Tool Gauges Pain in Non-Communicative Patients

Research has shown that an estimated 75 percent of patients towards the end of their lives have unalleviated pain, but some of these patients lack the ability to communicate their pain to medical staff and caregivers. Developed by researchers at the University of Maryland School of Nursing, a part of the University of Maryland, Baltimore, a tool has finally been created to assess acute pain in non-communicative patients.

This tool is known as MOPAT, standing for Multidimensional Objective Pain Assessment Tool.

MOPAT was created by four small-scale research projects in several locations over many years. It is made up of two standardized forms for nurses and other care providers to score values of behavioral and physical signs from the patient.

Behavioral indicators include facial expressions, moaning and muscle tension. Physical indicators include heart rate, blood pressure, and sweating.

The research team the developed the MOPAT based it on earlier work by nurses in post-anesthesia units, where sedated patients could not repot pain for themselves. They wrote that the tool, "Offers a unique approach to assessing palliative care patients across populations and settings."

The creators of MOPAT state that their tool concentrates on an immense need in medical care; patients who cannot communicate their discomfort levels are at greater risk for under treatment of pain, partly because assessing their pain has not always been consistent between practitioners.

"We have found that this tool is very sensitive. We are very happy that it is valid,” reported lead researcher Deborah McGuire, PhD, RN, FAAN, professor and director of the School's Developing Center of Excellence in Palliative Care Research and Oncology Graduate Program. McGuire has been attracted to the idea of such a tool sporadically for the past 15 years. She said that tests of MOPAT on hospice patients who are non-communicative before and after nurses administered medication show that the pain of the patients is decreased.

The researchers have reported on their tool in the current issue of the Journal of Palliative Medicine.

The possibilities of wide usage of the MOPAT tool are very apparent as well, and clearly can be practical for more than hospice patients. "We are hoping that it will be used as a standardized tool to help providers to assess pain for non-communicative patients in a variety of settings," said Karen Kaiser, PhD, RN-BC, AOCN, CHPN, adjunct professor at the School and clinical practice coordinator at the University of Maryland Medical Center (UMMC) across the road.

The study has been expanded to other hospitals by the researches, with the help of UMMC nurses who assisted in using the MOPAT to scale pain in patients from 22 diverse units of the hospital with a wide assortment of medical conditions. McGuire stated that the test results from the hospital trials have yet to be published, but that they confirm the tool is highly legitimate, sufficiently dependable and clinically useful. MOPAT is also being tested at The Hospice of Lancaster County, Pa.

"With further study, we hope to see if the MOPAT is helpful in monitoring any shifts in pain levels and aiding nurses and other care providers in management of non-communicative patients' pain,” reported Kaiser.

"This is a huge advance for practitioners working with patients with advanced illness,” said Mary Lynn McPherson, hospice pharmacist and professor at the University of Maryland School of Pharmacy. “Pain relief is a basic human right, and the validation of a tool that allows us to provide appropriate analgesics for this fragile population is a tremendous asset."

The tool theoretically could be used as "a common language," in the medical world, said Kaiser, which doesn't currently exist. "The way we have tested this is unique, because we used completely non-communicative patients, who are very hard to study."

The World Health Organization defines palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."