Pain underreporting associated with profound intellectual disability in emergency departments

Amor-Salamanca, A.; Menchón, José M.

doi:10.1111/jir.12355

Cited by 21 publications

(13 citation statements)

References 31 publications

(32 reference statements)

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“…The lower narcotic analgesia recommendation rates at ID group encounters in this study were another surprising finding, given that a diagnosis of ID is associated with multiple co-morbidities that make the experience of acute and chronic pain more likely than in the general population. 27,28 As noted previously, this finding should be interpreted with caution due to the relatively wide confidence intervals, although it is consistent with other literature 29,30,31 that raises questions about the adequacy of pharmacological pain management in people with ID. Clinicians face a number of challenges when assessing pain and analgesic treatment response in people with ID.…”

Section: Discussionsupporting

confidence: 90%

Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

et al. 2018

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BackgroundPeople with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID.AimTo compare medications recommended by GPs at encounters where ID is recorded versus other encounters.Design & settingAnalysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive.MethodMedication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs).ResultsAntipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters.ConclusionHigher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.

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Section: Discussionsupporting

confidence: 90%

Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

et al. 2018

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“…Third, individuals with IDD may be limited in their ability to comprehend the implications of an injury or pain and to Brain Sci. 2021, 11, 253 2 of 20 adequately communicate it to care givers; thus, they may not receive a proper diagnosis or care at a proper timing [8][9][10]. Finally, the overall low level of physical activity [11] and the reduced involvement in health decision making [12] may further increase the risk for pain in individuals with IDD.…”

Section: Introductionmentioning

confidence: 99%

Specific Behavioral Responses Rather Than Autonomic Responses Can Indicate and Quantify Acute Pain among Individuals with Intellectual and Developmental Disabilities

2021

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Individuals with intellectual and developmental disabilities (IDD) are at a high risk of experiencing pain. Pain management requires assessment, a challenging mission considering the impaired communication skills in IDD. We analyzed subjective and objective responses following calibrated experimental stimuli to determine whether they can differentiate between painful and non-painful states, and adequately quantify pain among individuals with IDD. Eighteen adults with IDD and 21 healthy controls (HC) received experimental pressure stimuli (innocuous, mildly noxious, and moderately noxious). Facial expressions (analyzed with the Facial Action Coding System (FACS)) and autonomic function (heart rate, heart rate variability (HRV), pulse, and galvanic skin response (GSR)) were continuously monitored, and self-reports using a pyramid and a numeric scale were obtained. Significant stimulus-response relationships were observed for the FACS and pyramid scores (but not for the numeric scores), and specific action units could differentiate between the noxious levels among the IDD group. FACS scores of the IDD group were higher and steeper than those of HC. HRV was overall lower among the IDD group, and GSR increased during noxious stimulation in both groups. In conclusion, the facial expressions and self-reports seem to reliably detect and quantify pain among individuals with mild-moderate IDD; their enhanced responses may indicate increased pain sensitivity that requires careful clinical consideration.

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“…However, in clinical settings, it has been reported that pain often goes undetected and undertreated in this group [ 19 , 20 , 21 ]. As defined by the IASP, pain is an experience that needs to be communicated by the patient to surrounding people in order for the patient to get adequate help, and people with IDs may not be able to provide self-reports of pain [ 22 , 23 ], even when the person possesses verbal skills [ 24 ]. Therefore, the identification of pain among them often relies on reports from caregivers.…”

Section: Introductionmentioning

confidence: 99%

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

2018

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Little is known about pain and pain treatment among people with intellectual disabilities (IDs). We aimed to describe pain and pain medications among older people with ID compared to the general population. Data on diagnoses and prescriptions were collected from national registers for the period between 2006 and 2012 for 7936 people with an ID and a referent cohort from the general population. IDs were associated with a decreased risk of being diagnosed with headaches, musculoskeletal pain, and pain related to the circulatory and respiratory systems, but they were associated with increased risk of being diagnosed with pain related to the urinary system. Among men, IDs were associated with an increased risk of being diagnosed with visceral pain. People with IDs were more likely to be prescribed paracetamol and fentanyl regardless of the type of pain but were less likely to be prescribed COX(1+2) and COX2 inhibitors and weak opioids. Healthcare staff and caregivers must be made aware of signs of pain among people with IDs who may not be able to communicate it themselves. Further research is needed to investigate whether people with IDs are prescribed paracetamol rather than other pain drugs due to physicians trying to avoid polypharmacy or if there are other reasons not to prescribe a greater range of pain treatments.

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Pain underreporting associated with profound intellectual disability in emergency departments

Cited by 21 publications

References 31 publications

Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

Specific Behavioral Responses Rather Than Autonomic Responses Can Indicate and Quantify Acute Pain among Individuals with Intellectual and Developmental Disabilities

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

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