Original ArticlesPain Assessment as Intervention A Study of Older Adults With Severe DementiaFuchs-Lacelle, Shannon PhD*; Hadjistavropoulos, Thomas PhD*; Lix, Lisa PhD, PStat†Author Information *Department of Psychology and Centre on Aging and Health, University of Regina †Department of Community Health Sciences, University of Manitoba, Saskatchewan, Canada Supported by a Canadian Institutes of Health Research (CIHR) New Emerging Team Grant, a CIHR Investigator Award to Thomas Hadjistavropoulos, and a CIHR Health Research Fellowship to Shannon Fuchs-Lacelle. Reprints: Thomas Hadjistavropoulos, PhD, Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK S4S 0A2, Canada (e-mail: [email protected]). Received for publication December 7, 2007; revised February 10, 2008; accepted March 3, 2008 The Clinical Journal of Pain: October 2008 - Volume 24 - Issue 8 - p 697-707 doi: 10.1097/AJP.0b013e318172625a Buy Metrics Abstract Objectives The communication impairments that characterize severe dementia make pain assessment challenging. As such, pain problems often go undetected. Our goal was to determine whether systematic pain assessment leads to improved pain management practices and decreases nursing stress in comparison with a control condition. Methods We adopted a 3-month comparative longitudinal design. Nursing staff regularly assessed dementia patients' pain through the use of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). A second group of nurses completed an attention-control measure for a control group of patients. In addition, nursing staff regularly completed measures of work stress to investigate the effects of the workload associated with systematic pain assessment on nurse stress. Results Regular use of the PACSLAC improved pain management practices over time as reflected in increased usage of analgesic medications (prescribed on “as needed” basis) in comparison with the control group. As pain interventions increased, a corresponding decrease in observable pain behaviors (as reflected on the PACSLAC assessments that were completed by the nurses) was observed. In addition, nurses who used the PACSLAC reported decreased distress and burnout over time. Discussion This investigation provides strong support for both the importance of systematic pain assessment in long-term care and for the clinical utility of the PACSLAC in improving pain management practices and decreasing caregiver distress. © 2008 Lippincott Williams & Wilkins, Inc.