Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment

Pain assessment tools in adults with communication disorders: systematic review and meta-analysis

BACKGROUND

Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders.

METHODS

A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms "pain assessment, "nonverbal communication" and "communication disorders" in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations.

RESULTS

Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients.

CONCLUSIONS

While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations.

TRIAL REGISTRATION

This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Neuropsychological Symptoms and Functional Capacity in Older Adults with Chronic Pain

The impact of chronic pain on neuropsychological functioning of older adults is under-studied. The present study examined the relationship between chronic pain, depression, anxiety, cognition, and functional capacity in community-dwelling older adults (ages 60-89) who completed an outpatient neuropsychological evaluation (N = 452). Psychometrically sound and validated measures were used to assess depression (Geriatric Depression Scale [GDS]), anxiety (Beck Anxiety Inventory [BAI]), cognitive functioning (the Mini Mental Status Exam [MMSE] and the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), and functional capacity (Texas Functional Living Scale [TFLS] and Instrumental Activities of Daily Living Questionnaire [IADL]). Multivariate analyses of covariance (MANCOVA) were conducted to examine differences between individuals with and without chronic pain, adjusting for age, education, gender, marital status, and other medical conditions. Results indicated that participants endorsing chronic pain displayed significantly higher levels of depression and anxiety, as well as lower levels of cognitive functioning and functional capacity, than those without chronic pain. Additionally, results of hierarchical multiple regressions indicated that chronic pain explained unique variance in all outcome variables, beyond demographic characteristics and health status. Chronic pain management may be an important intervention target for clinicians to help address cognitive and psychological functioning in older adults.