Reports from the Field

PIS scores pain best for impaired adults

Providers often have difficulty assessing pain in cognitively impaired adults. A comparison of three commonly administered pain scales found that the Philadelphia Pain Intensity Scale (PIS) appears to be the most useful and is easily used by nonprofessional caregivers in the community.

Standardized pain assessment instruments were administered to 156 cognitively impaired (CI) adults and their caregivers in the subjects’ home by trained research assistants between June and October 1998. Subjects were assessed with the following tools:

• Nonverbal Visual Analog Scale ("line" scale);

• Faces Pain Scale ("faces" scale);

• Philadelphia Pain Intensity Scale.

Research assistants observed pain behaviors in the subjects using the Hospice Approach Discomfort Scale. The subjects’ caregivers completed the "line," "faces," and PIS scales, as well as the Cornell Scale for Depression in Dementia. In addition, a baseline Mini-Mental State Exam, Functional Assessment Stage Test, and Geriatric Depression Scale were performed on all CI subjects by medical, nursing, or social work staff of Providence ElderPlace in Portland, OR, where study subjects were enrolled in the Program of All-inclusive Care for the Elderly (PACE).

Of the 104 subjects completing at least one pain assessment tool, 12.5% reported no pain and 87.5% reported some pain.

Other findings include:

• Sixty-seven percent of the subjects able to complete a pain assessment tool agreed with their caregiver about the level of their pain.

• The number of pain assessment tools completed decreased with increased cognitive impairment.

• The PIS was the tool most likely to be completed by both subjects and their caregivers.

• The Hospice Approach Discomfort Scale did not correlate well with other pain assessment tools used in the study.

[See: Krulewitch H, London MR, Skalel VJ, et al. Assessment of pain in cognitively impaired older adults: A comparison of pain assessment tools and their use by nonprofessional caregivers. J Am Ger Soc 2000; 48(12):1607-1611.]