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New Pain Measurement Scale, EPCA-2, May Benefit Non-verbal Seniors

Determining pain levels in patients is not an easy task since pain is such a subjective sensation. In verbal patients, they can be asked to rate their scale from 0 to 10 and to describe the intensity. Non-verbal patients, particularly the elderly who may also have dementia, are not as able to express the quality and quantity of pain.

The authors of this article developed a non-verbal pain scale, the Elderly Pain Caring Assessment (EPCA-2). The 8-item scale based on patient behaviors is meant to be used in day-to-day practice by healthcare professionals, particularly nurses.

To develop the scale, the authors recruited patients 340 patients who were 65 years or older (mean age: 79.4 years) and unable to verbally communicate complaints of pain. The diagnosis included bedsores (78 patients), cancer (74), dementia (68), stroke (54), other neuropathy (20), arthritis (26), or bone fracture (30). One hundred twelve patients were taking opioids, 171 were taking non-opioids, and 57 were taking non-analgesics. Eight criteria were established for observation by caregivers.

Before treatment to manage pain:

1- Facial expression
2- Spontaneous posture adapted at rest
3- Movements of the patient in and out of bed
4- Interaction of all kinds with other people

During intervention by the caregiver:

5- If the patient has an anxious reaction to the intervention
6- Reactions during the intervention
7- Reactions when the painful parts of the body are attended to
8- Complaints during intervention.

Each assessment had a scale of 0 to 4 for rating patient reaction.

The authors wrote that the raters (nurses, caregivers, and doctors) felt the structure of the assessment was sound and valid, with an inter-rater reliability being very good. The consistency was also rated as highly satisfactory.

In conclusion, the authors state, "After a short training session, EPCA-2 may provide nurses, caregivers, and doctors with a good instrument for pain assessment in NVC older patients."

References: Remy Morello, et al. A scale to measure pain in non-verbally communicating older patients: The EPCA-2 Study of its psychometric properties. In PAIN. December 2007. Vol. 133. Issue 1-3. Pp. 197-209.

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