Predictors of pain self-report in nursing home residents

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Abstract
The purpose of this study was to examine the influence of cognitive function and other biopsychosocial factors on test-retest agreement, four-week variability, and intensity of self-reported pain using the verbal 0 to 10 scale and a pain thermometer in 115 nursing home residents over four weeks. Pain was assessed twice on three days during week 1, and once each during weeks 2, 3 and 4. A forward stepwise regression procedure was used to examine the influence of biopsychosocial parameters (age, race, gender, educational status, marital status, comorbidity, cognitive function, depression, social support, physical function and self-rated health) on pain intensity, test-retest agreement and variability. There was a quadratic association between cognitive function and test-retest agreement with the 0–10 scale; residents with Folstein scores of 22–26 were more likely to show disagreement (50% of 34) than residents with scores 26 (7% of 71). Hi gher Folstein scores were also associated with greater pain intensity for both pain scales (p<0.001). Baseline pain intensity was significantly related to pain variability (0–10 scale only). The clinician should be cognizant of these relationships when interpreting verbalizations of pain in long-term care facilities.

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