What is Pain?

Pain is a personal experience influenced by physical, psychological and environmental factors. Only the person in pain can truly understand the intensity of the pain they are experiencing, and pain from the same cause can feel very different to different people. Peoples tolerances to pain can vary significantly also, and so caution should be taken to objectively assess a persons pain intensity. That is without your opinion, feelings or judgement influencing your assessment.

Clinical Definitions of Pain

1. Acute pain

Lasts a short time and will be over soon.  It may last only a few seconds, minutes or hours or may last several weeks.   This is the type of pain people experience with an injury, toothache or headache.  Its usually pain that is directly related to soft tissue damage such as a sprained ankle or a paper cut.

2. Recurring pain 

Is the kind that happens again and again. It may go completely away and then come back. Think migraines, backache or stomachache in the same place as you always get them.  While the pain may be similar in duration, location and intensity, it always goes away eventually.

3. Chronic pain 

May start with an injury, illness, accident or surgery, but instead of healing in the normal way, lasts for more than three months. It may not maintain the same intensity all the time, but it never really goes away. The most common sources of chronic pain include low back pain, headache and arthritic pain. It is unremitting, unrelenting and if not treated, can be debilitating. Chronic pain can cause significant psychological and emotional trauma and often limits an individual’s ability to fully function.

Pain and Dementia

Pain is commonly experienced by people living with dementia. Studies have estimated that persistent pain occurs in more than 50% of people living with dementia in home settings, and up to 80% of people living in residential aged care facilities.1.

 

Behaviours such as verbalizations/vocalizations (e.g. sighing, moaning, calling out, verbal abuse), noisy breathing, facial expressions (e.g. grimacing, frowning), restless or strained body expressions (e.g. rigid, tense, guarding, fidgeting, increased pacing/rocking), agitation/aggressiveness and resistance to care, are frequently the most prominent, or even the only feature of pain. However, these behaviours are commonly associated with symptoms of dementia, and not of pain.  Therefore, pain often goes unrecognised and under-treated in people with communication difficulties such as dementia.

How can PainChek® Help?

PainChek can help you to identify if changes in someone’s behaviour might mean they are in pain. As self-reporting pain in people with dementia is diminished, it is important to regularly assess and monitor pain.

How to Assess Pain

PainChek can be used to either rule pain in or out as the cause of a person’s change in behaviour. Pain assessment should be conducted when a person is resting and after movement. Please note that movement might intensify a person’s pain experience.

 

PainChek should be used when:

 

1.  a person is unable or less likely to tell you that they are in pain,

2.  in cases where there is a change in usual behaviour (out of character) for that person,

3.  if the carer suspects that pain may be present and even after the carer has made an attempt to manage pain.

 

Carers must be mindful of potentially painful medical conditions which may affect a person’s pain levels.

Adapted Recommendations From Australian Pain Society

The Australian Pain Society is a leading, non-for-profit authority for healthcare professionals involved in the management of pain, in 2018 they released recommendations on how and when pain assessments should be done when using pain scale measurements tools.2. As PainChek is a pain scale measurement tool, the following steps have been provided in line with these recommendations, to ensure proper assessments of pain with PainChek:

PainChek should be used as a movement-based pain assessment. Therefore you will need to observe the patient while they are moving or being moved. PainChek assessment should be done immediately following this movement and the results recorded in the App.

A second pain assessment should be done 1 hour after any intervention taken to manage the patient's pain. Examples of interventions include medication, heat packs or massage. If, at this assessment, the score on the pain scale is the same, or worse, contact your healthcare professional for advice.

Complete PainChek assessments hourly until the patient scores in the mild pain range, and then 4 hourly for 24 hours, treating pain as directed by your healthcare professional if it reoccurs.

If the pain/distress continues, and there is no improvement in that time, then it is essential to notify your healthcare professional of ongoing pain scores and what was done to manage the patient's pain.

1. Marjoleine J.C. Pieper Et al: Interventions targeting pain or behaviour in dementia: A systematic Review, Ageing Research Reviews 12 (2013) 1042- 1055.
2. Goucke CR, ed (2018). Pain in Residential Aged Care Facilities: Management Strategies, 2nd Edition, Australian Pain Society, Sydney.