The assessment of pain in older people

Royal College of Physicians, British Geriatrics Society and British Pain Society


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1 Pain awareness

  • All healthcare professionals should be alert to the possibility of pain in older people, and to the fact that older people are often reluctant to acknowledge and report pain

2 Pain enquiry

  • Any health assessment should include enquiry about pain, using a range of alternative descriptors (e.g. sore, hurting, aching)

3 Pain description

  • Where pain is present, a detailed clinical assessment of the multidimensional aspects of pain should be undertaken including:
    • sensory dimension: the nature, location and intensity of pain
    • affective dimension: the emotional component and response to pain
    • impact: on functioning at the level of activities and participation
  • An attempt to locate pain should be made by:
    • asking the patient to point to the area on themselves
    • the use of pain maps to define the location and the extent of pain
  • Pain assessment should routinely include the use of a standardised intensity rating scale, preferably a simple verbal descriptor scale or a numeric rating scale, if the person is able to use these

4 Communication

  • Every effort should be made to facilitate communication particularly with those people with sensory impairments (use of hearing aids, glasses etc)
  • Self-report assessment scales should be offered in an accessible format to suit the strengths of the individual

5 Assessment in people with impaired cognition/communication

  • People with moderate to severe communication problems should be offered additional assistance with self-report through the use of suitably adapted scales and facilitation by skilled professionals
  • In people with very severe impairment, and in situations where procedures might cause pain, an observational assessment of pain behaviour is additionally required
  • Pain behaviours differ between individuals, so assessment should include insights from familiar carers and family members to interpret the meaning of their behaviours

6 Cause of pain

  • Careful physical examination should be undertaken to identify any treatable causes. However, staff should be aware that pain can exist even if physical examination is normal

7 Re-evaluation

  • Once a suitable scale has been identified, serial assessment should be undertaken using the same instrument to evaluate the effects of treatment

Algorithm for assessment of pain in older people

Algorithm for assessment of pain in older people

*If there is doubt about ability to communicate, assess and facilitate as indicated in recommendations 4 and 5 of the guidelines

References

full guidelines available from…
British Geriatrics Society, Marjory Warren House, 31 St John’s Square, London EC1M 4DN (Tel – 020 7608 1369, Fax – 020 7608 1041) Email: general.information@bgs.org.uk
Website: http://www.bgs.org.uk

Royal College of Physicians, British Geriatrics Society and British Pain Society. The assessment of pain in older people: national guidelines. Concise guidance to good practice series, No 8. London: RCP, 2007. October 2007
First included: Feb 08.


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