Pain management in persons with intellectual disabilities living in institutions

Abstract

Background: Persons with severe intellectual disabilities often live in specialised care settings and suffer from comorbidities, some of them generating pain. The literature concerning pain assessment and management in this population is however limited. The main objective of this study was to determine the modalities of pain care in a sample of French institutions. Methods: This observational study focused on the modalities of pain assessment and management in six specialised care settings for persons with intellectual and/or psychomotor disabilities. Information about patients, pain evaluation, prevalence and how do healthcare professionals assess pain in noncommunicating intellectually disabled people was recorded. Results: The study included 218 residents and over the last month, 55% had pain, 87% suffered from acute pain and 16% from neuropathic pain. The use of pain scales for patients with communication impairment was unknown to the majority of healthcare professionals. Patients were prescribed 4 drugs a day, 68% had psychotropic drugs and over the last month, 98% of painful residents had received a non-opioid analgesic combined with a non-pharmacological technique in 78 % of them. Conclusion: Pain management must be carried out through accurate pain assessment and the limited knowledge of caregivers about pain assessment methods might contribute to insufficient pain care. It is necessary to train all caregivers about pain evaluation tools that must be adapted to the disability profile of the residents in order to provide the most effective assessment and treatment in these vulnerable patients.