ELDER PAIN--ASSESSMENT OF INTENSITY

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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.