• Joseph W Shega, Thomas Rudy, Francis J Keefe, Lisa Caitlin Perri, Olga Telgarska Mengin, and Debra K Weiner.
• Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, Illinois 60611, USA. shega@northwestern.edu
• J Am Geriatr Soc. 2008 Sep 1; 56 (9): 1631-7.

ObjectivesTo evaluate the validity of traditional pain behaviors (guarding, bracing, rubbing, grimacing, and sighing) in persons with and without cognitive impairment and chronic low back pain (CLBP).DesignProspective observational study.SettingOutpatient clinics.ParticipantsThirty-seven cognitively intact and 40 cognitively impaired participants with and without CLBP.MeasurementsFrequency of traditional pain behaviors.ResultsForty-six of the participants were pain free, and 31 had CLBP. The internal consistency reliability coefficient of the five pain behaviors was 0.32, suggesting that a unidimensional scale did not exist. Multivariate analysis of variance analysis according to the independent variables pain status (pain free vs CLBP) and cognitive status (intact vs impaired) with the dependent variable frequency of pain behaviors found significant differences according to pain status (F[5,61]=3.06, P=.02) and cognitive status (F[5,61]=5.41, P<.001) but without evidence of an interaction (F[5,61]=1.14, P=.35). Participants with CLBP exhibited significantly higher levels of grimacing (P<.001) and guarding (P=.02) than pain-free participants. Intact subjects exhibited fewer guarding (P=.02) and rubbing behaviors (P<.001) but a higher number of bracing behaviors (P=.03) than cognitively impaired participants.ConclusionThese results support the utility of facial grimacing in assessing pain in patients with mild to moderate cognitive impairment and call into question the validity of guarding and rubbing in assessing pain in persons with mild to moderate cognitive impairment.

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