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Pain Assessment Scale - PAS

Pain Assessment Scale - PAS. A procedure to assess pain in patients with disorders of consciousness 10-year anniversary symposium for Department of Neurorehabilitation, TBI unit. Oktober 7th and 8th 2010

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Pain Assessment Scale - PAS

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  1. Pain Assessment Scale - PAS A procedure to assess pain in patients with disorders of consciousness 10-year anniversary symposium for Department of Neurorehabilitation, TBI unit. Oktober 7th and 8th 2010 Rikke Guldager, RN, SD, Pia Brix, RN,Sylvia Andersen, RN, Lars Westergaard, MD, Dr. Med.Sci,Ingrid Poulsen Head of reseach unit. Department of Neurorehabilitation, TBI Unit, Glostrup Hospital.

  2. Agenda: Background: Aim: Method: Analysis: Results: Conclusion:

  3. Clinical problem: We have not previously systematically registered pain in patients with disorders of consciousness.The risk is inability to identify signs of pain. Requirement of accreditation

  4. Accreditation BE.6 • Identify patients with pain as part of the initial assessment and reassessments. • Pain relief is provided in compliance with hospital policies and procedures • Communicate with patients and families and advise them on pain and symptom management in accordance with their personal, cultural and religious beliefs. • Educate the health professionals in pain assessment and pain managementInternational standards for hospitals, 3.udg., 2008

  5. Aim: A systematic recording and assessment of pain in patients with disorders of consciousness with a Glascow Coma Score (GCS)<9, and to systematically detect and assess pain in more conscious patients with cognetive and/or communicative difficulties when a Visuel Analog Scale (VAS) can´t be used GCS≥9 Goal: To develop and validate a tool that can be used to pain assess patients with disorders of consciousness with severe acquired traumatic brain injury.

  6. Method: A pain-registration Scale PAS has been developed and constructed on the basis of literature search, first hand experience and expert knowlegde. Algorithm

  7. Defining signs: • Signs is what we as clinicians are observing. • A Patient with GCS 3-5 will often have physiological / autonomic signs. • Patients with GCS 6-7 will in addition to physiological / autonomic signs have body language as a symptom of pain • Patient with GCS 8-9 will in addition to physiological / autonomic signs and body language, have verbal communication. • Patient with GCS 10-15 will typically change behavior / body language, before the patient will exhibit physiological / autonomic signs.

  8. Validation of the PAS:Face validitySensitivity to changes Reliability

  9. Pilot Testing: 15 patients (93 measures) 12 male 3 female Age 19-69 years GCS 6-14

  10. Facial expression: 93 measures 28 showed signs of altered facial expression In 20 patients these signs disappeared after intervention

  11. Increased Tonus: 93 measures 24 patients had increased tone In 15 of these patients tone disappeared after intervention

  12. Sounds: 93 measures 23 patients showed signs of pain with sounds In 19 of these patients the sounds disappeared after intervention

  13. Conclusion: We believe that PAS is a useful tool in Clinical Practice. We can´t be sure that the signs we are measurering is unique signs for pain. We can´t say if our measures are signifikant We will keep up the work!

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