Topic C: DISEASE ENTITIES (HUMAN) S131

emphases general practioner mistake in prescribing tramadol without clearpain diagnosis. Also, patient had potential for addiction as well as an easyaccess to the drug. Another patient prescription of tramadol was in themanner “as needed”, only according to patient complaints without clearpain assessment and objective pain diagnosis. Caregiver ordinated the drugfor sedation and the consequence was acute confusional state of patientwith agitation and hallucinations. Third one suffered from neuromuscularpain due to arthropaty and find relief using tramadol, but because offorgetfulness used it more frequently than it was prescribed.Conclusion: Use of tramadol in this kind of circumstances requiresthe multidisciplinary approach and cooperation between pain specialist,general practioners, psychiatrist, caregivers, relatives and patients.

494PAIN INTENSITY IN THE ELDERLY: HOW RELIABLE ARECOMMONLY USED TOOLS?

J. Patijn1, I.E. Lame1 °, M.L. Peters2, M. van Kleef1. 1UniversityHospital Maastricht, Pain Management and Research Centre,Maastricht; 2University Maastricht, Department of Medical, Clinical andExperimental Psychology, Maastricht, The Netherlands

Background: We are increasingly confronted with patients with advancedage. Usually pain measurements are used, which has been validated for thepopulation <65 years. Therefore it is important that assessment tools areapplied that are reliable and valid both for younger and elderly patients.Aim of the study: To compare: number of mistakes, validity andpreference of used pain scales in younger and elderly pain patients.Methods: 338 patients of our outdoor clinic were included. Subjectswere subdivided in 6 age groups (each at least 50 subjects) and 5 scaleswere used in counter balanced order (horizontal VAS, vertical VAS, Box-11 scale, Box-21 scale and the 6-point verbal scale). Pain was scoredmomentary and strongest, weakest and average pain of the last week.Results: A significant increase in incorrect responding with advancingage was found and the age effect was independent of the scales used.Incorrect comprehension of scale ordinality also significantly increasedwith age. Construct validity analysis showed that scales loaded on a single“pain intensity” factor. The vertical VAS and the verbal pain scale hadlower loadings on this factor. This pattern was similar for younger andolder patients. Younger patients showed a clear preference for the Box-21.Elderly patients preferred first the verbal pain scale and as second theBox-21.Conclusions: All 5 scales are suitable for both younger and elderlypatients. The Box-21 scale may have some slight advantages over theother scales, while a vertical VAS seems to be the least preferred option.

495THE IMPACT OF LOW BACK PAIN AND AGE ON PHYSICALPERFORMANCE MEASURES IN OLDER ADULTS

T.E. Rudy1 °, S.B. Shenoy2, J. Slaboda3, S.J. Lieber4, D.K. Weiner5.1Anesthesiology & Biostatistics, 2Physical Therapy, 3Bioengineering,4Pain Institute, 5Medicine & Geriatrics, University of Pittsburgh,Pittsburgh, PA, USA

Background and Aims: Chronic low back pain (CLBP) is one of the mostdisabling conditions afflicting older adults. Combined with advancing age,CLBP may lead to even further declines. This study evaluated the effectsof pain and age on measures of physical function in older adults.Methods: Subjects were 323 community dwelling older adults (age 65–84), 160 pain-free and 163 with CLBP. We used 6 measures of physicalfunction that characterize ADLs: lifting, functional reach, chair rise, stairclimbing, gait speed, and seated trunk rotations.Results: CLBP subjects had lower scores on all six measures (P< 0.001).A discriminant function analysis showed trunk rotation, chair rise, andfunctional reach as the three most discriminating measures. Effects sizes(ES) were computed, and ranged from a high of 1.02 for trunk rotationto a low of 0.40 for lifting. Advancing age had an adverse impact on gaitspeed (ES = 0.35), functional reach (ES = 0.32), and stair climb (ES = 0.26).

Young older adults (65–74) with pain performed significantly worse thanthe middle older adults (age 75–84) without pain (P< 0.001).Conclusion: The impact of pain on physical performance was significantlygreater than the impact of chronological age. Thus, functional decrementsassociated with CLBP should be viewed as a target of rehabilitationinstead of a normal part of aging. Future research should evaluate whethertreatment that also targets improvements in functional performance inaddition to pain reduction strategies leads to greater improvements in theoverall quality of life.

496THE ASSESSMENT AND MANAGEMENT OF PAIN IN CAREHOMES: A SYSTEMATIC REVIEW OF THE LITERATURE

P.A. Schofield °, D. Reid. University of Sheffield, School of Nursing &Midwifery, Sheffield, UK

Background: There are increasing numbers of publications that suggestolder people are being neglected in research into pain and as a result oftheir vulnerability, in terms of the high numbers of cognitively impairedresidents in care homes appear to be even more under-represented withinthe literature.Objectives: This paper presents the findings of the first stage of theprogramme which involved a systematic review of the literature.Search Strategy: A number of electronic databases were searched toretrieve information for inclusion in this review. Some papers were handsearched and experts in the field were contacted. Non-English languagereports were not included in the review. Unpublished data were not sought,but some were included.Data Collection and Analysis: Seventy papers were collected for thisreview according to the inclusion/exclusion criteria.Main Results: Seventy papers were therefore included in the review. Fivemain themes were developed from the review. The majority of papers wererelated to the assessment of pain and the development of pain assessmenttools. The other main theme included issues around attitudes and barriersto pain management in the older adult. Fewer studies focussed upon non-pharmacological management and a small number of studies highlightedissues around implementation of guidelines and education to support thisimplementation.Authors Conclusions: A number of conclusions and recommendationsare made regarding further validation of pain assessment tools and the in-troduction of guidelines for pain management which need to be supportedby educational interventions for care home staff.

497AN EXPLORATORY STUDY OF LEG ULCER PAIN IN OLDERPEOPLE

T.M. Taverner °, M. Briggs, S.J. Closs. School of Healthcare Studies, TheUniversity of Leeds, Leeds, UK

Background and Aims: There is evidence to suggest that the majorityof people with leg ulcers have pain [1]. There is little evidence, however,to highlight what this group use to manage their pain. The purpose ofthe study was to investigate the pain experience and pain management forolder people with leg ulcers.Method: A grounded theory method was utilized. Twelve participantswere recruited from Primary Care Trusts in Leeds, UK. Interviews wereaudio-taped and transcribed. Coding of the text was undertaken by twoindependent researchers using NVIVO (qualitative analysis software).Results: Three overarching themes emerged from the data.Pain experienced: Participants used simple analgesics to manage theirpain. None were using drugs to manage neuropathic pain. Participantsdeveloped their own non-pharmacological strategies.Patients and Professionals Attitudes: Healthcare professionals and pa-tients focused predominantly on healing the ulcer. Healthcare professionalsconcentrated on procedural pain during dressing changes but did not appearto acknowledge the persistent nature of the pain.Conclusion: Leg ulcer pain appears to be an unrecognized chronic paincondition with parallel outcomes to other chronic pain conditions e.g.