Table 2. Pain self-report determination and tool selection process.
| Reliability and Ability to Self-Report Determination Process4 | Pain Tool Selection Process24 | Additional Considerations for Pain Tool Selection4 | ||
|---|---|---|---|---|
| Triggers to establish self-report ability: Note a diagnosis of cognitive impairment, dementia, or mental health condition, Note a condition that may interfere with verbal report (eg, aphasia), Administer a quick, reliable mental status examination, and/or Observe coherence of thoughts and verbal communication (and/or ability to explain what pain is to them). |
If older adult: Can communicate verbally or nonverbally purposefully (eg, pointing, head nods, etc.), can self-report reliably, and is cognitively intact. |
|
Use a valid, reliable, and patient-preferred self-report pain scale such as:
|
Congruent with patient's culture of pain expression, accurate language, and available in different languages (or can be easily translated). Accommodates patient's sensory impairments. Accommodates patient's developmental, intellectual, and cognitive level; easily understood. Easily and quickly explained to patient or observer. Easily used, scored, and recorded consistently. Can be used by interdisciplinary personnel. Easily linked to patient's comfort–function–mood goals. Meets organizational and regulatory standards. Fits with quality indicators and institutional documentation system. Can be used as data for quality improvement and evidence-based practice projects. |
| Cannot consistently communicate verbally or nonverbally purposefully, cannot self-report consistently, and has fluctuating cognitive status (eg, dementia, delirium). |
|
Attempt self-report first by using a valid, reliable, and preferred self-report pain scale (see previous) and observational pain–behavior tool such as:
|
||
| Techniques to establish reliability to self-report using pain tools: Ask older adult to pick 2 words that similarly describe pain from a list mixed with pain and nonpain descriptors and observe for conceptual understanding. Assess conceptual understanding on the use of a self-report pain scale by asking the person where mild and severe pain are represented on a 0–10 pain scale, then repeat this task several minutes later (should have the same or similar scores if reliably reporting pain)18; this can also be done by asking if 7 is more intense pain than 9 on the NRS. Use a pain screener test.21 |
Cannot communicate verbally, cannot self-report, and is not cognitively intact. |
|
Use an assessment protocol such as the:
|
|
Abbreviations: ADD, Assessment of Discomfort in Dementia Protocol; FPS-r, Faces Pain Scale-revised; IPT-r, Iowa Pain Thermometer-revised; MOBID-2, Mobilization-Observation-Behavior-Intensity-Dementia-2 pain scale; NRS, Numeric Rating Scale; PACSLAC-II, Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PAINAD, Pain Assessment in Advanced Dementia; VDS, Verbal Descriptor Scale.