Special Issue "Pain Assessment in Impaired Cognition"

A special issue of Brain Sciences (ISSN 2076-3425).

Deadline for manuscript submissions: closed (31 August 2021).

Special Issue Editors

Dr. Joukje M. Oosterman
E-Mail Website
Guest Editor
Donders Institute for Brain, Cognition and Behaviour, Radboud University
Interests: aging; neuropsychology; pain; dementia; cognitive reserve; MRI
Prof. Dr. Miriam Kunz
E-Mail Website
Guest Editor
Department of Medical Psychology and Sociology, University of Augsburg
Interests: pain; facial expression; dementia; neuropsychology

Special Issue Information

Dear Colleagues,

Assessing pain in individuals with cognitive impairment is a major challenge. Cognitive impairment reduces reliability of subjective pain reports, the gold standard for assessing pain. As a result, there has been an upsurge in the use of observational scales for pain assessment purposes in cognitive impairment. Whereas these observations are in general more reliable compared to subjective reports of pain, we still know very little of how different underlying pathologies and cognitive changes may, or may not, influence pain assessed via these methods. Specifically, clinical conditions differ immensely with regard to their cognitive deficits; it remains yet to be clarified how these different profiles influence behavioural responses to pain, pain observations and subjective reports. Moreover, whereas cognitive decline has in general been associated with a decline in clinical pain being reported, preliminary work on pathological brain changes in aging and dementia shows a different line of results. Here, more brain white matter atrophy has been related to an increase in clinical pain report, despite the cognitive loss that is also associated with higher atrophy levels. This illustrates the complexity of assessing pain in patients with cognitive impairment.

The aim of this Special Issue is to provide further insight into how cognitive impairment and underlying neuropathological changes influence (findings from) pain assessment in patients with cognitive impairment. Ultimately, its aim is to further understand how pain assessment can be improved in different clinical conditions.

We are soliciting original experimental and observational studies addressing pain assessment in relation to cognitive impairment/clinical diagnosis/neuropathology. Research focussing on pain processing and pain assessment in individuals with different types of cognitive impairments by use of various pain assessment methods and by also considering underlying mechanisms such as brain pathology and neuropsychological profile is especially welcome.

Dr. Joukje M. Oosterman
Prof. Miriam Kunz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pain observations
  • Clinical pain report
  • Experimental pain
  • Dementia
  • Cognitive impairment
  • Neuropathology
  • Autonomic responses

Published Papers (6 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Article
Faces of Pain during Dental Procedures: Reliability of Scoring Facial Expressions in Print Art
Brain Sci. 2021, 11(9), 1207; https://doi.org/10.3390/brainsci11091207 - 14 Sep 2021
Viewed by 160
Abstract
Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was [...] Read more.
Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was to assess the reliability in scoring facial expressions of pain in dental print art from the 17th, 18th, and 19th century, using a Short Form of the 15-item Pain Assessment in Impaired Cognition (PAIC15-SF) tool. Methods: Seventeen prints of patients undergoing dental procedures were scored twice by two inexperienced observers and an expert and once by a Gold Standard observer. Results: All observers achieved high intra-observer reliability for all four items of the category “facial expressions” and for three items of the category “body movements” (ICC: 0.748–0.991). The remaining two items of the category “body movements”, viz., “rubbing” and “restlessness”, were excluded from further research because it was not possible to calculate a reliable ICC. Overall, the intra-observer reliability of the expert was higher than that of the inexperienced observers. The inter-observer reliability scores varied from poor to excellent (ICC: 0.000–0.970). In comparison to the Gold Standard, the inter-observer reliability of the expert was higher than that of the inexperienced observers. Conclusion: The PAIC15-SF tool is universal enough even to allow reliable assessment of facial expressions of pain depicted in dental print art. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Graphical abstract

Article
Association between Self-Reported Pain, Cognition, and Neuropathology in Older Adults Admitted to an Outpatient Memory Clinic—A Cross-Sectional Study
Brain Sci. 2021, 11(9), 1156; https://doi.org/10.3390/brainsci11091156 - 31 Aug 2021
Viewed by 451
Abstract
Cognitive impairment has been linked to reduced self-reporting of pain. However, it is unclear whether the various cognitive functions are similarly and/or independently associated with such pain report measures. In the present study, we explored how executive functioning (EF), memory, and global cognition [...] Read more.
Cognitive impairment has been linked to reduced self-reporting of pain. However, it is unclear whether the various cognitive functions are similarly and/or independently associated with such pain report measures. In the present study, we explored how executive functioning (EF), memory, and global cognition relate to self-reported pain and investigated whether underlying neuropathology partially accounts for these results. We used Lasso categorical regression to analyze data from 179 individuals visiting a memory clinic. The data included the self-reported pain occurrence, intensity, severity and frequency, clinical diagnoses, neuropsychological scores, white matter hyperintensities, medial temporal lobe atrophy, depressive symptoms, and demographics. Our results showed that worse memory and EF performance predicted a lower pain occurrence. In those individuals who did report pain, worse memory predicted lower pain intensity, severity, and frequency levels, but for EF reversed effects were found, with worse EF predicting higher pain scores. These relationships were only partially explained by reductions in white matter and medial temporal lobe integrity. Similar effects were found for depressive symptoms. Our findings highlight the distinct associations of EF and memory with self-reported pain. A similar pattern of relationships found for both self-reported pain and depressive symptoms may reflect shared latent affective components. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Figure 1

