___________________________________________________ Pain Assessment and Management, 2nd Edition
The older adult frequently has comorbid diseases, a slower rate of tissue healing, more rapid muscle deconditioning, and reduced mobility (Larsson et al., 2017; Watson et al., 2022). It is estimated that more than 60% of the 46.2 million American adults over the age of 65 have persistent pain (Watson et al., 2022). Davidoff et al. (2020) found that 56% of the older adults reporting severe pain, which limited participation in valued occupations, were not prescribed medication for pain management. The most commonly studied pain location in older adults is their back, neck, and arthritis (Choudry et al., 2023). These authors found manipulative therapies to be the most studied approaches for older adults. Older adults may also have certain beliefs and challenges that affect pain assessment and management. Haber et al. (2023) found that older adults felt their pain was due to age and wear and tear on their bodies. These individuals most often used activity avoidance or modification and rest as ways to cope with the pain. Chen et al. (2020) carried out a systematic review and meta-analysis and found the lived experiences of individuals who have arthritis include a lonely path, an inevitable and endless process, and surviving through pain management. Older adults are more susceptible to chronic pain, and the medications targeting pain are less efficient (Tinnirello et al., 2021). These individuals experience changes in their ability to metabolize drugs, leading to increased risk for adverse side effects (Pedowitz et al., 2021). Comorbid diseases and polypharmacy are common and can put an older client at risk for drug-disease and drug-drug interactions (Watson et al., 2022). Often, older clients see a variety of specialists who are not always aware of what the other healthcare providers have prescribed. An attentive practitioner can sometimes help mitigate polypharmacy for these clients. PAIN ASSESSMENT Currently, there is no laboratory test for pain, and accurate pain assessment is difficult. The most important facets of pain management are serial assessments and the use of good communication skills. Remember that pain is whatever and whenever the client says it is. The attitude of the health pro-
fessional goes a long way toward allowing clients to fully and honestly talk about their pain. Practitioners are finding that they are seeing more individuals for chronic pain (McVeigh et al., 2022). These authors found that many feel ill equipped to treat this condition. Using a person-centered, holistic approach, practitioners can spend time helping clients understand their rights and responsibili- ties concerning pain and its management. Clients who are given the control to stop or refuse treatment during sessions are more likely to tolerate even painful treatment well. For successful treatment, practitioners must strive to coordinate with nursing staff and the clients themselves to ensure that the clients are offered adequate pain management to promote their participation in functional activities. Open communication is critical. The first step in assessing pain is to obtain a descrip- tion from the client of what their pain is and what it does. A pain assessment typically includes a numeric pain rating (e.g., 0 = no pain to 10 = worst pain), pain characteristics, duration, location(s), pattern, and description of what makes the pain better or worse. PAIN SCALES Many scales are available to help clients describe and locate their pain. Several are 0-to-10 ranking scales, with 0 being no pain, 1 being the least amount of pain, and 10 being unbear- able pain ( Figure 2 ). Even children who are 7 or 8 years old should have little difficulty using these numeric scales. Note: Pain scale vector clip art. https://publicdomainvectors. org/en/free-clipart/Pain-scale-vector-clip-art/26718.html The smiley face pain rating scale ( Figure 3 ) is a series of images showing a range of facial expressions from a happy smile to a grimace with tears. The standardized Faces Pain Scale-Revised (FPS-R) has been validated with pediatric patients and found to be equally effective and reliable when compared to the Verbal Numerical Rating Scale (vNRS) (Lamture & Lamture, 2024). The Face, Legs, Activity, Cry, Consolability (FLACC) Behav- ioral Pain Assessment Scale ( Figure 4 ) measures distress through observation of infants, children, and adults by objectively assessing facial expression, body movements, or behavior on a standard scale (Merkel et al., 1997). Malviya et al. (2006) revised the FLACC to better assess pain in children with cognitive impairment.
EXAMPLE OF A NUMERIC RATING SCALE
Source: Complied by Author
Figure 2
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