Guidelines for assessing pain in patients with
Cognitive Impairment and/or communication
problems-V1-0028-GUI-DCHS
Version No
1.0
Version Date
22/1/15
Review Date
22/1/17
GUIDELINES FOR ASSESSING PAIN IN PATIENTS
1. Within DCHS 3 pain assessment tools have been provided to help meet patient’s individual
needs:
i.
PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO
COMMUNICATE – this tool should be suitable for most patients as it contains a
body map to help patients identify the location of any pain and a pain scale to
measure the intensity of the pain
ii. PAIN ASSESSMENT TOOL FOR PATIENTS WITH COGNITIVE IMPAIRMENT
(Abbey Pain Scale) – this is an observational pain assessment tool for use with
patients who are unable to communicate due to Cognitive Impairment e.g.
Dementia. It requires staff to observe the patient’s behaviour for signs of distress,
pain and discomfort. It can be used alone or in combination with any of the other
pain assessment tools to form a complete individualised pain assessment. Separate
guidelines have been provided on how to use this tool – see GUIDELINES FOR
USING THE PAIN ASSESSMENT TOOL FOR PATIENTS WITH COGNITIVE
IMPAIRMENT (Abbey Pain Scale).
iii. PAIN ASSESSMENT TOOL FOR USE WITH FAMILY AND CARERS OF
PATIENTS WITH COGNITIVE IMPAIRMENT – this tool is also designed to identify
pain in patients who are unable to communicate due to Cognitive Impairment. It
needs to be completed with the patient’s family and carers to help identity known
signs to observe for when the patients is in pain or discomfort. There is a separate
section for recording interventions that have been found to help relieve the patient’s
pain, distress and discomfort. This tool can also be used in combination with any of
the other tools to provide additional guidance and information for staff on pain
assessment and treatment.
FLOW CHART FOR ASSESSMENT OF PAIN IN PATIENTS - has also been provided with
factors to consider and general guidance on assessing patient pain, including when to use
the pain tools provided
2. Self-reporting of pain is the “Gold Standard” method for identifying pain in patients including
those with mild to moderate Cognitive Impairment. For these patients use “PAIN
ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE”
3. In patients with Cognitive Impairment where communication is a problem using an
observational pain assessment tools is “The Gold Standard” e.g. use “PAIN ASSESSMENT
TOOL FOR PATIENTS WITH COGNITIVE IMPAIRMENT” (Abbey Pain Scale) and/or “PAIN
ASSESSMENT TOOL FOR USE WITH FAMILY AND CARERS OF PATIENTS WITH
COGNITIVE IMPAIRMENT”
4. When considering which observational pain assessment tool/s to use you need to ensure
that it will help to identity:
a)the type of pain
b)location of pain
c) Intensity of pain
5. Know the individual
a. behaviours that may indicate distress
b. underlying medical conditions e.g. pressure ulcers
c. how their distress affects their activities and participation
6. Consider that older patients are often more reluctant to report pain and are often used to
“putting up with it”
7. Pain assessment involves the whole team in partnership with the family when deciding
which pain assessment tool/s to use and the care and treatment to be implemented
8. Where patients are experiencing pain a care plan must be completed, detailing the pain
scoring tool to be used, the frequency of the review and interventions identified to help
relieve pain.
9. Assessing the patient regularly is essential as their needs may change due to deterioration
or improvement. This should be at every visit for patients within the community and at least
daily for in-patients depending on individual requirements.
10. Patients behaviour should be observed for at least 5 minutes particularly during physical
activity as this can help identify particular types of pain such as musculoskeletal
11. Don’t forget the patient’s distress may be emotional/physical/psychological. What is a minor
issue for one patient may be a major problem for another
12. Evaluate the situation – is distress caused by:
a) the environment e.g. is the patient new to the ward
b) other patients
c) fear, anxiety, anger, frustration
13. If the patient appears to be in pain can they tell you, can they point to where the pain is or
use a “Pain Map” e.g. “PAIN ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO
COMMUNICATE”
14. Patients may use other words for pain e.g. sore, hurting, and aching. Consider using cards
or charts with words patients can point to
15. To identify the severity of pain use a pain scale that the patient can point to e.g. use “PAIN
ASSESSMENT TOOL FOR PATIENTS WHO ARE ABLE TO COMMUNICATE”
16. Are there non pharmacological options that could be used
d. pressure relieving cushion/mattress
e. positional change
f. patient too warm/cold
g. supporting the patient with pillows
h. consider other therapies
Guidelines for assessing pain in patients with
Cognitive Impairment and/or communication
problems-V1-0028-GUI-DCHS
Version No
1.0
Version Date
22/1/15
Review Date
22/1/17
17. Treat/manage the likeliest cause of the patient’s distress
18. The goal is a reduction in the number or severity of the signs of distress
19. Trial prescribed medication and note the effects, consider alternative medication if
necessary e.g. if effects are not lasting try slow release formulas
20. A second evaluation should be conducted one hour after any intervention taken in response
to pain, to determine the effectiveness of any pain-relieving intervention.
21. If, at this assessment, the score on the pain scale is the same, or worse, consider further
intervention and act as appropriate.
22. Complete the pain scale hourly, until the patient appears comfortable, then four-hourly for 24
hours, treating pain if it recurs.
23. Record all the pain-relieving interventions undertaken.
24. Evaluate the patient’s care plan and the pain tool used and review if necessary
25. If pain/distress persists, undertake a comprehensive assessment of all facets of patient’s
care and monitor closely over a 24-hour period, including any further interventions
undertaken. If there is no improvement during that time, notify the medical practitioner
/prescriber of the pain scores and the action/s taken and up-date care plan accordingly.
References


NICE Guidelines
Royal College of Physicians, British Pain Society and British Geriatrics Society Guidance
on; The assessment of pain in older people 2007