The article Pain management in patients with dementia by Achterberg et al. (2013) is a literature review that explored four main perspectives concerning pain management among patients with dementia in order to make recommendations for further research and practice. Researchers explored the biological, assessment, organizational and educational, and practice perspectives. With regards to biological perspective, it was found that there is evidence from previous research that dementia had an impact on the perception and processing of pain. Concerning the assessment perspective, researchers found that the loss of communication ability presented a significant challenge for reporting pain.
As to the educational and organization perspective, high-quality training is essential for addressing the challenges of pain management in patients with dementia since the study identified gaps in staff knowledge. In practice, pain among patients with dementia is expressed through challenging behavior (Achterberg et al., 2013), so researchers underlined the need for more reliable studies with larger sample sizes to determine what interventions could be effective or not.
The findings of the literature review pointed to the lack of efforts with regards to effective assessment and treatment of pain among patients with dementia in different clinical contexts. Researchers identified the flaws existing in the process of pain assessment since dementia is a problem that impairs an individuals’ cognition.
Because dementia and pain are very common among elderly patients (due to the prevalence of conditions such as cardiovascular disease or arthritis), there is a need for better management efforts and clear guidance for health care providers (including nurses and pharmacists) with regards to making informed decisions when dealing with patients with dementia. Collaborative efforts should be further explored in future research to ensure subsequent improvements in the sphere of managing pain among patients with dementia (Achterberg et al., 2013).
Pain Assessment in Advanced Dementia Scale (PAINAD) is an assessment tool used by health professionals to assess the severity of pain among patients who experience severe demonstration. The tool requires a health care provider to observe a patient with dementia for a period of five minutes in order to score his or her behaviors. Such behaviors include breathing (independent of vocalization), negative vocalization, facial expression, body language, and consolability (“Pain Assessment in Advanced Dementia Scale,” n.d.).
It is allowed to observe a patient in a context of different settings, for example, in the state of their rest or after the administration of pain relief medication. Observing a patient in various situations can allow health care providers to see whether the environmental factors can affect specific behaviors. To give some examples, breathing can be characterized as “normal,” “occasional labored breathing,” or “noisy labored breathing” (“Pain Assessment in Advanced Dementia Scale,” n.d.). Body language, on the other hand, can be “relaxed,” “tense,” and “rigid” (“Pain Assessment in Advanced Dementia Scale,” n.d.).
The PAINAD tool provides explanations for scores from 0-2 points that rate the behaviors exhibited by patients. The total score can range from 0 to 10 points in total. According to “Pain Assessment in Advanced Dementia Scale” (n.d.), scores from 1-3 indicate mild pain, 4-6 are indicative of moderate pain while severe pain is represented by scores 7-10. By determining the level of pain a patient with dementia experiences, a healthcare provider can come up with an action plan for administering treatment to relieve the pain and improve the overall health outcomes.
References
Achterberg, W. P., Pieper, M. J., van Dalen-Kok, A. H., de Waal, M. W., Husebo, B. S., Lautenbacher, S.,…Corbett, A. (2013). Pain management in patients with dementia. Clinical Interventions in Aging, 8, 1471-1482.
Pain Assessment in Advanced Dementia Scale. (n.d.). Web.