Accessible summary• People with learning disabilities describe pain in terms of feelings or emotions.• Staff and doctors do not use pain recognition tools or communication aids.• People with learning disabilities often do not tell staff or family carers that they are in pain. If they do, they are unlikely to be given pain medication, and more likely to be taken to the doctors. • People with learning disabilities mostly know who is their doctor and understand what the doctor does. The majority of people said that the doctor explained what was wrong with them, what the medication was for and how often they needed to take it. • This research matters to people with learning disabilities. It is important that staff and carers recognise and manage pain well. Since this audit a pain training pack for staff and carers has been developed and is being used and booklets for both people with learning disabilities and staff and carers have been developed and given out. SummaryAn audit was conducted across Surrey to investigate pain recognition and management with people with learning disabilities. This section of the audit looked at what people with learning disabilities understood and experienced when they had pain compared to good practice from the literature. The results show that people with learning disabilities struggle to discuss pain effectively, and that little use is made of additional communication aids. People with learning disabilities rely on others to deal with their pain, but may not tell people that they are in pain. The most common response to having pain is to go to the doctors, and many people were not offered pain medication by staff. It was also reported that other alternative strategies were not used to manage pain. Although most people did not make the decision as to whether they needed to see their doctor, most people knew who their doctor was and reported good experiences in terms of information sharing once at the appointment. Further work has since been undertaken in Surrey to address the concerns raised in this audit through the development of information booklets on pain recognition and management for people with ª The Official Journal of the British Institute of Learning Disabilities learning disabilities and for staff and family carers, together with the development and roll out of pain training.

Accessible summary• Pain is not recognised and managed well for people with learning disabilities in residential settings -People with learning disabilities are not getting timely and appropriate 'as required' medication for their pain. • Staff do not use pain recognition tools or communication aids.• Some staff still believe that people with learning disabilities have a higher pain threshold than people without a learning disability. They also let this belief affect how they manage pain. • This research matters to people with learning disabilities. It is important that staff and carers recognise and manage pain well. We have developed a pain training pack for staff and carers and leaflets for both people with learning disabilities and staff and carers. SummaryThis audit investigated residential staff beliefs around pain thresholds and strategies they adopt to recognise and manage pain in people with learning disabilities across Surrey. A structured interview was constructed to elicit information. Results demonstrated that pain is not being effectively recognised or managed by residential staff in Surrey. It highlighted the need for training for staff in how to recognise and manage pain, as well as the need for appropriate pain recognition tools and communication aids to be utilised to support people with learning disabilities to be able to communicate their pain to others. It also indicated the need for better communication between staff and other services that the person with learning disabilities accesses.