Pain Management In The Post-Acute And Long-Term Care Setting
Key Points
Key Points
- Acute and chronic pain are common in the post-acute and long-term care (PA/LTC) setting, and they affect measures of patients’ wellbeing such as mood and the ability to perform activities of daily living. As many as 80% of LTC patients have at least one condition associated with pain.
- Persistent pain or its inadequate treatment is associated with many adverse outcomes in older people.
- Pain is frequently undertreated in cognitively impaired patients. Patients with cognitive impairment often manifest pain with nonverbal signs such as grimacing or furrowing their brow.
- Pain management should be considered a patient’s right in the LTC setting.
- Opioids should be used judiciously, taking into account the risks vs. benefits, goals of care and the pain's impact on the patient's functional ability.
- This pocket guide is primarily about acute and chronic pain (management might be somehow different for patients on Palliative Care/Comfort Measures Only, with less focus on monitoring of adverse effects).
- Given the heterogeneous patient population in the PA/LTC setting, from acute postoperative pain to the frail and imminently dying, various state and federal regulations and the current "opioid crisis," optimal pain management in this setting is often challenging.
Recognition
Recognit...
...ain present?...
...1. Some Conditions Associated With the Dev...
...on Misconceptions Among Patients and...
Assessment
...ssessment...
...EP 2: Have the characteristics and likely causes...
...onspecific Signs and Symptoms That...
Treatment
Treatme...
Table 4. General Principles for Prescribi...
...TEP 3: Provide appropriate interim...
STEP 4: Perform a pertinent history...
...e cause(s) of pain identified?...
STEP 6: Perform further diagnostic testing, as in...
...P 7: Have the probable cause(s) of pain been id...
...in additional evaluation or consultation...
...Have the probable cause(s) of pain been i...
...mmarize the characteristics and causes of the pat...
...: Adopt a patient-centered interdisciplinary...
...als for pain relief...
...13: Implement the care plan...
...Nonpharmacologic Treatments for PainHaving trouble...
...ted Non-Opioid Oral Analgesics Use...
...fic Recommendations for Selective and Nons...
...cal Opioid Oral AnalgesicsHaving trouble...
...9. Adjuvant Analgesic MedicationsHaving trou...
...0. Topical AnalgesicsHaving trouble vie...
...proximate Equianalgesic Dosing and Usual Sta...
Table 12. General Principles for Presc...
Table 13. Opioid Titration OptionsHav...
...Model Transdermal Fentanyl PolicyHaving trou...
...5. Methadone Use in the PA/LTCHaving trou...
...cations for Neuropathic PainHaving tro...
Monitoring
Monitoring
...TEP 14: Reevaluate the patient’s pain...
...ust treatment as necessary...
...: Is pain controlled?...
...entary and Alternative MedicineCAM th...
...tor the facility’s performance in the mana...
...7. Sample Performance Measurement...