Interventions in pain management for persons with an intellectual disability

Abstract

Pain is a multidimensional and subjective experience, and an ideal pain management regime needs to be comprehensive, integrative and involve all relevant persons. Multimodal interventions may include pharmacological, physical, social, psychological and spiritual approaches in order to address pain management at a molecular, functional, behavioural, cognitive and affective levels. Pain management interventions will vary according to pain aetiology, patient characteristics and preferences. In keeping with best practice guidelines for effective pain management, a structured approach incorporating an effective assessment of pain by the healthcare professional, identification of the source and type of pain and accurate documentation is essential. This article focuses on pharmacological and non-pharmacological pain management for individuals with intellectual disability.

Pain interventions in adults with intellectual disability: A scoping review and pharmacological considerations

“…Of the 16 articles included, five did not match our preset outcomes, although having been selected according to keywords and inclusion criteria. Four were narrative reviews (Mafrica & Fodale, 2006; Mafrica et al, 2006; McGuire & Kennedy, 2013; Symons et al, 2008) and one was a brief report (Doody & Bailey, 2019). They are nevertheless briefly summarized below.…”

“…In their brief report, Doody and Bailey (2019) give a general and comprehensive overview on the multidimensional aspect of pain, the need of an integrative approach, the importance of assessment and accurate documentation and the need to stick to the best practice guidelines in pain management. Regarding pharmacological interventions, general principles on pain management such as relieving pain and minimizing adverse effects are underscored.…”

“…Choosing treatment according to the nature of pain (nociceptive vs. neuropathic) and WHO ladder is detailed. As for non‐pharmacological interventions, the different techniques and their rational are presented (Doody & Bailey, 2019).…”

“…Hence, the very first key step for adequate pain management in adults with ID is the use of one of the validated pain assessment tools adapted to the individual patient's cognitive ability (Boerlage et al, 2013; Doody & Bailey, 2019; McGuire & Kennedy, 2013; Symons, Shinde, & Gilles, 2008). Moreover, before making the diagnosis, one should develop a working hypothesis on the potential origin of pain and perform the appropriate clinical and paraclinical exams (Doody & Bailey, 2019).…”

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

“…This first‐ever finding coincides with the global epidemic of inappropriate use of therapeutic opioids (Humphreys ) and highlights the necessity for development of multimodal pain management strategies including pharmacological, physical and psychosocial approaches in PwNDD (Bryson et al . ; Doody & Bailey ). Given the subjective nature of pain experience and the prevalent co‐morbid mental disorders in PwNDD, it is particularly important for healthcare professionals to conduct effective pain assessment and identify high ADE risks associated with opioids prescriptions in PwNDD who would have difficulties expressing discomfort.…”