TY - JOUR
T1 - The evaluation of acute pain in individuals with cognitive impairment
T2 - A differential effect of the level of impairment
AU - Defrin, Ruth
AU - Lotan, Meir
AU - Pick, Chaim G.
N1 - Funding Information:
The authors thank Prof. Patrick J. McGrath and Mrs. Lynn M. Breau for their advice and for the NCCPC-R version. This study was supported by a grant from the Shalem Foundation – the Israeli Central Fund for the development of services for the retarded in the local councils.
PY - 2006/10
Y1 - 2006/10
N2 - The present study investigated whether the level of cognitive impairment (CI) affects acute pain behavior and how it is manifested. Participants were 159 individuals (mean age 42 ± 12), 121 with CI (divided into four groups according to the level of CI: mild, moderate, severe, profound) and 38 with normal cognition (controls). The behavior of the participants before and during acute pain (influenza vaccination) was coded by two raters with the Facial Action Coding System (FACS - scores facial reactions to pain) and the Non-Communicating Children's Pain Checklist (NCCPC-R - scores both facial and general body reactions). Individuals with severe-profound CI exhibited elevated FACS and NCCPC-R values at baseline compared with all other groups (p < 0.01). Both FACS and NCCPC-R scores of individuals with mild-moderate CI and controls increased significantly during vaccination (p < 0.001). In contrast, individuals with severe-profound CI exhibited high rates of "freezing reaction" (stillness) during vaccination, manifested mainly in the face and therefore resulting in elevation of only NCCPC-R scores but not of FACS's. The results suggest that the level of CI affects baseline as well as pain behavior and it is therefore necessary to choose an appropriate behavioral tool to measure pain in these individuals accordingly. For example, tools based on facial reactions alone might provide the false impression that individuals with severe-profound CI are insensitive to pain (due to freezing).
AB - The present study investigated whether the level of cognitive impairment (CI) affects acute pain behavior and how it is manifested. Participants were 159 individuals (mean age 42 ± 12), 121 with CI (divided into four groups according to the level of CI: mild, moderate, severe, profound) and 38 with normal cognition (controls). The behavior of the participants before and during acute pain (influenza vaccination) was coded by two raters with the Facial Action Coding System (FACS - scores facial reactions to pain) and the Non-Communicating Children's Pain Checklist (NCCPC-R - scores both facial and general body reactions). Individuals with severe-profound CI exhibited elevated FACS and NCCPC-R values at baseline compared with all other groups (p < 0.01). Both FACS and NCCPC-R scores of individuals with mild-moderate CI and controls increased significantly during vaccination (p < 0.001). In contrast, individuals with severe-profound CI exhibited high rates of "freezing reaction" (stillness) during vaccination, manifested mainly in the face and therefore resulting in elevation of only NCCPC-R scores but not of FACS's. The results suggest that the level of CI affects baseline as well as pain behavior and it is therefore necessary to choose an appropriate behavioral tool to measure pain in these individuals accordingly. For example, tools based on facial reactions alone might provide the false impression that individuals with severe-profound CI are insensitive to pain (due to freezing).
KW - Acute pain
KW - Behavior
KW - Cognitive impairment
KW - FACS
KW - NCCPC-R
UR - http://www.scopus.com/inward/record.url?scp=33748677685&partnerID=8YFLogxK
U2 - 10.1016/j.pain.2006.04.031
DO - 10.1016/j.pain.2006.04.031
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C2 - 16781070
AN - SCOPUS:33748677685
SN - 0304-3959
VL - 124
SP - 312
EP - 320
JO - Pain
JF - Pain
IS - 3
ER -