ELDER PAIN--ASSESSMENT OF INTENSITY

虽然已经对疼痛评估进行了科学调查 并对非老年人群的干预，努力提供科学完善的 老年基地一直有限。关于声音疼痛的研究 老年人的评估措施实际上是不存在的，但 对于证实老年人疼痛管理的优点来说是必不可少的。《长河》 P.I.的长期目标是建立准确的疼痛评估 针对老年人的方法，并最终测试用于 减轻老年人的疼痛或其影响。《公约》的具体目标 目前的研究是建立疼痛的心理测量学特性 加大对老年人的措施，正确识别困难 对选定的措施作出反应，并确定对选择有用的因素 适合老年人的认知、精神运动和运动工具 视觉能力。阶段1将尝试确定可靠性和 面部疼痛评定量表作为疼痛强度评估方法的有效性 在老年人社区样本中(n=120)，使用 排名、安置任务和重测方法。将对数据进行分析 采用符合率，差异显著的t检验， 重复测量的方差分析，以及等级相关系数。 第二阶段将使用基于实验室的实验性疼痛刺激(接触热 模式)以尝试建立心理测量学属性和效用 用于评估疼痛强度的选定测量仪器(视觉 类比量表、言语描述量表、数字评价量表、言语 老年人和非老年人的数字评定量表和面部疼痛量表) 受试者控制不同的教育水平，以及精神运动， 视觉和认知障碍。老年(n=73)受试者 从社区、一家老年诊所和疗养院招募。 非老年人对照对象(n=73)将从 社区。每名受试者都将参加一个实验环节。 哪6种接触热的强度从43摄氏度到51度不等 C度将通过电子设备应用于前臂腹侧- 受控接触热模式。每个温度将呈现两次，并且 在实验过程中随机穿插。所有参与者 是否会根据所选的五种疼痛强度对感觉强度进行评级 在每一次有害的热刺激后进行测量。疼痛阈值将是 在会议开始时确定用于建立 对每个工具的答复的有效性。分析将包括意义 测试比例差异、线性回归相关性、 因子分析和多元方差分析。第三阶段将 比较这些选定疼痛的心理测量学特性和效用 老年人(n=73)临床环境中的强度测量 73名经历疼痛的非老年受试者。受试者将被要求 在第二阶段的五个工具中的三个工具上对他们当前的疼痛强度进行评级 为关节疼痛就诊前30分钟 联合注射利多卡因和类固醇后。分析将涉及 与阶段2中类似的技术。在查看了可用的 手术后急性疼痛的疼痛评估与管理研究， AHCPR急性疼痛管理指南小组得出的结论是 具有既定心理测量学特性的工具不可用 和老人在一起。至关重要的是，方法论研究 先测定仪器测量老年人疼痛的能力 进行实质性调查以控制这一人群中的疼痛。

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.