A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers

Abstract

Background: The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest. Objective: The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessmentinolderadults,aswellasthepractice,policy,andregulatorydriversthatsupportthispracticechange.

Post-operative Physiotherapeutic Rehabilitation in a Rare Case of Avulsion Fracture of Tibial Attachment of Posterior Cruciate Ligament: A Case Report

“…Early patient education is utmost important and lack of patient awareness can lead to complications [14]. In such pandemic era the follow up and exercise prescription can be done using telephone [15]. Many of the related studies have reflected on similar aspects [16][17][18][19].…”

Study Protocol Modeling Evoked Pain in Older African Americans With Knee Osteoarthritis

“…Pain intensity ratings are obtained before, during, and immediately after each pain-provoking task using the Defense and Veteran’s Pain Rating Scale. Pilot data revealed a preference for this scale in older AAs because it is clinically aligned (0–10 numeric rating anchors), descriptive (descriptors of effect of intensity on activity/function level), and a graphic tool (uses a color gradient, progressive faces of pain, and vertical bars of increasing size) to best describe their pain (Booker et al, 2021).…”

CE: Assessing Movement-Evoked Pain

“…Observation of evoked pain involves asking the patient to perform a relevant movement-related task associated with the condition of interest. 12 For example, a patient with postoperative bowel resection may be asked to take a deep breath and cough. 29 Another example of MEP assessment may involve asking a patient with a successful total knee arthroplasty to flex within a given range of motion or move from supine to sitting or from sitting to standing following herniorrhaphy.…”

“…In addition, assessing and addressing dynamic pain can reduce immobility, a known risk factor for chronic hyperalgesic postsurgical pain, and can reveal potency differences between analgesic approaches, such as thoracic epidural, lumbar epidural, and patient-controlled analgesia 15. Given the importance of assessing function and pain during movement, Booker and colleagues advocated dynamic pain assessments, noting that traditional, one-dimensional assessments of pain at rest provide little or no information on the characteristics and triggers of pain, such as movement or immobility, and their impact on function 12. The implications for pain control are enormous, because MEP is particularly prevalent and disabling in patients with acute postoperative pain.…”