While pain assessment tools should attempt to address each of these behaviours, the assessment of some requires evidence of prior behavioural norms and observation of behavioural changes over time. For paramedics called to see patients with the potential presence of pain this information may unavailable, and observation over time impractical given the operational pressures to minimise scene and transport times. However, facial expressions may be an Selleck BKM120 important indicator of pain, with evidence that prototypical facial expressions of pain are reliably identified by observers

Inhibitors,research,lifescience,medical of another individual’s pain-related expressions, and that observers are able to discriminate between facial expressions associated with pain and those associated with other emotions such as fear[35]. In an experimental pain setting the facial responses of patients with dementia and those in the healthy control group were Inhibitors,research,lifescience,medical closely related to the intensity of the stimulation, leading to a conclusion

that Inhibitors,research,lifescience,medical facial expression may be an important pain assessment tool in patients with impaired cognition or inability to self-report their pain experience[41]. Facial changes associated with pain have been shown to be consistent across the lifespan [42], and as the identification of facial cues does not require the establishment of base rate data or trends in behaviour this may be an important cue that can be assessed by paramedics in order to identify the presence of pain. In addition, this does not demand assessment over time as is required by some other behavioural cues. 3. Seek information

from others Information should be sought from the patient’s Inhibitors,research,lifescience,medical family, close friends or carers regarding changes in behaviour that may be associated with Inhibitors,research,lifescience,medical the presence of pain. People who know the patient well are likely to be able to report subtle changes in the patient’s behaviour or daily activities that may suggest pain. This use of surrogate reporting of pain has some advantages over a naive assessment of pain. However, evidence shows a tendency for doctors[43] and allied health professionals to underestimate the severity of the patient’s pain experience[44,45]… This phenomenon has also been observed DNA ligase in the prehospital setting[46]. As such the use of surrogate measures of pain should be supported by other clinical evidence wherever possible. 4. Use a pain assessment tool Although the patient’s ability to use pain assessment tools such as the VNRS and VNRS depends on the extent of cognitive impairment, patients should still be asked to provide an assessment of their pain using these tools as there is evidence that they may be successfully used in patients with mild to moderate cognitive impairment[47].