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Pain occurs regularly among nursing home residents with dementia. There are indications that appliance of structural pain assessment can contribute to the adequate diagnosis of pain. The aim of this study is to gain insight into applied interventions after diagnosing pain with an observational pain scale (PACSLAC-D) among nursing home resident with dementia. During a six week period pain was measured twice a week, among 22 residents of a psychogeriatric nursing home ward, using the PACSLAC-D. Interventions undertaken as a result of a pain score were inventoried on a data-sheet. After the third and sixth week implementation of pain assessment was evaluated. In total 264 pain assessments using the PACSLAC-D were conducted. Of all scheduled standardized measurements 90% was completed. Sixty observations resulted in a pain score. Completed datasheets (N=39) showed that a pain score often (N=17) did not result in any intervention. The majority of interventions that were undertaken consisted of a non pharmacological approach (N=19). Evaluation meetings indicated that the PACSLAC-D was considered useful, though the chosen procedure of standardized measurements twice a week was not yet ideal. This study demonstrates that although there was a high compliance rate, pain relieving interventions were not frequently applied.

Non-verbal pain assessment scales are useful tools for pain evaluation in persons with communication disorders and moderate-severe dementia. The Doloplus was one of the first scales to be developed and validated as a pain assessment tool in older adults with dementia. This study aims at evaluating the translation of the Doloplus scale in five languages, as regards test-retest and inter-rater reliability. Results show that both tests are good or excellent for the English, Italian, Portuguese and Spanish versions and moderate for the Dutch version. These results bring a unique opportunity to include the translated Doloplus scale in daily assessment of elderly persons with communication disorders, and future studies should focus on enriching the validation of the scale in each language., (Copyright 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.)

Older persons with dementia may become confronted with a decline in the level of physical activity. Indeed, a positive relationship between physical activity and cognition has been demonstrated. Although the causality of this relationship needs to be confirmed in advanced dementia, particularly animal experimental studies show the possible negative influence of restrained physical activity on behavior of patients with dementia. Patients with dementia, who get immobilized because of agitation and restlessness, may show an increase in these two symptoms. Another cause for reduced physical activity or inactivity may be the experience of pain. Pain experience may even increase in dementia by neuropathological changes in the central nervous system. There is an increasing (inter)national interest for the development of a more reliable assessment and treatment of pain, for the causality of the relationship between pain and physical (in)activity, and for the causality of the relationship between physical (in)activity and cognition in dementia. In the present paper, the various topics will be addressed in this order.

Objectives: Ventilated preterm infants are at high risk for procedural pain exposure. In Switzerland there is a lack of knowledge about the pain management in this highly vulnerable patient population. The aims of this study were to describe the type and frequency of procedures and to determine the amount of analgesia given to this patient group in two Swiss neonatal intensive care units., Method: A retrospective cohort study was performed examining procedural exposure and pain management of a convenience sample of 120 ventilated preterm infants (mean age = 29.7 weeks of gestation) during the first 14 days of life after delivery and born between May 1st 2004 and March 31st 2006., Results: The total number of procedures all the infants underwent was 38,626 indicating a mean of 22.9 general procedures performed per child and day. Overall, 75.6% of these procedures are considered to be painful. The most frequently performed procedure is manipulation on the CPAP prongs. Pain measurements were performed four to seven times per day. In all, 99.2% of the infants received either non-pharmacological and/or pharmacological agents and 70.8% received orally administered glucose as pre-emptive analgesia. Morphine was the most commonly used pharmacological agent., Discussion: The number of procedures ventilated preterm infants are exposed to is disconcerting. Iatrogenic pain is a serious problem, particularly in preterm infants of low gestational age. The fact that nurses assessed pain on average four to seven times daily per infant indicates a commitment to exploring a painful state in a highly vulnerable patient population. In general, pharmacological pain management and the administration of oral glucose as a non-pharmacological pain relieving intervention appear to be adequate, but there may be deficiencies, particularly for extremely low birth weight infants born <28 weeks of gestation.

The aim of this paper is to present an overview of the literature on the factors influencing decision-making in the nursing care of children in pain. To that effect published and unpublished references were reviewed. The most frequently cited factors influencing the assessment and management of pain in children are summarized and discussed. Finally recommendations are made where further research is warranted.

This article reports on a qualitative study, that explored factors influencing nurses' pain assessment and interventions with children. Although many factors appear to influence decision-making processes, nurses seem to attach more weight to some factors than to others. For example, medical diagnosis and the intensity with which the child expresses its pain are used as determining factors for the decision to administer analgesics. In this article the results of the study, their relationship to information reported in the literature as well as their implications for practice and research are further elaborated and discussed.

Background Critically ill patients often undergo unpleasant procedures. We quantified the effects of an unpleasant stimulus on physiological and behavioral parameters and evaluated how they are modified by sedation and analgesia. Methods A 6-month study in the 30-bed intensive care unit ( ICU) of a university hospital examined 21 sedated patients from various diagnostic groups. Hemodynamic and respiratory parameters, pupil size, facial expression, muscle tone, body movement, and the Richmond Agitation- Sedation Scale ( RASS) score were measured before and during intratracheal suctioning, first in sedated patients, after sedation was stopped, and after an opioid bolus. Results Before intratracheal suctioning, patients had RASS scores of −1.8 ± 1.2 (mean ± standard deviation; sedation), −0.6 ± 1.7 (sedation stop), and −0.9 ± 1.4 (analgesia) ( P = 0.014). Intratracheal suctioning significantly increased RASS during both sedation (to −0.6 ± 1.7) and sedation stop (to 1.0 ± 1.5) (both P < 0.01), but not during analgesia. Systolic blood pressure increased during sedation (by 9 ± 10 mmHg), during sedation stop (by 15 ± 17 mmHg) and during analgesia (by 9 ± 4 mmHg; all P < 0.01), but diastolic pressure only during sedation and sedation stop (both P < 0.01). Facial expression, body movement, and muscle tone changed significantly during the episodes of intratracheal suctioning. Heart rate, tidal volume, and pupil size remained stable under all conditions. Conclusions Intratracheal suctioning evoked significant changes in some physiological and behavioral parameters. Some physiological changes were suppressed by analgesia, but at our ICU's standard doses, neither analgesia nor sedation attenuated changes in behavioral parameters at the intensity tested. [ABSTRACT FROM AUTHOR]