Researchers Develop Tool to Assess Pain in Non-Communicative Patients

A new tool to assess acute pain in non-communicative patients has been developed by researchers at the University of Maryland School of Nursing. The tool is the product of four small-scale research projects in several locations over many years. It consists of two standardized forms for nurses and other care providers to score values of behavioral and physical indicators or signs from the patient.

Other research has shown that an estimated 75 percent of patients at end of life have unrelieved pain, researchers said. They added that their tool addresses a tremendous need in medical care because patients who cannot self-report are at risk for under treatment of pain, partly because assessing their pain has not always been consistent between practitioners.

Tests of their Multidimensional Objective Pain Assessment Tool (MOPAT) on non-communicative hospice patients before and after nurses administered medication show that the patients' pain is lessened, said lead researcher Deborah McGuire, Ph.D., RN, FAAN, professor and director of the School's Developing Center of Excellence in Palliative Care Research and Oncology Graduate Program."

The researchers have now expanded their study with the help of UMMC nurses who assisted in using the MOPAT to rate pain in patients from 22 different units of the hospital with a wide variety of medical conditions. The hospital testing results, yet to be published, McGuire said, confirm that the tool is highly valid, adequately reliable, and clinically useful. They are also testing MOPAT at The Hospice of Lancaster County, Pa.

McGuire has been interested in the idea of such a tool off and on for the past 15 years, including her work at Emory University and the University of Pennsylvania before joining the University of Maryland in 2004. "With further study, we hope to see if the MOPAT is helpful in monitoring any shifts in pain levels and aiding nurses and other care providers in management of noncommunicative patients' pain," Kaiser said. The tool theoretically could be used as "a common language," Kaiser added, which doesn’t currently exist. "The way we have tested this is unique, because we used completely noncommunicative patients, who are very hard to study."

Hospice pharmacist Mary Lynn McPherson PharmD, BCPS, CDE said, "This is a huge advance for practitioners working with patients with advanced illness. Pain relief is a basic human right, and the validation of a tool that allows us to provide appropriate analgesics for this fragile population is a tremendous asset." McPherson is a professor at the University of Maryland School of Pharmacy.

The researchers have reported on their tool in the current issue of the Journal of Palliative Medicine.

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