Pain in dementia

The ageing revolution is changing the composition of our society with more people becoming very old with higher risks for developing both pain and dementia. Pain is normally signaled by verbal communication, which becomes more and more deteriorated in people with dementia. Thus, these individuals unnecessarily suffer from manageable but unrecognized pain. Pain assessment in patients with dementia is a challenging endeavor, with scientific advancements quickly developing. Pain assessment tools and protocols (mainly observational scales) have been incorporated into national and international guidelines of pain assessment in aged individuals. To effectively assess pain, interdisciplinary collaboration (nurses, physicians, psychologists, computer scientists, and engineers) is essential. Pain management in this vulnerable population is also preferably done in an interdisciplinary setting. Nonpharmacological management programs have been predominantly tested in younger populations without dementia. However, many of them are relatively safe, have proven their efficacy, and therefore deserve a first place in pain management programs. Paracetamol is a relatively safe and effective first-choice analgesic. There are many safety issues regarding nonsteroidal anti-inflammatory drugs, opioids, and adjuvant analgesics in dementia patients. It is therefore recommended to monitor both pain and potential side effects regularly. More research is necessary to provide better guidance for pain management in dementia.publishedVersio

Implementing a Paradigm Shift: Incorporating Pain Management Competencies into Pre-Licensure Curricula

Objective The purpose of this article is 1) to present the historical context and rationale for competency-based pain management education; and 2) to suggest learning tools that faculty might apply into their teachings and their institutions\u27 pre-licensure curricula for promoting conceptual learning based on competency-based pain management education. Design Based on the well-documented need to improve the competency of health care professionals in pain assessment and management, an interprofessional group of health care providers collaborated and then convened in August 2012 to develop core competencies for pain management for the pre-licensure programs of study across health care disciplines. This interprofessional group of pain educators achieved consensus on a common set of pain-related competencies intended to be implemented across a variety of pre-licensure professional programs. Setting A group of the interprofessional faculty, who participated in the development of the core competencies for pain management, provides a follow-up of how to implement learning tools within teaching and curricula, based on competency education in pre-licensure health care. Results Broad questions about how to incorporate competencies into pre-licensure curricula, for all health provider pre-licensure programs, including how to assess competency across individuals and how to teach in ways that emphasize the demonstration of conceptual learning, remain unanswered. This article reviews how the use of competencies creates historical context for a shift from teaching to learning and concludes with suggestions and exemplars in applying core competencies for pain management in pre-licensure programs

The Relationships among Pain, Nonpain Symptoms, and Quality of Life Measures in Older Adults with Cancer Receiving Hospice Care

Objective.  Gathering firsthand or reported information about patients in the final stages of terminal cancer is difficult due to patient frailty, cognitive impairment, excessive fatigue, and severity of illness, as well as gatekeeping by hospice providers and caregivers, and highly variable documentation practices. We sought to further understand and elucidate end‐of‐life experiences in older cancer patients through the application of validated tools employed in the hospice setting. This article summarizes data collected about pain, non‐pain symptoms, and other aspects of quality of life (QOL) as reported by older hospice patients or by their caregivers during the 2 weeks of hospice care. Design.  Data was collected from an ongoing Institutional Human Subjects Review Board‐approved research project with 94 older adults with cancer or their caregivers receiving service in a home setting from 14 Midwestern hospices. Participants completed one or two telephone interviews. Instruments used to gather information include the Brief Pain Inventory and the Brief Hospice Inventory. Results.  Data analysis showed mean “worst pain” ratings significantly decreased from Interview 1 to Interview 2, and pain reports were significantly correlated with fatigue, anxiety, appetite, comfort, symptom control, and overall QOL. Conclusions.  Our findings reinforce previously held views that older patients with cancer experience pain and non‐pain symptoms. And both pain and non‐pain symptoms can impact and confound the treatment of other symptoms and interfere with the patient's overall QOL. The results of this study support the assertion that hospice care can have a positive impact on pain severity and related suffering, as well as patient QOL as death approaches.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87068/1/j.1526-4637.2011.01113.x.pd

The Effect of a Translating Research into Practice (TRIP)‐Cancer Intervention on Cancer Pain Management in Older Adults in Hospice

Background.  Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain‐free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective.  This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence‐based pain practices for older adults with cancer in community‐based hospices. Setting.  This Institutional Human Subjects Review Board‐approved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. Methods.  Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results.  Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence‐based practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to post‐intervention in the experimental group was greater; however, the result was not statistically significant ( P  = 0.1032). Conclusions.  Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a community‐based hospice intervention, including determining and measuring intervention fidelity prospectively.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93516/1/j.1526-4637.2012.01405.x.pd

Recruitment of family caregivers of persons with dementia: Lessons learned from a pilot randomized controlled trial

