Pain Management in the Elderly: Diagnosis

Diagnosing Pain: The Patient Knows

The most accurate evidence of pain is based on the elder’s own report. However, obtaining pain information can be tricky. If you ask your elderly relative if he or she is in pain, the answer may be a simple “No.” Try being more specific. Questions such as these can often elicit surprising responses: “Are you achy?”; “Is your back sore?”; “Is your knee still bothering you?”; and “Have you been sleeping well?”.

A health care professional will use an assessment test to determine pain intensity. The test helps compare a senior’s pain before and after use of a particular medication or pain therapy technique (Chronic Pain in the Elderly, Patient Care, Sept. 30, 2000). The American Geriatric Society (AGS) recommends number, word, and picture scales to identify pain levels. The number scale is a range of increasing numbers that indicates the severity of pain. The patient circles the appropriate number. The word scale describes different pain levels and asks the senior to pick the words that best describe how he or she is feeling.

If the elder is illiterate or cognitively impaired, the picture or “faces” scale may be helpful. This is a series of cartoon faces exhibiting expressions that range from relaxed to grimacing, illustrating the degree of pain that the elder may be experiencing (The Management of Chronic Pain in Older Persons, Clinical Practice Guidelines, JAGS Vol. 46 (5), May 1998). The elder points to the appropriate face. The Nonverbal Visual Analog Scale is often used for those with Alzheimer’s disease or other forms of dementia. The patient is shown a line and makes a mark between the extremes of “no pain” and “worst pain” (Assessing Pain in the Confused Elderly Patient, American Family Physician, July 15, 2001).

An AGS geriatric pain assessment form provides a way to track pain and summarize the physician’s findings and plan of action. It includes a list of the types of pain (for example, burning, stinging, shooting, radiating), numbers measuring pain intensity, and space to list the factors exacerbating pain and to describe mood, gait, balance, sleep quality, medications and other information.

For information about pain treatment, see Treating the Pain and Pain Management Research.

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Diagnosing and Treating Pain:

• Patient Reports of Pain
• Pain Treatment

	Sample Faces Pain Scale
		0	No Pain
		1	Hurts a Little
		2	Hurts a Little More
		3	Hurts Even More
		4	Hurts Whole Lot
		5	Hurts Worst

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