Assessing Pain in Nonresponsive Hospice Patients: Development and Preliminary Testing of the Multidimensional Objective Pain Assessment Tool (MOPAT)

McGuire, Deborah B.; Reifsnyder, JoAnne; Soeken, Karen L.; Kaiser, Karen; Yeager, Katherine A.

doi:10.1089/jpm.2010.0302

Cited by 35 publications

(36 citation statements)

References 12 publications

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“…The potential translational utility of this approach is also demonstrated by the recent BOLD imaging study showing analogous activation of the NAc in rats in response to pain onset and offset as described in humans [11]. Additionally, it is noted that there are circumstances in humans where determining whether pain is present is difficult, including schizophrenia, Alzheimer’s, mental retardation, elderly or young children including neonatal patients [4; 35; 42; 63; 67]. In these individuals, ongoing pain might be unmasked with imaging the activation of this circuit with a transient pain relieving intervention allowing for appropriate decisions in medical management of the patient.…”

Section: Discussionmentioning

confidence: 98%

Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: A potential biomarker of efficacy

Xie

Patwardhan

et al. 2014

Pain

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Preclinical assessment of pain has increasingly explored operant methods that may allow behavioral assessment of ongoing pain. In animals with incisional injury, peripheral nerve block produces conditioned place preference (CPP) and activates the mesolimbic dopaminergic reward pathway. We hypothesized that activation of this circuit could serve as a neurochemical output measure of relief of ongoing pain. Medications commonly used clinically including gabapentin and non-steroidal anti-inflammatory drugs (NSAIDs) were evaluated in models of post-surgical (one day following incision) or neuropathic (14 days following spinal nerve ligation, SNL) pain to determine if the clinical efficacy profile of these drugs in these pain conditions was reflected by extracellular dopamine (DA) release in the nucleus accumbens (NAc) shell. Microdialysis was performed in awake rats. Basal DA levels were not significantly different between experimental groups and no significant treatment effects were seen in sham-operated animals. Consistent with clinical observation, spinal clonidine produced CPP and produced a dose-related increase in net NAc DA release in SNL rats. Gabapentin, commonly used to treat neuropathic pain produced increased NAc DA in rats with SNL, but not in animals with incisional, injury. In contrast, ketorolac or naproxen produced increased NAc DA in animals with incisional, but not neuropathic, pain. Increased extracellular NAc DA release was consistent with CPP and observed selectively with treatments commonly used clinically for post-surgical or neuropathic pain. Evaluation of NAc DA efflux in animal pain models may represent an objective neurochemical assay that may serve as a biomarker of efficacy for novel pain-relieving mechanisms.

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Section: Discussionmentioning

confidence: 98%

Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: A potential biomarker of efficacy

Xie

Patwardhan

et al. 2014

Pain

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“…The MOPAT was modified to serve as a measure of two dimensions of pain (Behavioral and Physiologic) that could be used in non-communicative individuals across palliative care settings. In the original formulation, the developers included a third dimension, Sensory, focusing on the temporal pattern of pain 56 . The Behavioral Dimension is comprised of four behaviors scored on a scale of 0 (no behavior displayed) to 3 (most severe behavior): 1) Restlessness , 2) Tense muscles , 3) Frowning/grimacing , and 4) Patient Sounds , which are summed for a Behavioral Dimension score ranging from 0-12.…”

Section: Review Of Selected Pain Assessment Toolsmentioning

confidence: 99%

“…The Sensory Dimension is designed to assess pattern of pain by using Behavioral and Physiologic ratings over time, in conjunction with knowledge of pain etiology, to choose among three groups of adjectives adapted from the McGill Pain Questionnaire Long Form (brief/momentary/transient; rhythmic/periodic/intermittent; continuous/steady/constant). Several small-scale developmental studies that were conducted in inpatient hospice settings demonstrated initial evidence of reliability, validity, and clinical utility of the Behavioral and Physiologic dimensions, but little use of the Sensory dimension 56 . These results led to full-scale psychometric evaluation of a revised MOPAT consisting of Behavioral and Physiologic dimensions in both the acute care hospital and inpatient hospice settings.…”

Section: Review Of Selected Pain Assessment Toolsmentioning

confidence: 99%

Pain Assessment in Noncommunicative Adult Palliative Care Patients

McGuire

Kaiser

Haisfield-Wolfe

et al. 2016

Nursing Clinics of North America

Self Cite

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Synopsis Palliative care patients who have pain are often unable to self-report their pain placing them at increased risk for under-recognized and under-treated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for non-communicative adult patients.

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“…The behavioral responses to pain can be misinterpreted by others, especially health providers (Wilkie, Berry et al, 2010). Well-known examples of pain-related behaviors include behaviors to control the pain such as preventing it, reducing it through positions, reporting it, and taking analgesics (Wilkie, Keefe, Dodd, & Copp, 1992), some of which have informed behavioral assessment tools for persons not able to communicate their pain (McGuire, Reifsnyder, Soeken, Kaiser, & Yeager, 2011). Other behavioral responses include interference with activities of daily living (Goebel et al, 2009; Vallerand et al, 2007), can be complex, and involve caregivers.…”

Section: Critical Evidence and Issuesmentioning

confidence: 99%

Pain and symptom management in palliative care and at end of life

Wilkie

Ezenwa

2012

Nursing Outlook

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The purpose of this review is to provide a literature update of the research published since 2004 on pain and symptom management in palliative care and at end of life. Findings suggest that pain and symptom are inadequately assessed and managed even at the end of life. Although not pervasive, there is evidence of racial/ethnic disparities in symptom management in palliative care and at end of life. There is a need for a broader conceptualization and measurement of pain and symptom management as multidimensional experiences. There is insufficient evidence about mechanisms underlying pain at end of life. Although there are advances in the knowledge of pain as a multidimensional experience and the many symptoms that occur sometimes with pain, still gaps remain. One approach of addressing the gaps will involve assessment and management of pain and symptoms as multidimensional experiences in people receiving palliative care and at end of life.

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Assessing Pain in Nonresponsive Hospice Patients: Development and Preliminary Testing of the Multidimensional Objective Pain Assessment Tool (MOPAT)

Abstract: The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.

Cited by 35 publications

References 12 publications

Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: A potential biomarker of efficacy

Activation of mesocorticolimbic reward circuits for assessment of relief of ongoing pain: A potential biomarker of efficacy

Pain Assessment in Noncommunicative Adult Palliative Care Patients

Pain and symptom management in palliative care and at end of life

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