Title

Pain Management In The Post-Acute And Long-Term Care Setting

Authoring Organization

Post-Acute and Long-Term Care Medical Association

Publication Month/Year

November 1, 2012

Last Updated Month/Year

October 17, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This Pain Management CPG is not only about pain treatment but also about addressing the many questions and issues that influence—and are  influenced by—pain management (e.g., patients with limited cognition and verbal communication, survey-related issues, opioid diversion, substance use disorders).

Target Patient Population

Patients in the post-acute and long-term care (PALTC) setting

Target Provider Population

Medical director, attending physicians, advanced practice clinicians, director of nursing, nursing staff, pharmacist, therapists, social workers, dietitians, and nursing assistants

PICO Questions

  1. What is pain?

  2. What is the prevalence of pain and conditions that predispose to pain?

  3. What are some common challenges in managing pain?

  4. What preparation/systems/processes does a facility need to support effective pain management?

  5. When should routine and interim screening for pain be performed?

  6. What are key elements of a medical practitioner/nurse assessment for pain?

  7. How should we define and characterize an individual’s pain?

  8. What are key aspects of documentation related to pain?

  9. What are key elements of a physical assessment related to pain?

  10. What are key considerations in diagnosing causes of pain?

  11. What are key concepts and vocabulary related to discussing and managing pain?

  12. What factors influence a pain management plan?

  13. What are additional considerations for pain management in specific situations?

  14. What are general considerations for prescribing analgesics?

  15. What are the approaches to prescribing and administering as needed and standing doses of analgesics?

  16. What are the pharmacological options for managing pain?

  17. What are the indications, specific considerations, and challenges related to opioid analgesics?

  18. When is a pain consultation indicated in managing pain, and how should the staff and practitioners interact with pain consultants?

  19. What is the role of hospice in managing pain, and how should facilities and practitioners interact with hospice providers?

  20. What should be monitored regarding pain and how should it be done?

  21. How should decisions be made about changing, adding, or stopping analgesics?

  22. How should a facility oversee and review its pain management approaches, including the use of opioids to treat pain?

  23. How should a facility monitor for and address issues of opioid-related disorders in patients?

  24. How should a facility monitor for and address issues of drug diversion among staff, residents, and others?

  25. How should facilities and practitioners take into account nursing home regulations and surveys in managing pain?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Long term care

Intended Users

Nurse, nurse practitioner, physician, physician assistant, social worker

Scope

Management

Keywords

Pain Management

Methodology

Number of Source Documents
39
Literature Search Start Date
January 1, 2003
Literature Search End Date
December 31, 2015
Description of External Review Process
37 organizations and patient representatives participated in peer review process
Description of Public Comment Process
37 organizations and patient representatives participated
Specialties Involved
Geriatric Medicine, Pain Medicine, Post Acute And Long Term Care
Description of Systematic Review
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List of Questions
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Description of Study Criteria
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Description of Search Strategy
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Description of Study Selection
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Description of Evidence Analysis Methods
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Description of Evidence Grading
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Description of Recommendation Grading
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Description of Funding Source
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Company/Author Disclosures
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