A Collaborative Expert Literature Review of Pain Education, Assessment and Management

Abstract

Pain assessment and management in older adults requires a special emphasis on the needs of this population, which is often not considered within general education. The purpose of this study was twofold: to determine the availability of education on pain in older adults around the world, and to present a review and synthesis of published guidelines and key papers on pain assessment and management in older adults. Following on from this study we intend to make recommendations on what work needs to be carried out in future to inform the development of a curriculum or curriculum content specifically dedicated to pain management for older adults. A discussion forum was set up through the Pain in Older Adults Special Interest Group of the International Association for the Study of Pain (IASP) at the end of 2009. This forum was initiated to determine the current level and availability of education available around the world for health professionals on pain in older adults. A number of IASP members from countries around the world participated in the discussion and identified educational courses on pain in older adults from their member country. Following on from this discussion, a number of leading experts agreed to collate guidelines and key papers and conduct a critical review using Appraisal of Guidelines Research and Evaluation (AGREE) criteria. A total of 14 guideline documents on pain assessment and management were reviewed by the group. The papers were reviewed and graded and then agreed between reviewers. From the guideline review, some recommendations can be made, but primarily, the key recommendation from this work was to develop collaboration and a review of key evidence on which future research may be developed so an educational focus may be highlighted. This article presents a summary of those documents along with recommendations for improved and consistent education informed by the guidelines currently developed, and consistent evidence-based assessment and management of chronic pain in older adults.

Advancing the pain management in older adults agenda forward through the development of key research and education priorities: A Canadian perspective

“…The scoping review validated seven out of 13 of the education priorities that were identified through the focus groups, as well as added seven more key priorities to our list (see Figure 1 ). The most highly endorsed education priorities were (1) the belief that it is normal for older adults to experience pain, 9 , 40 – 45 (2) appropriate pain assessment strategies, 40 – 43 , 45 , 47 – 53 , 55 – 58 (3) pharmacological management of pain, 9 , 40 , 44 , 48 – 50 , 54 – 56 , 58 (4) fear of client overdose or adverse drug events, 9 , 40 , 42 , 48 , 50 , 58 (5) pain treatment for persons with dementia, 40 , 44 , 45 , 50 – 53 , 55 , 56 (6) lack of postsecondary courses specific to pain management, 40 , 43 , 49 – 51 and (7) recognizing clinical signs of pain. 40 , 45 , 48 , 50 – 53 , 55 – 58 …”

The sustainability of evidence-based pain management practices in aged care

“…More attention is being paid nationally and internationally to pain assessment and management in older people, particularly those with dementia (Charette & Ferrell, 2011;Cunningham et al, 2010;Goucke, 2018;Herman, Johnson, Ritchie, & Parmelee, 2009;Herr et al, 2011;Husebo et al, 2012;McAuliffe, Nay, O'Donnell, & Fetherstonhaugh, 2009;Takai et al, 2010) more than ever before. A number of resources have been developed, to improve and implement best practice pain management principles for the care of the older person in pain (Goucke, 2018;Schofield et al, 2012).…”

“…Cammer et al (2013) noted, that assessment of the environment into which a new practice is to be implemented, should be undertaken prior to implementing the change. This ensures that impediments in the environment may be identified and modified, and strategic plans implemented to support staff in making the practice change (Cammer et al, 2013 (Abdulla et al, 2013;Goucke, 2018;Kaasalainen et al, 2010;Savvas et al, 2014b;Schofield et al, 2012). However, the implementation of guidelines has been inadequate or ineffective.…”

“…A culturally and linguistically diverse (CALD) background, means the presence of language and cultural barriers. A number of barriers at the resident, staff, facility and system levels have also been identified (Bruneau, 2014;Caughey, Vitry, Gilbert, & Roughead, 2008;Department of Health and Ageing, 2008;Goucke, 2018;Hillen et al, 2017;Schofield et al, 2012). All of these, individually or collectively, can affect the pain assessment and management process.…”

“…There have been a number of international resources developed to improve care in the area of pain assessment and management in older people and people living with dementia (Abdulla et al, 2013;American Geriatric Society [AGS], 2002; AGS Panel on the Pharmacological Management of Persistent Pain in Older Persons, 2009;Ferrell et al, 2009;Schofield et al, 2012).…”