Progress in pain assessment: the cognitively compromised patient

Abstract

Purpose of review-Pain assessment is essential for patient care in many settings, but it proves difficult when the patient is cognitively compromised or otherwise unable to produce a conventional pain report. This review describes progress in pain assessment technology that involves the coding of human facial expression.Recent findings-It is possible to quantify facial expression by coding patterns of facial muscle contraction and relaxation. These patterns are action units, and they can gauge the intensity of pain as well as signal its occurrence. The experience of pain seems to generate a unique facial expression comprising several action units. Concerns have existed about whether demented patients produce diagnostically meaningful facial expressions of pain because they tend to generate more non-specific facial expressions and perhaps code pain intensity less well than normals. Recent work shows that facial expression reflects pain as well or better in demented patients compared to normals.Summary-Although still nascent, coded facial expression appears to work reliably as a pain assessment tool with cognitively compromised patients. Clinical application awaits the development of technology that can automate facial coding and scoring.

Can Adding a Standardized Observational Tool to Interdisciplinary Evaluation Enhance the Detection of Pain in Older Adults with Cognitive Impairments?

“…All the participants in our sample had clear verbal communication problems and severe cognitive impairments. This is significant, as older populations with mild to moderate dementia do not express their pain (via facial expression) as strongly as do older adult populations with moderate to severe dementia [55–57]. Furthermore, our sample of participants was very inclined to present with pain behavior during transfers/mobilizations, as almost all of the recruited residents were receiving analgesics prior to the beginning of the study.…”

Pain in patients with dementia: A review of pain assessment and treatment challenges

“…48 In the last 35 years, more than 35 pain assessment instruments for older persons with dementia have been developed, tested, and reviewed in the literature. 19,20,[48][49][50][51][53][54][55] Most of these instruments are based on the idea that the patients' acute or chronic pain experience is communicated by changes in facial expression, vocalization, and body movements. 22 It has also been suggested that one of the primary functions of pain behaviour is to elicit the aid of others.…”

Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

“…Research is ongoing to refine relevant indicators and establish tools to measure pain in nonverbal older adults. Frequency of behavior presentation and key behaviors, such as facial grimacing or expression, are beginning to emerge as important factors to detect and judge severity of pain in those with dementia [56–58].…”