What methods can be used to assess pain in the elderly?
There are a number of pain assessment instruments used throughout medicine. Many of the most commonly used instruments are unidimensional and measure only pain intensity. Examples of these include the visual analog scale (VAS) and the Wong-Baker Faces Pain Rating Scale, which provide a visual with a series of faces with varying levels of discomfort from a happy face to a crying face that a patient can identify with. Alternatively, there is the pain thermometer, variations of which include visual factors such as gradual color scales from blue to red or yellow to red, with red identifying severe pain.
Although these instruments can be useful, pain is a multidimensional experience with sensory and emotional components that further impact a patient’s psychological and functional abilities, especially in the elderly population. It is therefore more valuable to perform a complete pain assessment in which unidimensional scales are used in conjunction with multidimensional pain instruments, known as Verbal Descriptor Scales (VDS) to measure pain experience. The McGill Pain Questionnaire (MPQ) is one such multidimensional scale that uses subjective word descriptors as well as a five-point pain intensity scale to evaluate the sensory, affective, and evaluative components of pain. In addition, there is the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), which is divided into three parts. The first part measures the chronic pain experience, including perceived interference of pain, spousal concern, distress, life control, and severity. The second part assesses the patient’s perceptions on the degree to which spouses display negative behaviors in response to the pain, and the third part assesses a patient’s self-report on their ability to perform everyday activities.