ELDER PAIN--ASSESSMENT OF INTENSITY

虽然对疼痛评估进行了科学研究， 并在非老年人中进行干预，努力提供完善的科学 老年人的基础有限。声音痛的研究 老年人的评估措施几乎不存在，但 对于证实老年疼痛管理的优点至关重要。长 P.I.的长期目标是建立准确的疼痛评估 为老年人提供的方法，并最终测试用于 缓解老年人的疼痛或其影响。该委员会的具体目标 目前的研究是建立疼痛的心理测量特性， 针对老年人的强度措施，正确识别困难 对选定的措施作出反应，并确定有助于选择的因素 老年人的适当工具，基于认知、心理和 视觉能力。第1阶段将尝试确定可靠性， 面孔疼痛量表作为评估疼痛强度方法的有效性 在老年社区样本（n= 120）中，使用 排名，安置任务，和重测方法。将对数据进行分析 使用一致性百分比，显著性差异的t检验， 重复测量方差分析和等级相关系数。 第二阶段将使用基于实验室的实验性疼痛刺激（接触热 热模式），试图建立心理测量的属性和效用 选定的测量仪器，以评估疼痛强度（视觉 模拟量表，语言描述量表，数字评定量表，语言 数字评定量表和面部疼痛量表） 控制不同教育水平的受试者，以及心理学， 视觉和认知障碍老年（n=73）受试者将 从社区、老年诊所和疗养院招募。 非老年对照受试者（n = 73）将从 社区每个受试者将参加一个实验会议， 这6个强度的接触热从43摄氏度到51 摄氏度将被施加到前臂腹侧的电子- 控制接触式热电极。每个温度将显示两次， 在实验期间随机散布。所有参与者 将根据五种选定的疼痛强度对感觉强度进行评级 在每次有害热刺激后进行测量。疼痛阈值将是 在届会开始时确定， 对每种工具的有效性。分析将包括显著性 比例差异检验，线性回归相关性检验， 因子分析和多变量方差分析。第三阶段将 比较这些选定疼痛的心理测量特性和效用， 老年人（n = 73）临床环境中的强度测量， 非老年（n = 73）受试者出现疼痛。将要求受试者 使用第2阶段五种工具中的三种评估他们当前的疼痛强度 就在关节疼痛的诊所预约之前， 联合注射利多卡因和类固醇后。分析将涉及 与第二阶段类似的技术。在审查了可用的 疼痛评估和急性术后疼痛管理的研究， AHCPR急性疼痛管理指南小组得出结论， 具有既定心理测量特性的工具不可用 和老年人在一起重要的是， 确定仪器测量老年人疼痛的能力， 进行实质性研究以管理该人群的疼痛。

Although scientific investigation has been conducted on pain assessment and intervention in the non-elderly, efforts to provide a sound scientific base for the elderly have been limited. Investigations of sound pain assessments measures in the elderly are virtually nonexistent, but are essential for substantiating the merit of elder pain management. The long term objectives of the P.I. are to establish accurate pain assessment methods for the elderly and ultimately, to test interventions used to relieve pain or its impact in the elderly. The specific aims of the current research are to establish the psychometric properties of pain intensity measures for the elderly, identify difficulties in correctly responding to selected measures, and identify factors useful for selecting the appropriate tool for the elderly based on cognitive, psychomotor and visual capabilities. Phase 1 will attempt to determine the reliability and validity of the Faces Pain Scale as a method of assessing pain intensity in the elderly with a well-elderly community sample (n= 120), using ranking, placement tasks, and test-retest methods. Data will be analyzed using percentage of agreement, t-test for significant differences, repeated measures analysis of variance, and rank correlation coefficient. Phase 2 will use laboratory-based experimental pain stimuli (contact heat thermode) to attempt to establish the psychometric properties and utility of selected measurement instruments to assess pain intensity (visual analog scale, verbal descriptor scale, numeric rating scale, verbal numeric rating scale and faces pain scale) for elderly and nonelderly subjects controlling for varying educational levels, and psychomotor, visual, and cognitive impairment. Elderly (n=73) subjects will be recruited from the community, a geriatric clinic, and nursing homes. Nonelderly comparison subjects (n = 73) will be recruited from the community. Each subject will participate in an experimental session in which 6 intensities of contact heat varying from 43 degrees C to 51 degrees C will be applied to the ventral forearm by an electronically- controlled contact thermode. Each temperature will be presented twice and randomly interspersed during the experimental session. All participants will rate sensation intensity on the five selected pain intensity measurements after each noxious heat stimulus. Pain threshold will be determined at the beginning of the session to be used in establishing validity of responses to each tool. Analyses will include significance tests for differences in proportions, linear regression correlations, factor analyses and multivariate analysis of variance. Phase 3 will compare the psychometric properties and utility of these selected pain intensity measurements in clinical settings with elderly (n = 73) and nonelderly (n = 73) subjects experiencing pain. Subjects will be asked to rate their current pain intensity on three of the five tools from Phase 2 immediately preceding a clinic appointment for joint pain and 30 minutes after joint injection with lidocaine and steroid. Analysis will involve techniques similar to that in Phase 2. After reviewing the available research on pain assessment and management for acute-post-operative pain, the AHCPR Acute Pain Management Guideline Panel concluded that assessment tools with established psychometric properties are not available for use with the elderly. It is essential that methodological studies which determine instruments' abilities to measure pain in the elderly precede substantive investigations to manage pain in this population.