Article
Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards
Brain Sci. 2021, 11(7), 869; https://doi.org/10.3390/brainsci11070869 - 29 Jun 2021
Viewed by 480
Abstract
Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed [...] Read more.
Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0–45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Figure 1

Article
Paediatricians’ Views on Pain in Children with Profound Intellectual and Multiple Disabilities
Brain Sci. 2021, 11(3), 408; https://doi.org/10.3390/brainsci11030408 - 23 Mar 2021
Viewed by 629
Abstract
Pain is a frequent issue in children with profound intellectual and multiple disabilities (PIMD). Its identification and treatment can prove highly challenging for primary care physicians, mainly because of the children’s limited communication abilities. We used an online survey to explore paediatricians’ views [...] Read more.
Pain is a frequent issue in children with profound intellectual and multiple disabilities (PIMD). Its identification and treatment can prove highly challenging for primary care physicians, mainly because of the children’s limited communication abilities. We used an online survey to explore paediatricians’ views regarding the experience and management of pain in children with PIMD and invited 480 professionals working in the canton of Vaud, Switzerland, to take part. We received 121 responses (participation rate 25.5%). A large majority of respondents provided care to children with PIMD. All paediatricians considered that these children feel pain at least as much as typically developing children. However, paediatricians had mixed views on their tolerance to pain. More than 90% held the view that their pain is under-assessed and undertreated. The principal barriers they reported to appropriate management were communication limitations with the child, difficulties in pain assessment, lack of knowledge about children with disabilities and lack of experience. Paediatricians have complex opinions regarding how children with PIMD experience pain and how to manage this problem. Professional education and training on the specificities of children with PIMD, including how to address their pain, seem necessary to foster paediatricians’ ability and confidence in approaching this complex issue. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Figure 1

Article
Specific Behavioral Responses Rather Than Autonomic Responses Can Indicate and Quantify Acute Pain among Individuals with Intellectual and Developmental Disabilities
Brain Sci. 2021, 11(2), 253; https://doi.org/10.3390/brainsci11020253 - 18 Feb 2021
Viewed by 785
Abstract
Individuals with intellectual and developmental disabilities (IDD) are at a high risk of experiencing pain. Pain management requires assessment, a challenging mission considering the impaired communication skills in IDD. We analyzed subjective and objective responses following calibrated experimental stimuli to determine whether they [...] Read more.
Individuals with intellectual and developmental disabilities (IDD) are at a high risk of experiencing pain. Pain management requires assessment, a challenging mission considering the impaired communication skills in IDD. We analyzed subjective and objective responses following calibrated experimental stimuli to determine whether they can differentiate between painful and non-painful states, and adequately quantify pain among individuals with IDD. Eighteen adults with IDD and 21 healthy controls (HC) received experimental pressure stimuli (innocuous, mildly noxious, and moderately noxious). Facial expressions (analyzed with the Facial Action Coding System (FACS)) and autonomic function (heart rate, heart rate variability (HRV), pulse, and galvanic skin response (GSR)) were continuously monitored, and self-reports using a pyramid and a numeric scale were obtained. Significant stimulus-response relationships were observed for the FACS and pyramid scores (but not for the numeric scores), and specific action units could differentiate between the noxious levels among the IDD group. FACS scores of the IDD group were higher and steeper than those of HC. HRV was overall lower among the IDD group, and GSR increased during noxious stimulation in both groups. In conclusion, the facial expressions and self-reports seem to reliably detect and quantify pain among individuals with mild-moderate IDD; their enhanced responses may indicate increased pain sensitivity that requires careful clinical consideration. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Figure 1

Article
Pain, Complex Chronic Conditions and Potential Inappropriate Medication in People with Dementia. Lessons Learnt for Pain Treatment Plans Utilizing Data from the Veteran Health Administration
Brain Sci. 2021, 11(1), 86; https://doi.org/10.3390/brainsci11010086 - 11 Jan 2021
Cited by 1 | Viewed by 785
Abstract
Alzheimer’s disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high [...] Read more.
Alzheimer’s disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain—accompanied by evidence about the analgesic efficacy of opioids—has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012–30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered. Full article
(This article belongs to the Special Issue Pain Assessment in Impaired Cognition)
Show Figures

Figure 1

Back to TopTop