IMPLEMENTATION OF PAIN SCALE USE IN PEOPLE WITH INTELLECTUAL DISABILITIES IN CLINICAL PRACTICE: A POST-STUDY FOLLOW-UP

Abstract

Assessing pain in people with intellectual disabilities (PWID), particularly those with multiple sensory and motor impairments, is a complex clinical challenge often overlooked, leading to the risk of underestimating pain. The Serafico Institute in Assisi investigated pain assessment in this population using the revised Face, Legs, Activity, Cry, Consolability (R-FLACC) scale and self-report tools. This follow-up study examined the reporting of unexplained behavioral changes and the use of pain scales in routine clinical practice one year after the initial research. A total of 110 participants (72% male; mean age 27 years, range 2-54) were enrolled, including 27 children (25%) and 83 adults (75%). Over seven months, 252 episodes of unexplained behavioral changes were recorded: 227 (90%) assessed with R-FLACC and 25 (10%) via self-report. Of these, 148 (59%) were classified as pain-related, 83 (33%) as distress episodes, and 21 (7%) remained unexplained. The number of episodes reported and consistent use of pain scales, indicate heightened awareness among healthcare and educational staff towards unexplained behaviors that might signal pain, prompting appropriate evaluation and treatment. Pain assessment has now become an integral component of Serafico Institute's clinical practice and operational guidelines for PWID.

Keywords: assessment; behavior; complex; disabilities; distress; pain.