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Pain Assessment and Management in the Long-Term Care Setting

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Abstract

The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings.

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REFERENCES

  1. Gagliese L, Melzack R. Chronic pain in elderly people, Pain 1997; 70: 3–14.

    Google Scholar 

  2. Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients, Journal of Pain and Symptom Management 1995; 10: 591–598.

    Google Scholar 

  3. Ferrell BR, Rhiner M. High-tech comfort: Ethical issues in cancer pain management for the 1990s, Journal of Clinical Ethics 1991; 2: 208–112.

    Google Scholar 

  4. Ferrell BA. Pain evaluation and management in the nursing home. Ann Int Med 1995; 123: 681–687.

    Google Scholar 

  5. Ferrell BA. Pain management in elderly people, Journal of American Geriatric Society 1991; 39: 64–73.

    Google Scholar 

  6. Ferrell BA. Pain evaluation and management in the nursing home. Ann Int Med 1995; 123: 681–687.

    Google Scholar 

  7. Myers JS. Cancer pain: Assessment of nurses' knowledge and attitudes, Oncology Nursing Forum 1985; 12: 62–66.

    Google Scholar 

  8. Hurley AC, Volicer BJ, Hanrahan PA, Houde S, Volicer L. Assessment of discomfort in advanced Alzheimer patients, Research in Nursing & Health 1992; 15: 369–377.

    Google Scholar 

  9. Herr KA, Mobily PR. Complexities of pain assessment in the elderly, J Gerontological Nursing 1991; 17: 12–19.

    Google Scholar 

  10. The National Council on the Aging. The study of pain and older Americans, New York: Louis Harris and Associates, Inc., 1997.

    Google Scholar 

  11. Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home, Journal of the American Geriatrics Society 1990; 38: 409–414.

    Google Scholar 

  12. Parke B. Pain in the cognitively impaired elderly, The Canadian Nurse 1992; 88: 17–20.

    Google Scholar 

  13. Hitchcock LS, Ferrell BR, McCaffery M. The experience of chronic nonmalignant pain, Journal Of Pain and Symptom Management 1994; 9: 312–318.

    Google Scholar 

  14. McCaffery M, Ferrell BR. Patient age: Does it affect your pain-control decisions? Nursing91, 1991; 21: 44–48.

    Google Scholar 

  15. Pain in demented and elderly patients: Is it unspoken and untreated? Medical Ethics Advisor 1995, July; 11: 85–88.

    Google Scholar 

  16. Farrell MJ, Katz V, Helme RD. The impact of dementia on the pain experience, Pain 1996; 67: 7–15.

    Google Scholar 

  17. Parmelee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents, Journal of the American Geriatrics Society 1993; 41: 517–522.

    Google Scholar 

  18. McCaffery, M. Pain Control: Barriers to the use of available information, CANCER 1992; 70: 1438–1449.

    Google Scholar 

  19. McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. St. Louis: The C.V. Mosby Company, 1989.

    Google Scholar 

  20. Friedman FB. PRN analgesics: Controlling the pain or controlling the patient? RN 1983, March; 67, 70, 72, 74, 76, & 78.

  21. Hackett TP. Pain and prejudice: Why do we doubt that the patient is in pain? Medical Times, 1971; 99: 130–141.

    Google Scholar 

  22. Faries JE, Mills DS, Goldsmith KW, Phillips KD, Orr J. Systematic pain records and their impact on pain control, Cancer Nursing 1991; 14: 306–313.

    Google Scholar 

  23. Meinhart NT, McCaffery M. Pain, A Nursing Approach to Assessment and Analysis. Norwalk, Connecticut: Appleton-Century-Crofts, 1983.

    Google Scholar 

  24. Teske K, Daut RL, Cleeland CS. Relationships between nurses' observations and patients' self-reports of pain, Pain 1983; 16: 289–296.

    Google Scholar 

  25. Porter FL, Malhotra KM, Wolf CM, Morris JC, Miller JP, Smith MC. Dementia and response to pain in the elderly, Pain 1996; 68: 413–421.

    Google Scholar 

  26. Ferrell BA, Ferrell BR. Assessment of chronic pain in the elderly: The Sepulveda GRECC Method No. 40, Geriatric Medicine Today 1989; 8: 123–134.

    Google Scholar 

  27. Marzinski LR. The tragedy of dementia: Clinically assessing pain in the confused nonverbal elderly, Journal of Gerontological Nursing 1991; 17: 25–28.

    Google Scholar 

  28. Acute Pain Management Guideline Panel. ACUTE PAIN MANAGEMENT: OPERATIVE OR MEDICAL PROCEDURES AND TRAUMA CLINICAL PRACTICE GUIDELINE. AHCPR Publication No. 92-0032. Rockville, MD. Agency for Health Care Policy and Research, US Department of Health and Human Services, Public Health Service, 1992.

  29. Jacox A, Carr DB, Payne R, et al. MANAGEMENT OF CANCER PAIN. CLINICAL PRACTICE GUIDELINE NO. 9. AHCPR Publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994.

