• Pain Manag Nurs · Aug 2020

    Integrated Management of Pain in Advanced Dementia.

    • Mercedes Montoro-Lorite, Ester Risco, Montserrat Canalias-Reverter, José Antonio Rodríguez-Murillo, Marta García-Pascual, and Adelaida Zabalegui.
    • Unidad Geriatría de Agudos Hospital Clinic, Barcelona, Spain; Instituto de Hematología y Oncología, Hospital Clínic, Barcelona, Spain. Electronic address: mmontoro@clinic.cat.
    • Pain Manag Nurs. 2020 Aug 1; 21 (4): 331-338.

    AimDevelop and evaluate the implementation of a protocol for comprehensive management of pain in advanced dementia.MethodQuasi-experimental study carried out between September 2015 and May 2016 in an acute geriatric unit. Following development of the protocol and nurse training, 22 participants were recruited through consecutive sampling to form the intervention group (IG). Pain assessment was performed using the Pain Assessment in Advanced Dementia Spanish version (PAINAD-Sp) instrument and by nurse report-rating using the Numeric Rating Scale (NRS) and control group, with pain assessment through nurse-report using an NRS. Interventions carried out following perception of pain were done according to the actions algorithm created for this purpose. Follow-up was carried out daily during the hospital stay.ResultsSome 98% of the actions were performed correctly following the protocol. All (100%) of patients had a scheduled prescription for analgesics. Significant differences between mean pain scores at admission and discharge were found through PAINAD-Sp using a Wilcoxon sign test of -2.9543 (p = .004). Analysis of pain perception scores revealed a statistically significant positive correlation between the number of nonpharmacological actions performed and the pain score values obtained in the IG (rho Spearman: 0.617, p < .001) and the control group (rho Spearman: 0.922, p < .001). A high correlation was also observed in the IG between assessments conducted using PAINAD-Sp and NRS (intraclass correlation coefficient: 0.921).ConclusionsThe implementation of an agreed-upon, standardized protocol for comprehensive pain management in advanced dementia, including nurse training, leads to systematic application of all the protocol stages, and therefore better pain management.Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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