老年痴呆患者疼痛评估工具的研究进展

疼痛是一种主观感觉,迄今尚无特异性的生理指标反映疼痛程度,临床上常根据患者自评结果(self-report)来判断疼痛严重程度.但是,自评式评估量表通常以患者能够理解和准确量化自身的疼痛程度为基础,而这要求患者有一定程度的逻辑思维、抽象思维、想象及交流能力,而对有认知功能障碍者,如痴呆老人,自评结果可能无法反映其真实的疼痛程度[1-4].     

重度老年痴呆患者疼痛评估的研究与护理

目的探讨老年痴呆患者疼痛临床评估方法,以及降低疼痛应激的护理对策。方法将符合诊断标准的40例重度老年痴呆患者随机分为评估组和对照组各20例。在常规静脉采血过程中使用中文版晚期老年痴呆疼痛评估量表（C-PAINAD）进行评分。根据评分给予评估组相应的非药物疼痛处理,对照组不给予任何处理。在疼痛刺激后60min对两组患者再次进行评分。结果两组患者在采血过程中均存在不同程度的疼痛,但两组比较差异无统计学意义（P〉0．05）;60min后评分结果比较,评估组明显低于对照组（P〈0．01）。结论重度老年痴呆患者仍能感知到疼痛,根据评分给予相应的非药物处理可减轻其疼痛感。     

老年性痴呆病人的疼痛评估及护理进展

从老年性痴呆病人的疼痛经历、对老年性痴呆病人疼痛的评估以及药物止痛、非药物止痛方面阐述了老年性痴呆病人的疼痛护理。     

老年痴呆患者疼痛评估与护理干预的研究进展

随着疼痛学的发展,疼痛护理工作日益受到重视,疼痛作为临床最常见的症状之一,国际上已有将疼痛列为除血压、脉搏、呼吸和体温之外的第5大生命体征,对患者进行评估和记录的趋势[1]。在我国,老龄人口比例逐年上升,2005年中国60岁和65岁以上老年     

老年痴呆患者疼痛评估及管理最佳证据总结

目的 总结老年痴呆患者疼痛评估及管理的最佳证据,为老年痴呆患者疼痛的评估和管理提供证据支持,改善老年痴呆患者的疼痛护理质量。方法 用PICO模型构建循证护理问题,按照“6S”证据金字塔模型依次检索2010年1月1日—2020年2月29日发布在UpToDate、BMJ Best Practice、JBI、NICE、RNAO、CINAHL、中国生物医学数据库、知网、万方等数据库的相关文献,2名具备硕士学位的循证护理师独立进行文献质量评价及证据筛查,证据汇总后由项目团队综合归类。结果 共纳入文献12篇：证据总结3篇,指南2篇,系统评价5篇,随机对照试验2篇。从纳入的文献中共提取55条证据,最终综合成26条最佳证据共6个维度,分别是疼痛评估时机与量表、疼痛评估方法、干预措施、疼痛管理、培训与教育、组织保障。结论 临床管理者需重视老年痴呆患者疼痛评估,使用适宜疼痛评估工具及方法,采取针对性干预措施,并且需对医务人员进行老年痴呆患者疼痛相关知识的培训,在证据应用的过程中应评估临床情景及现有的医疗环境,制订符合临床实际的老年痴呆患者疼痛管理计划。     

老年性痴呆病人的疼痛评估及护理进展

从老年性痴呆病人的疼痛经历、对老年性痴呆病人疼痛的评估以及药物止痛、非药物止痛方面阐述了老年性痴呆病人的疼痛护理。     

疼痛评估

疼痛已被护理人员作为除体温、脉搏、呼吸和血压以外的“第五个生命体征”来评估与处理,但不充分的疼痛治疗仍然是一个普遍存在的临床问题。研究表明,医务人员对疼痛评估不足和缺乏疼痛知识是有效疼痛管理的主要障碍。     

他人疼痛评估与患者实际疼痛偏差的研究进展

在整个疼痛管理中疼痛评估是第一步和最关键的一步,但是在这一过程的实践中,医护人员对患者疼痛状况的评估与患者实际疼痛状况之间经常出现一些偏差,影响疼痛评估的正确性,也直接影响疼痛管理的效果。现对相关问题综述如下。     

癌症患者疼痛的评估和干预

国际疼痛学会对疼痛的定义是：疼痛是一种令人不快的感觉和情绪上的感受，伴随有现存的和潜在的组织损伤。在临床工作中，疼痛已成为继体温、脉搏、呼吸、血压4大生命体征之后的第5生命体征，日益受到重视。疼痛问题在许多疾病中都有所表现，而在癌症病人身上表现得尤为突出。据统计，全世界有癌症患者约1400万，其中30％～60％伴有不同程度的疼痛，同时根据2003年11月11日中国医药报的统计，我国目前癌症患者已超过700万，其中51％～62％的患者伴有不同程度的疼痛，并且疼痛程度中度和重度者均达到了30％。癌痛会让癌症患者痛苦、焦虑，使患者丧失生活的勇气和信心，加速病情的恶化。而缓解或消除癌痛，不仅能减轻患者身心的痛苦，还能对患者的免疫功能起保护作用，从而抑制肿瘤细胞的扩散和转移。因此，癌症止痛在我国乃至全世界均具有非常重要的意义。本文就近几年国内外癌性疼痛评估和干预的状况综述如下。     

癌症患者疼痛的评估和干预

国际疼痛学会对疼痛的定义是:疼痛是一种令人不快的感觉和情绪上的感受,伴随有现存的和潜在的组织损伤.在临床工作中,疼痛已成为继体温、脉搏、呼吸、血压4大生命体征之后的第5生命体征,日益受到重视[1].疼痛问题在许多疾病中都有所表现,而在癌症病人身上表现得尤为突出.     

