Pain assessment in non-communicative patients: the Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN).

BACKGROUND AND AIMS: Although pain in the elderly is a common and important problem, it is frequently underestimated and undertreated. Pain assessment in elderly people is often more difficult than in the general population, because of the occurrence of dementia and other cognitive impairments that may compromise the ability to communicate the presence and the intensity of pain to hospital staff. Recently, several observational tools have been developed in order to assess pain behaviors in non-communicative patients. The aim of the present study was to verify if the Italian version of the Non- Communicative Patient's Pain Assessment Instrument (NOPPAIN) could be used in a hospital setting. METHODS: Sixty severely demented patients (MMSE /=23, language test score >/=4) were selected on the basis of their cognitive status and language skills. NOPPAIN forms were filled in at the same time by two nursing staff members after patients' daily care activities; behavioral indicators of the affective state and communicative patients' reports of pain were also collected. RESULTS: Significant interrater agreement was found in the subscores of the four main sections of the NOPPAIN and also in the total score. In addition, in cognitively intact patients there was a moderate (about 0.50) but significant correlation between NOPPAIN ratings and pain self-reports. A positive correlation between pain scores and negative affective state scores was also found, especially in cognitively impaired patients. CONCLUSIONS: The preliminary data of the present study support the reliability and validity of the Italian version of the NOPPAIN, which appears to be an easy-to-use tool in the assessment of pain in hospitalized non-communicative patients.

[The Italian version of NOPPAIN Scale: validation during education]. / La versione italiana della scala NOPPAIN: validazione in un contesto di formazione.

UNLABELLED: Pain assessment in elderly people may be complex due to the occurrence of neurodegenerative disorders, which often impair the ability to verbally report pain to hospital staff Several tools have been developed to assess pain behaviors in patients unable to communicate. The Italian version of the Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN) has shown good preliminary qualities in the clinical setting. AIM: Aim of the paper is to analyze the psychometric properties of the Italian version of the NOPPAIN in a training setting. METHODS: 142 hospital staff members of the Medical Department of Vicenza Hospital assessed with NOPPAIN 5 videotapes, portraying different levels of pain intensity. Inter-rater reliability (nonparametric Kendall's W) and construct validity were examined. RESULTS: A significant inter-rater agreement was found overall (Kendall's W = 0.89, p < 0.01) and for each of the 5 videos; inter-rater agreement was high both in the total score and in the main sections of the tool. NOPPAIN scores correctly discriminated between the different levels of pain intensity. CONCLUSION: The results confirm interrater reliability and construct validity of the Italian version of the NOPPAIN.