A conceptual model for assessing the risk of unidentified pain

• Published in: The journal of pain Vol. 27; p. 104722
• Main Authors: Boon, Jeffrey T., Failla, Michelle D., Anderson, Alison R., Melnyk, Bernadette M., Bruehl, Stephen, Von Ah, Diane, Muench, Ulrike, McElfresh, Jessica, Carter, Michael, Monroe, Todd B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2025
• Subjects: Conceptual model; Humans; Integrative review; Models, Theoretical; Pain; Pain - diagnosis; Pain - psychology; Pain Measurement; Risk Assessment; Unidentified pain; Unidentified pain risk; Integrative review; Pain; Unidentified pain risk; Conceptual model; Unidentified pain
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2024.104722

Untreated or undertreated pain is well established as a significant problem, but unidentified pain is a distinct construct that still needs to be clearly modeled or fully described. This paper aims to develop a conceptual model of unidentified pain in humans with the goal of future development of an unidentified pain risk tool. A multi-phase process was employed consisting sequentially of 1) brainstorming followed by consensus building, 2) peer-review and publication of an integrative theoretical review protocol for “unidentified pain,” 3) conduct of the integrative review, and 4) a repeated brainstorming session to identify areas of risk for unidentified pain to produce a conceptual model. Brainstorming led to a consensus on “unidentified pain” as the concept of interest, followed by developing a review protocol. Twenty-four abstracts were reviewed after database searches, and four articles were included for full-text review. Three pain risk areas (hazards) were identified: cognition/communication problems, being alone or in the absence of a surrogate/proxy report, and the presence of known painful conditions or treatments and a conceptual model was developed. The hazards are posited to have the potential to both interact and be cumulative, increasing the risk for unidentified pain. There is currently no risk tool for assessing unidentified pain. The development of this conceptual model will be used for future development and psychometric testing of a tool to recognize the risk for unidentified pain in humans. This focus article describes the development a conceptual model for the concept of unidentified pain in humans. This pain may occur in individuals who experience one or more interactive and cumulative hazards: cognition/communication problems, being alone, absence of a surrogate/proxy report, or presence of known painful conditions or treatments. ●Some individuals may be unable to report their pain and alert healthcare providers to intervene.●A structured literature review suggests no current theoretical model for assessing unidentified pain.●A conceptual model of unidentified pain risk could assist clinicians in recognizing unidentified pain.●Recognizing unidentified pain is likely to enhance the management of untreated pain.