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
...ecogniti...
...s pain present?...
.... Some Conditions Associated With the Develop...
...ommon Misconceptions Among Patients and Caregi...
Assessment
Assessm...
...: Have the characteristics and likely causes o...
...3. Nonspecific Signs and Symptoms...
Treatment
Treatme...
...e 4. General Principles for Prescr...
...3: Provide appropriate interim treatment f...
...a pertinent history and physical exam...
...: Are the cause(s) of pain identified?...
...m further diagnostic testing, as indicated...
...7: Have the probable cause(s) of pain been id...
...P 8: Obtain additional evaluation or consu...
...Have the probable cause(s) of pain...
...ize the characteristics and causes of the...
...a patient-centered interdisciplinary...
...: Set goals for pain relief...
...13: Implement the care plan...
...npharmacologic Treatments for PainHavi...
.... Selected Non-Opioid Oral Analgesics Use...
...fic Recommendations for Selective...
...typical Opioid Oral AnalgesicsHaving trouble v...
Table 9. Adjuvant Analgesic MedicationsHaving trou...
...e 10. Topical AnalgesicsHaving tro...
...Approximate Equianalgesic Dosing and Usu...
...General Principles for Prescribing and Titrat...
...able 13. Opioid Titration OptionsHaving tro...
...el Transdermal Fentanyl PolicyHaving trouble...
...Methadone Use in the PA/LTCHaving trouble viewin...
...edications for Neuropathic PainHaving trouble vie...
Monitoring
...onitoring...
...eevaluate the patient’s pain...
...treatment as necessary...
...s pain controlled?...
...ry and Alternative MedicineCAM therapies have b...
...17: Monitor the facility’s perform...
...ample Performance Measurement IndicatorsHaving t...