Pain assessment in elderly patients with severe dementia

The purpose of this study was to assess the reliability and validity of facial expressions as pain indicators in patients with severe dementia. Based on interviews with patients who could report pain, we defined characteristics of decubitus ulcers associated with reports of pain during dressing changes. We then evaluated 9 patients who had ulcers with these characteristics but were unable to communicate verbally because of severe dementia. We videotaped their facial expressions before and during their decubitus ulcer dressing change. We showed the videotape segments, in random order, to 8 medical students and 10 nurses. The 18 viewers were asked to infer the presence or absence of pain based on their observations of the patients' facial expressions and vocalizations. The dressing change of decubitus ulcers extending beyond the subcutaneous tissue, covering an area of at least 9 cm(2), and with a moist surface, was always reported as painful by study patients able to report (95% confidence interval of 69-100%). The intraclass correlation coefficient for the answers of the 18 viewers evaluating each videotape segment for the presence of pain was 0.64. Sensitivity, specificity, and positive and negative predictive values of viewers' ratings of facial expressions and vocalizations as a measure of the presence of pain were: 0.70, 0.83, 0.90, and 0.81. The intraclass correlation coefficient for the answers rating pain intensity was only 0.10, indicating only slight agreement beyond chance. Assuming dressing changes of ulcers reported as painful by communicative patients are also painful in non-verbal severely demented patients, clinician observations of facial expressions and vocalizations are accurate means for assessing the presence of pain, but not its intensity, in patients unable to communicate verbally because of advanced dementia.     

Pain assessment in people with dementia

Pain in older adults is very often undertreated, and it may be especially so in older adults with severe dementia. Changes in a patient's ability to communicate verbally present special challenges in treating pain, and unrelieved pain can have serious consequences, including declines in physical function and diminished appetite. The Pain Assessment in Advanced Dementia (PAINAD) scale has been designed to assess pain in this population by looking at five specific indicators: breathing, vocalization, facial expression, body language, and consolability. A trained nurse or other health care worker can use the scale in less than five minutes of observation. For an online video showing nurses using the PAINAD scale and other pain-assessment tools, go to http://links.lww.com/A251.     

Pain assessment and management in persons with dementia

Pain is a significant problem for older adults, and it has the potential to negatively impact their independence, functioning, and quality of life. In order for pain to be managed effectively, it first must be assessed carefully and systematically. Pain assessment in patients with dementia should start with self-report of pain, but must incorporate assessment of nonverbal pain behaviors. Pain treatment in older adults should be tailored to the individual. Pain medications can be used safely in elders, and they may be more effective when combined with nonpharmacological treatment. Despite the preponderance of research on pain, relatively few investigations have focused on pain in older adults in general, and on persons with dementia specifically. Better strategies for assessing pain, using observational methods, are the cornerstone of effective pain management in persons with dementia. Practitioners must be knowledgeable about pain treatment, and use both pharmacological and nonpharmacological strategies to relieve pain. Moreover, clinicians must be aware of the barriers to effective pain management and work to overcome them. In so doing, they may make significant contributions to managing pain in patients with dementia, and in improving the quality of life of this vulnerable population of elders.     

Pain assessment in older people with dementia: literature review

Title.  Pain assessment in older people with dementia: literature review.
Aim.  This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers.
Background.  Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain.
Data sources.  Searches were conducted of CINAHL, Medline and other databases for the period 1993–2007 using the search terms pain, dementia, assess*, barrier* and obstacle*.
Methods.  Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute.
Results.  Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools.
Conclusion.  More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.     

Pain perception and tolerance in patients with frontotemporal dementia

Pain management in elderly people with cognitive impairment poses special challenges, due to difficulties in pain assessment and specific neurodegenerative changes along pain pathways. Most studies have concentrated on Alzheimer’s disease (AD) patients, in whom some contrasting findings have been found. For example, while psychophysical data suggest a selective blunting of the affective dimension of pain, pain-related fMRI signal increases have also been described. Few data have been reported in patients with frontotemporal dementia (FTD). By electrical stimulation, we have measured pain threshold and pain tolerance in clinically diagnosed FTD patients with SPECT cerebral hypoperfusion. We performed our analysis on two separate and overlapping subgroups selected on the basis of (1) neuropsychological scores below cut-off values (2) a strictly localized frontal and/or temporal hypoperfusion. We observed increased pain threshold in the first group and increased pain threshold and pain tolerance in the second group. Our results suggest differences in pain processing changes in distinct types of dementia, while at the same time caution that pain perception assessment may depend on the criteria adopted for diagnosis.