Chronic Pain: What Reduces Residents’ Pain?
01 Nov Chronic Pain: What Reduces Residents’ Pain?
More than half of nursing home residents experience chronic pain. Many conditions can cause people to have pain and pain-related diagnoses such as arthritis are very common in older populations. Multiple studies have shown that pain is likely under-reported, due to challenges in consistent identification of pain due to dementia. To treat pain, we often rely on medications, as well as non-pharmacologic approaches. Medications are the mainstay of treatment but many, such as opioids, carry risks as well.
Key Takeaways
More than half of all nursing home residence experience chronic pain
Chronic pain impacts resident quality of life
Chronic pain medications work and should be used in conjunction with education
Accurately documenting baseline and follow up pain scores is critical to treating chronic pain effectively
Chronic pain is a major issue for nursing home residents. While the healthy aging process can include conditions that lead to pain such as arthritis, chronic pain can also be debilitating in a residential setting. For example, residents with chronic pain may lose out on social activities or activities of daily living, leading to isolation and depression.
A recent meta-analysis of clinical trials to treat pain in nursing homes was recently published by researchers at Athabasca University and the University of Alberta. The researchers found, perhaps not surprisingly, that pain medications worked the best to reduce pain. They also found that there was evidence that non-pharmacologic treatments worked and some improvements with education programs. They did not find positive results for medication treatments that are non-analgesic, although some of the medications tested are not commonly used for pain in the United States. In practice, the use of non-analgesic medications to treat pain are usually added on to supplement usual pain medications, e.g.-some anti-depressants are used as an adjunct treatment. Interventions that took a combination approach showed promise as well. There are many non-pharmacologic approaches to treating pain, such as positioning, that we often use and were not tested here. This analysis only included clinical trials of non-pharmacologic interventions and those were exercise, acupressure, and humor therapy.
Clinical trials are expensive and difficult to do and meta-analyses can be useful to provide the “big picture” by pooling data from many trials. There is, of course, important variation among studies to consider. In this meta-analysis, trials were done in different countries, with differing lengths of follow up, for example. There are some useful takeaways from this work, primarily that pain medications work and there are other impactful strategies as well. Pain impacts day to day quality of life and function and thus attention to pain management is critical when caring for nursing home residents. We should use pain medications and document response to treatment so we can use the lowest effective doses. When the current care plan is not working for a patient, we need to reach into our toolbox to add on or switch therapies. There are no quick fixes for chronic pain, but there are strategies to manage it.
References
E Sirsch, A Lukas, C Drebenstedt, et al. Pain assessment for older persons in nursing home care: an evidence-based practice guideline J Am Med Dir Assoc, 21 (2) (2020), pp. 149-163, 10.1016/j.jamda.2019.08.002
2020/02/01/
Knopp-Sihota JA, MacGregor T, et al. Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis. 2022 JAMDA 23(9):1507-1516.
Miu DKY, Chan KC. Under-detection of pain in elderly nursing home residents with moderate to severe dementia. J Clin Gerontol Geriatr, 5 (2014), pp. 23-27
Osmancevic S, Bauer S. Pain and its associated factors in nursing home residents. Geriatr Nurs. 2022 Sep-Oct;47:13-17. doi: 10.1016/j.gerinurse.2022.06.005. Epub 2022 Jun 29. PMID: 35779377.
Y Takai, N Yamamoto-Mitani, Y Okamoto, K Koyama, A. Honda Literature review of pain prevalence among older residents of nursing homes Pain Manag Nurs, 11 (4) (Dec 2010), pp. 209-223, 10.1016/j.pmn.2010.08.006
