Pain assessment among non-communicating intellectually disabled people described by nursing staff

How does a person with different communication get appropriate medical care? This is a problem that I think about a lot. When Pediatrics published Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs, there was much debate about what it said or didn’t say about GI problems and autism. Leaving all that aside, I felt that the great strength of the paper was discuss the issues of medical care in a group of patients where communication and sensory difficulties can have a major impact on how the physician comes to a diagnosis. I was told by one doctor that about 70% (or more) of the information a doctor typically relies upon to come to a diagnosis is direct communication with the patient.

With that in mind, I was intrigued when I saw this abstract come up:

Pain assessment among non-communicating intellectually disabled people described by nursing staff.

Kankkunen P, Jänis P, Vehviläinen-Julkunen K.

Itä-Suomen Yliopisto, Kuopion Kampus, Hoitotieteen Laitos, PL 1627 70211, Kuopio, Finland.
Abstract

The purpose of this study was to describe pain assessment among non-communicating intellectually disabled people living in long term care described by nursing staff. The target group of the study consisted of the nursing staff working at seven mental retardation units in different parts of Finland. The data were collected during spring 2008 by a semi-structured questionnaire (Non-communicating Children’s Pain Checklist – Revised, N=222), and the response rate was 82% (n=181). The data were analyzed by statistical methods (Kruskall-Wallis test, Mann-Whitney U test) and by content analysis. The findings were described as parameters, frequencies, percentages, and as statistical significance.The nursing staff considered their competence in identifying pain in non-communicating intellectually disabled people to be adequate, and they were of the opinion that enough attention is paid to pain. Almost all nursing staff assessed pain and the effect of treatment of pain on the basis of behavioural changes. Two thirds assessed the pain based on physiological changes. However, no pain assessment tools were used to assess pain and the effects of managing it. Two thirds of the staff considered the pain threshold to be high among non-communicating intellectually disabled people.The findings of this study can be utilized in nursing practice and research, as well as in further education for pain assessment. Additional studies are needed to develop pain assessment to be more systematic among non-communicating intellectually disabled people.

I’m not fond of the term “non-communicating”, but I also recognize that the title of a paper doesn’t give one much room to make a more nuanced statement. That said, I like that this team is attempting to work out how to treat a patient with whom the nurses do not have verbal or other direct communication.

This is a tough balancing act. Obviously, I would like to think that pain is managed. I would also like to know that patients are not over-medicated either. So when I read that the nurses felt that “considered their competence in identifying pain in non-communicating intellectually disabled people to be adequate, and they were of the opinion that enough attention is paid to pain” I want to believe it, but I also want verification. As noted in the abstract, “no pain assessment tools were used to assess pain and the effects of managing it”. This is a start, but only a start. As the authors note: ” Additional studies are needed to develop pain assessment to be more systematic among non-communicating intellectually disabled people.”