[Pain assessment in cognitively impaired elderly patients]

Pain assessment in nursing home patients is often challenging because of cognitive failure. Demented patients receive less optimal pain treatment than those who are cognitively intact. Inappropriate pain assessment is likely to be an important reason for problems with proper diagnosis and treatment of pain in the cognitively impaired. Self-report of pain by standardized questionnaires is recommended for those with mild cognitive failure. For those who are unable to self-report, observational assessment is an alternative.

Structured pain assessment tools are reviewed, with emphasis on their feasibility in cognitively impaired patients.

Several assessment tools for observational pain assessment are available, but none of them is satisfactory validated. Observational tools are used by a trained observer who rates behaviour indicative of pain according to pre-defined clues. The Checklist of Non-verbal Pain Indicators (CNPI) and the Doloplus-2 are both observational tools that are translated into Norwegian. The Norwegian CNPI is in an early phase of validation, while the Doloplus-2 is tested in a Norwegian pilot validation study with promising results.

It is important to establish a common standard for systematic pain assessment in the cognitively impaired, both clinically and in research. Further validation of the CNPI and the Doloplus-2 is recommended.