Guidelines for a Palliative Approach in Residential Aged Care

Additional characteristics of breakthrough pain that should also be considered are: [134]
• duration;
• intensity;
• quality, characteristics (e.g. aching, shooting);
• precipitating factors (if any), such as bowel movement, change in the weather;
• factors that relieve the pain;
• sudden or slow onset;
• occurrence in relation to time of analgesic doses; and
• frequency (number of occurrences in past 24 hours).
6.2.5 Pain assessment tools
Horgas and Dunn (2001) [136] (Level QE) found that there was incongruence between nursing
assistants’ perception of pain and the resident’s self-report of pain in the majority of cases in a
paired rating study. The results suggest that residents could be at risk of over or under treatment
of pain and therefore, pain assessment tools are recommended.
Pain assessment should include a history of the resident, including pain location, type,
frequency and severity as well as the impact on the resident’s daily life activities. One study
compared the simple question, “Do you have pain?” with three assessment tools (Visual
Assessment Scale, Behavior [Faces] Scale, Pain Descriptive Scale) and found that the assessment
tools were more accurate than simply asking the question about pain [137] (Level III-3). A range
of pain assessment tools can be used, such as:
• The Functional Pain Scale (FPS). The FPS is considered a reliable, valid, responsive and
acceptable tool for use with older persons [138] (Level III-2).
• The Numerical Rating Scales (NRS). The NRS refers to all the possible combinations of pain
rating scales that use numbers, whether they are graphically or verbally presented and whether
they contain word anchors or not. However, usually these scales use a continuum from 0 to
10 where 0 signifies no pain and 10 signifies unbearable pain. The advantages of this tool are
that it circumvents the difficulties with language as with some assessment tools, is easy to use
and has a high degree of sensitivity [139] (Level IV). The disadvantage of this tool is that the
higher the cognitive impairment (MMSE score 0–9), the less likely that the resident will be
able to complete the NRS [139] (Level IV) Even with repeated explanation to residents with severe
cognitive impairment, the rate of successful completion of the NRS was still poor. [139]
• The McGill Pain Questionnaire (MPQ). The MPQ is a multidimensional questionnaire
that assesses the individual’s site of pain, sensory, affective and quality, changes over time,
and intensity. [140] The criticisms of the questionnaire centre on the complexity and length
of the questionnaire.
• The Brief Pain Inventory (BPI). The BPI has been used extensively in research due to its
reasonable validity and reliability; it has also proven useful in a variety of clinical settings,
including with people diagnosed with terminal cancer. [141] It takes about 15 minutes to
complete and has been translated into Vietnamese, Chinese, Filipino and French. [134]
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