The “About Pain and Dementia” section in the PainChek® App covers three topics:
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What is Pain?
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Why is accurate Pain Assessment so important?
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What is PainChek®?
See the following sections for the contents of each topic.
In July 2020, the International Association for the Study of Pain (IASP) updated is definition of Pain to: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” As such Pain is a personal (subjective) experience influenced by physical, psychological and environmental factors. Only the person in Pain can truly understand the intensity of the Pain they are experiencing, and Pain from the same cause can feel very different to different people. Tolerance to Pain can also vary significantly among people, and so caution should be taken to objectively assess a person's Pain experience. That is without your opinion, feelings or judgement influencing your Assessment.
Pain can be:
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Acute Pain (i.e. Pain that resolves with tissue healing, which lasts less than 3 (or 6) months) most commonly occurs when our physical-self has been hurt, or is in danger of being hurt. Acute Pain usually occurs in response to injury or illness (for example, an acute back ‘strain’, a sprained ankle, a strained muscle or other conditions like appendicitis). Acute Pain initially protects us. The experience of acute Pain is designed to help stop us injuring ourselves in the same way again: we remember what happened and try and limit the risk of that happening again. Acute Pain is also designed to allow the body time to repair and recover.
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Recurring Pain is the kind that happens again and again. It may go completely away and then come back. Think migraines, backache or stomach ache in the same place as you always get them. While the Pain may be similar in duration, location and intensity, it always goes away eventually.
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Chronic Pain may start with an injury, illness, accident or surgery, but instead of healing in the normal way, lasts for more than three months. It may not maintain the same intensity all the time, and it may be persistent or recurrent. The most common sources of chronic Pain include low back Pain, headache and arthritic Pain. It is unremitting, unrelenting and if not treated, can be debilitating. Chronic Pain can cause significant psychological and emotional trauma and often limits an individual’s ability to fully function.
Pain commonly occurs in people with dementia, with somewhere between 50% to 80% experiencing chronic Pain. However, detecting it can be challenging, as people with advanced dementia may have difficulty verbalising when they are in Pain. As a result Pain often goes undetected and untreated in this vulnerable population. PainChek®, which is a behavioural (observational) Pain Assessment tool like the Abbey Pain Scale (APS) and the Pain Assessment in Advanced Dementia (PAINAD) is designed to assist the user to identify changes in behaviour that might mean a Resident is in Pain. As Resident’s dementia progresses their ability to self-reported Pain diminishes, as such it is important Pain Assessments are conducted regularly.
Pain Assessment should be conducted when a Resident is resting and after movement. Please note that movement might intensify a person's Pain experience. PainChek® can be used to assist in understanding whether Pain is or is not one of the potential causes of a person's change in behaviour.
Behavioural Pain Assessment tools, like PainChek®, should be used when:
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a Resident is unable or less likely to say they are in Pain,
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in cases where there is a change in usual behaviour (out of character) for that Resident,
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if the you suspect that Pain may be present and again after an intervention has been implemented to manage Pain.
You should always be mindful of potentially Painful medical conditions or interventions which may affect a Resident's Pain levels.
These recommendations are in line with the American Society of Pain Management Nurses in the 2019 Position Statement: “Pain Assessment in the Patient Unable to Self-Report”, which suggest that following approach to the Assessment of Pain in people with advanced dementia:
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Use the Hierarchy of Pain Assessment Techniques
a. Be aware of potential causes of Pain including known Painful interventions.
b. Attempt self-report.
c. Observe patient behaviours.
d. Solicit reporting of Pain and behaviour/activity changes.
e. Attempt analgesic trial.
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Utilize behavioural Pain Assessment tools, as appropriate.
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Minimize emphasis on vital signs.
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Assess regularly, reassess post-intervention, and document.
Further, in line with the Australian Pain Society 2018 guidelines on “how and when Pain Assessments should be conducted when using a Pain measurement tool”, the following recommendations are made to ensure best practice when using behavioural Pain Assessment tools, like PainChek®:
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Should be used for movement-based Pain Assessment. Therefore, you need to observe the Resident while they are moving or being moved. The Assessment should be done immediately following this movement and the results recorded (in the case of PainChek® in the app).
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A second Pain Assessment should be done 1 hour after any intervention taken to manage the Resident's Pain. Examples of interventions include medication, heat packs or massage. If, at this Assessment, the score on the Pain scale is the same, or worse, the Resident’s doctor should be consulted for advice.
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Complete follow-up Assessments hourly until the Resident’s Pain scores are in the mild Pain range, and then 4 hourly for 24 hours, treating Pain as directed by the Resident’s doctor if it reoccurs.
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If the pain/distress continues, and there is no improvement in that time, then it is essential that you notify the Resident’s doctor of the ongoing Pain scores and what has been done to manage the Resident's Pain experience to date.
PainChek® is an app based behavioural Pain Assessment tool designed to assist you to identify if the Resident you are caring for is in Pain.
PainChek® is a secure smartphone or tablet based medical device that uses artificial intelligence identify nine facial expressions indicative of the presence of Pain and user observations captured through a series of digital checklists to document the presence or absence of a further 33 Pain-related features (behaviours). Each feature documented is assigned a score of 1. The the app automatically calculates a Resident's Pain score based on the sum of the Pain features present. Based on the Pain score the app then automatically assigns a Pain intensity (i.e. No Pain, Mild Pain, Moderate Pain or Severe Pain). The PainChek® Pain score and Pain intensity will assist you in deciding whether treatment is required. This information is securely stored in the cloud and may be shared in real-time with all members of the healthcare team involved in the care of your Resident.
It is important to note that PainChek® does not give advice on what to do if Pain is detected. In these instances you should always seek or follow the advice of the Resident’s doctor.
It is also important to assess and reassess the Resident's Pain after every intervention, to ensure the Pain intervention is working. In any circumstance when you are unsure or have concerns about the well-being of the Resident you are caring for, you should contact the Resident’s doctor.
Automated reporting features enable you to follow the Resident’s Pain experience over time.