Pain in Elderly Patients Having Communication Disorders. Clinical Trial
Official title:
Concordance of Pain Detection in Patients by Doloplus® and Algoplus® Behavioural Scales.
The pain of the elderly is often trivialized and ignored in spite of its high frequency: the
chronic pain affects 50 % of the elderly living at home, 49 to 83 % of those living in
institution and 80 % of this population at the end of life.
The evaluation of pain appeals to the same strategy as to the younger subject but with some
specificities, related more to the pathologies associated with the ageing than to the real
age. For that purpose, the investigators have self-assessment scales as the Numeric Pain
Rating Scale which is adapted to estimate acute and chronic pains, but this scale presents a
bias because, some patients do not express spontaneously their pain.
So behavioural scales were elaborated to solve the difficulties of detection and to care the
pain of the elderly. The Algoplus® scale (5 items which takes less than one minute to be
completed) whose objective is the observation of behavioural changes caused by the acute
pain in elderly having communication disorders. The Doloplus® scale (30 items which allow in
few minutes a good evaluation of pain) whose objective is the observation of behavioural
changes caused by the chronic pain in elderly having communication impairments.
In practice, because of its popularity, the Algoplus® scale is widely used out of the
specificity in which it has been validated. Practitioners, worried about this misuse,
suggested to Doloplus® group, to test the concordance between the two behavioural scales in
order to develop recommendations more targeted. The risk is that the use of the Algoplus®
scale may underestimate pain that would have been detected by Doloplus® scale, and lead to
under-treatment or non-treatment of pain in elderly having communication disorders.
This study aims to establish the concordance between these two scales to generate advices
and recommendations to assess efficiently the pain in this vulnerable population.
The main objective of this study is to assess whether the use of Algoplus® scale is in good
concordance with Doloplus® scale.
The secondary objective of this study is to assess the concordance with different levels of
Algoplus® pain scale: (0-1), (2-3), (4-5).
The physician investigator will identify and include patients in the study according to the
inclusion criteria. Management of patients do not differ from the usual care in the service
concerned. During the usual patient care, several pain assessments will be performed:
Numeric Pain Rating Scale, MMSE score if the patient is able to communicate, Algoplus® scale
and Doloplus® scale will be performed by doctors and/or caregivers without patient's
participation. The patient will be assessed by two doctors and or caregivers (the time
interval between the two assessments must be as short as possible).
In a first step, 48 hours after patient admission in the care service, a first
doctor/caregiver will assess pain with Numeric Pain Rating Scale and evaluate MMSE score if
it is possible and then assess pain with the Algoplus® scale. The results of the Numeric
Pain Rating Scale, the Algoplus® scale and the MMSE score will be recorded in the medical
record and in the study Case Report Form.
In a second step, less than 3 hours after the first assessment, a second doctor/caregiver
will assess pain with the Doloplus® scale and the result will be recorded in the medical
record and in the study Case Report Form.
The Case Report Form (containing demographic data, the history of pain, analgesics
treatment, scores of Numeric Pain Rating Scale, MMSE, Algoplus® scale and Doloplus® scale)
will be faxed to the Coordinating Center at Clermont-Ferrand in the day.
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Time Perspective: Cross-Sectional