Paramedic assessment of pain in the cognitively impaired adult patient

A systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults.Two systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use.The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to evaluate the effectiveness of paramedic pain management practice in older adults to ensure that the care of all patients is unaffected by age or disability.Although pain is a commonly encountered complaint in prehospital and emergency medicine settings, evidence of inadequate analgesia has been widely documented. Poor pain management practice has been described in the emergency department (ED)[1], and variations in pain management practice in this setting have been associated with ethnicity[2], gender[3], and extremes of age[4].Reasons for inadequacies in pain management practice are likely to be multifactorial. Failure to assess for the presence and severity of pain may be one factor, as efforts to make pain measurement mandatory in the ED have been sh