New Tool Assesses Pain in Non-Communicative Patients

Newswise — A valid and reliable tool to assess acute pain in noncommunicative 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, say researchers.

They say 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, says lead researcher Deborah McGuire, PhD, RN, FAAN, professor and director of the School's Developing Center of Excellence in Palliative Care Research and Oncology Graduate Program. She says, "We have found that this tool is very sensitive. We are very happy that it is valid."

MOPAT can be useful for more than hospice patients. "We are hoping that it will be used as a standardized tool to help providers to assess pain for noncommunicative patients in a variety of settings," says Karen Kaiser, PhD, RN-BC, AOCN, CHPN, adjunct professor at the School and clinical practice coordinator at the University of Maryland Medical Center (UMMC) across the street.

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, says McGuire, 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," says Kaiser. The tool theoretically could be used as “a common language,” says Kaiser, 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 says, “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.

The research team developed MOPAT based on earlier work by nurses in post-anesthesia units, where sedated patients could not self-report pain. They wrote that the tool "offers a unique approach to assessing palliative care patients across populations and settings."

The World Health Organization defines palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

MOPAT consists of scoring patients' pain levels on two sets of signs from patients: behavioral signs of pain, and physical signs. Behavioral signs include facial expressions, moaning and muscle tension. Physical signs include heart rate, blood pressure, and sweating.

The School of Nursing and School of Pharmacy are on the Baltimore campus of the University of Maryland.