Dr. Sandy LeFort has spent more than 25 years studying how people experience pain, and how to better assess and manage it.

A faculty member and researcher at Memorial University’s School of Nursing since 1995, she has presented at world-wide conferences on the subject, written articles, papers, even developed a patient education program. As such, she is considered an expert in the field.

But just a few months ago, Dr. LeFort was asked to collaborate on an area of pain research that was completely new for her: How do you assess pain in people who are deaf, and use sign language to communicate?

Surprisingly, there is very little research available on the subject.

“This is a whole new world we haven’t really explored,” said Dr. LeFort, who was invited to research the subject by Dr. Victor Maddalena, of the Faculty of Medicine’s Division of Community Health, and Myles Murphy, executive director of the Newfoundland and Labrador Association for the Deaf (NLAD). The two had been studying palliative care in the deaf community, and pain assessment was identified as a key issue.

“Nurses are asking people about pain all the time,” said Dr. LeFort. “But we’ll have a hard time assessing pain and providing treatment if there is a communication barrier.”

A literature review confirmed the lack of research in this area; Drs. LeFort and Maddalena discovered only one article about an Italian research project on pain assessment of people who are deaf.

Working with Mr. Murphy, who has been a voice and an advocate for the deaf community for many years, they created focus groups among the NLAD membership.

“Hearing people rely on voice, intonation − the doctor can hear the anger and frustration,” said Mr. Murphy, speaking through American Sign Language interpreter Sheila Keats. “Always the hardest question to respond to is, ‘How bad is your pain? Describe your pain.’ A deaf person can’t hear so they have to use their eye; the visual cues are the ones you are trying to pick up.”

The team made several key findings. The importance of the presence of both American Sign Language and deaf interpreters at health care visits was confirmed, and that pain visual analogue scales with 1-10 rankings can be useful but must be easy to read and understand.  Photos or drawings depicting facial expressions were also deemed potentially useful as a pain assessment tool.

The research team plans a second phase of the project to delve further into their findings, and develop tools that will be useful for the deaf community and for health care practitioners.

“It’s the beginning of an important area of research,” said Dr. LeFort, “and a wonderful partnership with the deaf community.”