ A total of 183 REPOS observations in 100 patients were analysed. Almost 90% of patients had an advanced malignancy; observations were done a median of 3 days (IQR 1 to 13) before death. Internal consistency of the REPOS was 0.73. The Pearson product moment correlation coefficient ranged from 0.64 to 0.80 between REPOS and NRS scores. REPOS scores declined with median 2 points (IQR 1 to 4) after a pain-reducing intervention (p < 0.001). Optimal sensitivity (0.81) and specificity (0.62) were found at cut-off score 3. __Conclusions:__ This study demonstrates that the REPOS has promising psychometric properties for pain assessment in non-communicative end-of-life patients. Its application may be of additional value to relieve suffering, including pain, in palliative care

Children with intellectual disabilities and pain perception: a review and suggestions for future assessment protocols

AIM: This was to review what is known about pain assessment in children with intellectual disabilities and to translate findings into clinical dental practice. Methods: Literature review. Review: The association between anxiety and pain as reported in the literature was explored. The specific pain expressions for individuals with Down’s syndrome and those with autism are discussed with available literature. Various pain assessment instruments for cognitively impaired children have comparable content but vary in number of items. However, none of these instruments has been tested or implemented in the dental setting. Five pain assessment instruments for children with intellectual disabilities are described in more detail and these instruments were primarily tested for postoperative children. There are only limited data available on their use in dental treatments. Suggestions for step-bystep implementation of pain assessment in dental practice are given.Conclusion: Further studies in dental practice are recommended to achieve optimal pain management during dental procedures in individuals with intellectual disabilities

Children with intellectual disabilities and pain perception: a review and suggestions for future assessment protocols

AIM: This was to review what is known about pain assessment in children with intellectual disabilities and to translate findings into clinical dental practice. Methods: Literature review. Review: The association between anxiety and pain as reported in the literature was explored. The specific pain expressions for individuals with Down’s syndrome and those with autism are discussed with available literature. Various pain assessment instruments for cognitively impaired children have comparable content but vary in number of items. However, none of these instruments has been tested or implemented in the dental setting. Five pain assessment instruments for children with intellectual disabilities are described in more detail and these instruments were primarily tested for postoperative children. There are only limited data available on their use in dental treatments. Suggestions for step-bystep implementation of pain assessment in dental practice are given.Conclusion: Further studies in dental practice are recommended to achieve optimal pain management during dental procedures in individuals with intellectual disabilities

Validity of the Rotterdam Elderly Pain Observation Scale for institutionalised cognitively impaired Dutch adults

Background: The Rotterdam Elderly Pain Observation Scale (REPOS) has not yet been validated for institutionalised cognitively impaired adults. To fill this gap of knowledge, we tested psychometric properties of the REPOS when used for pain assessment in this population. Methods: In this multicentre observational study, residents were filmed during a possibly painful moment and at rest. Healthcare professionals were asked to rate residents' pain by means of a Numeric Rating Scale (NRS)-proxy. Two researchers assessed pain with the REPOS and the Chronic Pain Scale for Non Verbal Adults with Intellectual Disabilities (CPS-NAID) from video-recordings. Results: In total, 168 observations from 84 residents were assessed. Inter-observer reliability between the two researchers was good, with Cohen's kappa 0.72 [95% confidence interval (CI) 0.64 to 0.79]. Correlation between the REPOS and CPS-NAID for a possibly painful moment was 0.73 (95% CI 0.65 to 0.79). Sensitivity (85%) and specificity (61%) for the detection of pain were calculated with REPOS ≥ 3 and NRS ≥ 4 as a reference value. Item response theory analysis shows that the item grimace displayed perfect discrimination between residents with and without pain. Conclusion: The REPOS is a reliable and valid instrument to assess pain in cognitively impaired individuals.</p