Pain Assessment as Intervention: A Study of Older Adults With Severe Dementia : The Clinical Journal of Pain

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Pain Assessment as Intervention

A Study of Older Adults With Severe Dementia

Fuchs-Lacelle, Shannon PhD*; Hadjistavropoulos, Thomas PhD*; Lix, Lisa PhD, PStat

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The Clinical Journal of Pain 24(8):p 697-707, October 2008. | DOI: 10.1097/AJP.0b013e318172625a



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.


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.


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.


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.

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