Model of pain assessment in people with learning disabilities presented


Describing pain is a difficult thing to do. Often we may feel our vocabulary is insufficient to capture what is happening in our bodies when we feel pain. A number of ways to help express pain have been explored, for example through the use of art. This was explored recently in a BBC radio programme that looked at ways in which artists expressed pain in their work, art may help to bridge the communication gap between a patient suffering pain and a doctor, trying to understand that pain in order to help alleviate it.

For people with learning disabilities of course, this difficulty is magnified as a result of additional communication problems.

Work to develop pain assessment tests for people with severe or profound learning disabilities has been done, with the development of baseline measurement and checklists of significant indicators of pain along with functional analysis combined in a pain assessment tool.

The authors in this study looked at one of these tools, the Non-Communicating Adults Pain Checklist (NCAPC). This 18 item checklist has been developed from a larger 27 item list for non-communicating children.

The researchers set out to develop a pain model for adults with learning disabilities. They used video recordings of 228 participants before and during an influenza vaccination.

They constructed their mode using data they had previously collected using confirmatory factor analysis of the sum scores. Confirmatory Factor Analysis is a statistical approach allowing researcher to test whether or not a relationship between observed variables and underlying constructs  exists or not. They tested the model on a sample of 89 participants who had been randomly chosen.

What they found was that the constructed model reflected two categories of pain responses:

  • a basic response of physiological measures and body reaction,
  • an advanced response of vocal and emotional reactions, as well as facial and protective expressions.

They tested the model using two further statistical approaches, the goodness of fit index which describes the amount of discrepancy between values observed in a study and the values that would be expected in the model being tested and RMSEA which is used to indicate any unexplained variance in the values.They found the model they had constructed showed ‘excellent’ Goodness of Fit and an ‘acceptable’ RMSEA value

The researchers concluded that the model of pain behaviour they present is valid and that it might improve understanding of pain in people with learning disabilities and therefore facilitate better pain management

A model for pain behavior in individuals with intellectual and developmental disabilities, Meir L et al., in Research in Developmental Disabilities, 33, 6, 1984–1989

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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