    Google Scholar 

  30. Weissman D, Dinndorf P, Dahl J eds., HANDBOOK OF CANCER PAIN MANAGEMENT, 5th Edition. Wisconsin Cancer Pain Initiative, Madison Wisconsin, 1996.

  31. Beaver WT. Impact of non-narcotic oral analgesics on pain management. Am J Med 1988; 84: 3–15.

    Google Scholar 

  32. Portenoy RK, Foley KM, Stulman J, Kahn E, Adelhardt J, Layman M, Cerbone DF, Inturrisi CE: Plasma morphine and morphine-6-glucuronide during chronic morphine therapy for cancer pain: plasma profiles, steady-state concentrations and the consequences of renal failure. Pain 1991; 47: 13–19.

    Google Scholar 

  33. Payne R: Transdermal Fentanyl: Suggested Recommendations for Clinical Use. J Pain Symptom Manage 1992; 7: S40–S43.

    Google Scholar 

  34. Portenoy RK: Continuous infusion of opioid drugs in the treatment of cancer pain: guidelines for use. J. Pain Symptom Manage 1986; 1: 223–228.

    Google Scholar 

  35. Bruera E, Brenneis C, Michaud M et al: Use of subcutaneous route for the administration of narcotics in patients with cancer pain. Cancer 1988; 62: 407–411.

    Google Scholar 

  36. Bruera E, Brenneis C, Paterson AH et al: Use of methylphenidate as an adjuvant to narcotic analgesics in patients with advanced cancer. J Pain Symptom Management 1989; 4: 3–6.

    Google Scholar 

  37. Foley KM: Controversies in cancer pain: Medical perspectives. Cancer 1989; 63: 2257–2265.

    Google Scholar 

  38. Porter J, Jick H: Addiction rate in patients treated with narcotics (letter). New Engl. J Med 1980; 302: 123.

    Google Scholar 

  39. Max MB, Culname M, Schafer SC et al: Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology 1987; 37: 589–594.

    Google Scholar 

  40. Spiegel K, Kalb R, Paternak GW: Analgesic activity of tricyclic antidepressants. Ann Neurol 1983; 13: 462–465.

    Google Scholar 

  41. Max MB, Lynch SA, Muir J, Shoar SE. et al. Effects of desipramine, amitryiptyline and fluoxitine on pain in diabetic neuropathy. NEJM 1992; 326: 1250–1256.

    Google Scholar 

  42. Fisher K and McPherson ML. Gabapentin. American Journal of Hospice and Palliative Care 1997; 14: 311–312.

    Google Scholar 

  43. Galer BS. Neuropathic pain of peripheral origin: advances in pharmacologic treatment. Neurology 1995; 45 (sup): S17–S25.

    Google Scholar 

  44. Swerdlow M: Anticonvulsant drugs and chronic pain. Clin Neuropharmacol 1984; 7: 51–82.

    Google Scholar 

  45. Weinberger J, Nicklas WJ, Beri S: Mechanism of action of anticonvulsants, Neurology 1976; 26: 162–173.

    Google Scholar 

  46. Weissman D, Duffer D, Vogel V et al: Corticosteroid toxicity in neuro-oncology patients. J Neurooncology 1987; 5: 125–128.

    Google Scholar 

  47. Thorsteinsson G. Chronic pain: use of TENS in the elderly. Geriatrics 1987; 42: 75–82.

    Google Scholar 

  48. Max MB. Improving outcomes in analgesic treatment: is education enough? Ann Intern Med 1990; 13: 885–889.

    Google Scholar 

  49. Weissman DE, Griffie J, Gordon DB, Dahl JL. A role model program to promote institutional changes for management of acute and cancer pain. J Pain Symptom Manage 1997; 14: 274–279.

    Google Scholar 

  50. Bookbinder M, Coyle, N, Kiss M, Goldstein ML, et al. Implementing national standards for cancer pain management: program model and evaluation. J Pain Symptom Manage 1996; 12: 334–347.

    Google Scholar 

  51. Weissman DE. Educating home health professionals in cancer pain management. Home Health Care Consultant 1995; 2: 10–18.

    Google Scholar 

  52. Ferrell BR, Dean GE, Grant M and Coluzzi P. An institutional commitment to pain management. J Clin Oncol 1995; 13: 2158–2165.

    Google Scholar 

  53. Gordon, DB, Dahl JL and Stevenson KK (eds). BUILDING AN INSTITUTIONAL COMMITMENT TO PAIN MANAGEMENT. Wisconsin Cancer Pain Initiative, Madison, WI, 1996.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226-0509, USA

    David E. Weissman

  2. Lakeland Nursing Home, Elkhorn, WI, 53121-4361, USA

    Sandra Matson

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  1. David E. Weissman
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  2. Sandra Matson
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Weissman, D.E., Matson, S. Pain Assessment and Management in the Long-Term Care Setting. Theor Med Bioeth 20, 31–43 (1999). https://doi.org/10.1023/A:1009923907285

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