When They Can’t Tell You About the Hurt: Assessing Pain in People with Intellectual or Developmental Disabilities

By Sylvia Foley, AJN senior editor

When S.M., a 47-year-old resident at a facility for people with intellectual or developmental disabilities, started hitting himself in the left eye, his caregivers weren’t sure why. S.M., whose developmental quotient is equivalent to that of a two- or three-year-old, couldn’t tell them. Some thought he was frustrated at not being allowed to drink as much coffee as he wanted; others thought a recent decrease in his medication—quetiapine (Seroquel)—might be a factor. But a chart review revealed that both his father and brother had a history of cluster headaches. Was S.M.’s behavior an indicator of headache pain? How could clinicians best assess him?

In this month’s CE feature, authors Kathy Baldridge and Frank Andrasik provide an overview of pain assessment in people with intellectual or developmental disabilities, summarize the relevant research, and discuss the applicability of the American Society for Pain Management Nursing practice guidelines for assessing pain in nonverbal patients. The guidelines describe various behavioral pain assessment tools, some of which might be useful with S.M. and others like him. Other assessment methods include

a search for pathologic conditions or other problems or procedures known to cause pain; the observation of behaviors that might indicate pain; and the use of proxy reports (also called surrogate reports) by people who know the person best, whether family caregivers or professionals.

S.M. was encouraged to draw himself and what the “hurt” felt like; two […]

2016-11-21T13:14:41+00:00 December 14th, 2010|Ethics, nursing perspective, pain management|3 Comments

Poor Assessment of Nursing Home Residents’ Pain — What Can Be Done?

A recent study sought to find out whether relatives and caregivers (proxies) understood residents’ pain well enough to assist in pain assessment and to discover what factors affected their judgments of pain. The findings showed, however, that their reports didn’t consistently match the pain ratings of nursing home residents themselves.

It’s particularly difficult to assess pain in cognitively impaired nursing home residents. This means that there’s a lot of suffering that goes untreated. This AJN article in the December issue discusses the findings of a new study on the topic and offers some recommendations we obtained from the study authors. Here’s another excerpt:

The authors suggest that pain management in nursing homes could be improved through caregiver education, including the implementation of pain assessment education in combination with treatment. They recommend basic training for nurses and nursing assistants on pain, pain behavior, and pharmacologic and nonpharmacologic pain treatment, such as “massage, applying warmth, mobility[, and] distractions with music or story telling.” They also suggest that “treatment effects could be determined more easily using a pain observation scale.”

So check out the article, and also let us know what else can we do to more accurately assess the pain of nursing home residents.

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Readers Comment on Vicodin, Percocet Ban


In his July 6 post on the proposed Vicodin, Percocet ban, AJN editor Jacob Molyneux wrote, “A number of clinicians and patients have expressed alarm at the potential loss of Vicodin and Percocet, both of which are mainstays of pain management in the U.S.” He cited pain expert Carol Curtiss’s concern that such a ban could have “even more drastic implications than most people yet understand,” then asked readers, “Should we worry?”

Some commenters think so:  nester writes

If suddenly the combos become unavailable and pain relief is that much harder to come by, every Tom, Dick, and Harry with a sprain is going to flock to the ER for the good stuff… not once, but daily until the pain is gone or they are refused treatment.  If you can’t go to just any doc to get narcotic pain relievers, the pain relief specialists will have lines out the door also.

And Abigail Nobel says, “Educate before banning these affordable, essential components of pain control. Why should everyone suffer for the carelessness of a few?”

But Judy Newberger says that although she initially agreed with the ban, an interview with an elderly patient who was given Percocet and was already taking acetaminophen changed her mind.

Labels were not read, discharge papers were not thoroughly reviewed. Did no one review what meds he was on before they sent him home? I now am FOR removing Rx and OTC combination pain and other combination meds with acetaminophen.

Thanks to all for […]

2016-11-21T13:25:09+00:00 July 17th, 2009|nursing perspective, pain management|0 Comments