Evaluación de la intensidad del dolor en pacientes geriátricos con y sin deterioro cognitivo

Abstract

OBJECTIVES - The main objective of this study was to compare the utility, the psychometric properties and the applicability of four pain scales of pain intensity: Faces Pain Scale (FPS), 21 Box-pain Scale (BS-21), Present Pain Intensity (PPI) and Pain Thermometer (TMD) in a sample of older patients, without cognitive impairment or with mild or moderate cognitive impairment. The secondary objectives were: 1) To determinate reliability, construct validity, post-dictive validity and bias of the four scales. 2) To determinate the accuracy that the different scales were performed 3) To determinate the grade of preference of each scale. 4) To determinate what scale presents the best properties to be used with determinates subgroups of older patients with different cognitive levels or age. Material and methods. 121 older patients with chronic pain were recruited from a long term care facilities (mean age: 76.6 years). After verify inclusion criteria, ratings of pain intensity were measured with the four different scales: FPS, BS-21, PPI and TMD. Patients made ratings of current pain two times / day (morning and afternoon) for 7 consecutively days. At the afternoon they also made retrospective daily ratings of maximum, minimum and usual pain. Last day patients also made a retrospective weekly measure. Results. Comparing results of the different pain rating scales, values of BS-21 were more consistent in intra-class reliability and construct validity. Factor analysis of "pain intensity" construct and correlation coefficients of aggregated and retrospective pain scores are higher with the BS-21. Bias was lower in BS-21 than the other three scales. Results are maintained in both groups of patients, cognitively impaired and unimpaired. In number of errors or grade or preference, FPS obtained the bests results. In general, patients with cognitive impairment obtained worse reliability and more error rate with the four scales. Conclusions. The majority of patients, with or without cognitive impairment, can respond the scales. There are not differences in pain intensity related to cognitive level. In general terms, patients with cognitive impairment realized more errors than patients unimpaired. Older patients made more errors and have more bias than younger patients. The scale with better psychometric properties, independently of the age or the cognitive level of the patients, was BS-21. This scale is a good first option to assess pain intensity in older people. Nevertheless, with this scale patients realized more errors and is the less preferred for patients. In patients with cognitive impairment, independently of their age, FPS is a good option for theirs psychometrics characteristics, errors rate and grade of preference. In patients cognitively unimpaired, independently of their age, TMD is a good option for theirs psychometric properties. Nevertheless, with this scale patients realized more errors. Moreover, is less preferred than other scales