Family caregivers play an essential role in supporting the health and well-being of older adults with dementia, a population projected to increase rapidly over the coming decades. Enrolling caregivers of people with dementia (PWD) in research studies is vital to generating the evidence necessary to support broader implementation of efficacious intervention programs in real-world care delivery, but a range of challenges impede recruitment and enrollment of sufficiently large and representative sample sizes. In this article, we characterize the challenges and lessons learned from recruiting caregivers of PWD to participate in a pilot randomized control trial. We utilize Bronfenbrenner's ecological model to categorize the challenges into three levels: individual (i.e., understanding caregivers’ time constraints and motivations), community (i.e., reaching underrepresented populations and accessing caregiver support groups) and institutional (i.e., obtaining informed consent and navigating research registries). We found that establishing rapport and maintaining flexibility with participants was crucial for motivating individuals to enroll in our study. Building trust with local communities by collaborating with support group leaders, appointing a co-investigator who is already embedded within a given community, and establishing equitable partnerships with organizations increased recruitment rates. At the institutional level, engaging experts in regulatory affairs and geriatrics may help overcome barriers in obtaining approval from institutional review boards. We also recommend using research registries of individuals who offer their contact information to researchers. The lessons learned from our research—including the challenges and potential solutions to overcome them—may promote more effective and efficient recruitment in future research

Core competencies for pain management: results of an interprofessional consensus summit.

ObjectiveThe objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.MethodsAn interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached.ResultsThe consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain.ConclusionsThese competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain

Překlad Revidované verze Iowské stupnice bolesti do českého jazyka a její lingvistická validace pro výzkumné šetření zaměřené na české pacienty s cévní mozkovou příhodou

Aim: Patients with a stroke could benefit from vertical self-report pain instruments. Such instruments are not available in the Czech language. The aim was to translate and linguistically validate the Revised Iowa Pain Thermometer into Czech for use by Czech patients with a stroke. Methods: Three translators, three nursing expert panels, and seven patients with a stroke participated in this methodological study that took place between January and April 2017. The International Society for Pharmacoeconomics and Outcomes Research guidelines were used to direct the process. This 10-phase process was supported by quantitative and qualitative methods, such as content validity indexing and modified kappa calculations, discussions with nursing experts, as well as cognitive debriefing with patients. Results: Based on the content validity index, the modified kappa values, and the experts’ feedback, a preliminary Czech version was developed. Cognitive debriefing revealed that most patients had some difficulty using the instrument. Conclusions: The translation and linguistic validation process was demanding as it was difficult to recruit nurses and translators meeting the determined selection criteria; furthermore, many steps were required. However, using a less stringent methodology would have probably produced a Czech version that would not be as suitable for the intended target group – Czech patients with a stroke. The findings underscore the importance of involving representative users, i.e., patients with a specific health condition, in the translation and linguistic validation of self-report instruments. Psychometric properties of the Czech version will be established in a clinical study that will involve Czech patients with strokes.Cíl: Pro pacienty s cévní mozkovou příhodou by mohlo být přínosem využití vertikálně prezentovaných sebehodnoticích škál bolesti. Tyto škály nejsou v českém jazyce k dispozici. Cílem bylo do českého jazyka přeložit Revidovanou verzi Iowské stupnice bolesti a provést její lingvistickou validaci tak, aby mohla být využita českými pacienty s cévní mozkovou příhodou. Metoda: Do této metodologické studie, probíhající od ledna do dubna 2017, byli zapojeni tři překladatelé, tři panely odborníků z oboru ošetřovatelství a sedm pacientů s cévní mozkovou příhodou. Celý proces byl řízen v souladu s guidelines International Society for Pharmacoeconomics and Outcomes Research. Tento proces, skládající se z 10 fází, byl podpořen kvantitativními a kvalitativními metodami, jako jsou index obsahové validity a výpočty modifikovaného koeficientu kappa, diskuse s odborníky z oboru ošetřovatelství i kognitivní rozhovor s pacienty. Výsledky: Předběžná česká verze byla vytvořena na základě indexu obsahové validity, hodnot modifikovaného koeficientu kappa a zpětné vazby od odborníků. Kognitivní rozhovor ukázal, že většina pacientů měla s použitím nástroje potíže. Závěr: Proces překladu a lingvistické validace byl náročný, protože bylo obtížné provést nábor sester a překladatelů splňujících stanovená výběrová kritéria; navíc se proces skládal z mnoha kroků. Avšak využití méně striktní metodologie by pravděpodobně vedlo k tvorbě české verze, která by pro zamýšlenou cílovou skupinu – české pacienty s cévní mozkovou příhodou – nebyla tak vhodná. Naše zjištění zdůrazňují, že je důležité do procesu překladu a lingvistické validace sebehodnoticích nástrojů zapojit reprezentativní uživatele, to znamená pacienty s konkrétním onemocněním. Psychometrické vlastnosti české verze budou zjišťovány ve výzkumném šetření, které bude zaměřené na české pacienty s cévní mozkovou příhodou