ORIGINAL ARTICLE: Pain in people with learning disabilities in residential settings – the need for change

Abstract

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.

Pain experience and management in a forensic intellectual disability service

“…In accordance with previous research, HAPs were not being used to their full potential, lacking personalised information and patient preferences (Beacroft and Dodd, 2009). Despite this, nurses had good knowledge of their patients' health complaints and presentations.…”

“…Beacroft and Dodd, 2009). The finding that all patients were routinely prescribed and administered PRN analgesia, or another appropriate treatment for pain, was positive.…”

Nursing people with intellectual disability and dementia experiencing pain: An integrative review

“…WHO developed the analgesia pain ladder, recommending regular administration of pain relief where pain is suspected, with regular reassessment and review, recommending a recognised pain assessment tool and a three‐step approach to analgesic medication based on effectiveness and response (World Health Organization, ). Misconceptions by nurses and healthcare professionals regarding people with intellectual disability are that they are seen as a homogenous group, who are insensitive to pain and considered to have a higher pain threshold (Beacroft & Dodd, ; Symons, Shinde, & Gilles, ). However, this is not substantiated within research (McGuire & Kennedy, ) and current opinion is that the low‐level reports of pain are due to communication challenges rather than an absence of pain (Cleary & Doody, ; Kerr et al, ).…”

The reported expression of pain and distress by people with an intellectual disability

“…One important mediating factor is the interpretation that others make of indicators of pain. Accessing appropriate health care may depend on parents or carers picking up and correctly interpreting indicators from people with an intellectual disability that they are in pain (Foley & McCutcheon 2004, Beacroft & Dodd 2010). However, beliefs, such that this group have a higher pain threshold than the general population (Beacroft & Dodd 2010), despite evidence that this generalisation does not apply to all people with an intellectual disability (Biersdorff 1994), may mean that signals are missed, misinterpreted or wrongly attributed to a cause other than pain (Kerr et al.…”

“…Indeed, there is a body of research suggesting that people with an intellectual disability may not have the communication abilities to express when they are in pain or the nature of the pain they are experiencing (Regnard et al. 2007, Beacroft & Dodd 2010, 2011). As a result, many pain assessments for use by healthcare professionals have been developed on the basis of behavioural indicators (e.g.…”