Physiological Psychology, University of Bamberg, Markuspl. 3, 96045, Bamberg, Germany.
Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
BMC Geriatr. 2018 Apr 11;18(1):88. doi: 10.1186/s12877-018-0773-8.
For patients with advanced dementia, pain diagnosis and assessment requires observations of pain-indicative behavior by others. One type of behavior that has been shown to be a promising candidate is the facial response to pain. To further test how pain-indicative facial responses are, we investigated the predictive power of observational facial descriptors to (i) predict the self-report of pain and (ii) to differentiate between non-painful and painful conditions. In addition, the expertise of the observers (nurses vs. healthy controls) and the cognitive status of the observed (dementia vs. cognitively healthy) were considered.
Overall 62 participants (32 nurses and 30 control subjects) watched 40 video-clips, showing facial expressions of older individuals with and without dementia during non-painful and painful pressure stimulation. After each clip, participants were asked to rate the videos using commonly used facial descriptors of pain and also to provide global pain estimate ratings of how much pain the observed individual might have experienced.
Out of the 12 facial descriptors used, only 7 were able to differentiate between non-painful and painful conditions. Moreover, participants were better in predicting the pain self-report of the observed individuals when using facial descriptors than when using global pain estimates. Especially, the anatomically-orienting descriptors (e.g. opened mouth, narrowing eyes) showed greatest predictive power. Results were not affected by pain-expertise of the observers (nurses vs. control subjects) or diagnostic status of the observed (patients with dementia vs. cognitively unimpaired subjects).
The fine-grained and specific observation of facial responses to acute pain appeared to provide valid indication of pain that is not compromised when patients with dementia are observed. The regular professional training does not put nurses at advantage to detect pain via facial responses.
对于患有晚期痴呆症的患者，疼痛的诊断和评估需要他人观察疼痛指示行为。已经证明一种有前途的行为类型是疼痛的面部反应。为了进一步测试疼痛指示性面部反应的预测能力，我们调查了观察性面部描述符的预测能力，以（i）预测疼痛的自我报告，（ii）区分无痛和疼痛状态。此外，还考虑了观察者的专业知识（护士与健康对照者）和观察对象的认知状态（痴呆与认知健康）。
共有 62 名参与者（32 名护士和 30 名对照者）观看了 40 个视频片段，这些片段显示了患有和不患有痴呆症的老年人在无痛和疼痛性压力刺激期间的面部表情。观看每个视频片段后，参与者使用常用的疼痛面部描述符对视频进行评分，并对观察对象可能经历的疼痛程度进行总体疼痛估计评分。
在所使用的 12 个面部描述符中，只有 7 个能够区分无痛和疼痛状态。此外，参与者使用面部描述符预测观察对象的疼痛自我报告的能力优于使用总体疼痛估计的能力。特别是，具有解剖定向的描述符（例如张开嘴、眯眼）表现出最大的预测能力。结果不受观察者疼痛专业知识（护士与对照组）或观察对象诊断状态（痴呆患者与认知无障碍受试者）的影响。
对急性疼痛的面部反应的精细和具体观察似乎为疼痛提供了有效的指示，而不会因观察痴呆患者而受到影响。定期的专业培训并不会使护士在通过面部反应检测疼痛方面具有优势。
