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
...ognition...
...TEP 1: Is pain present?...
...1. Some Conditions Associated With the D...
...able 2. Common Misconceptions Among Patient...
Assessment
...sessment...
STEP 2: Have the characteristics and likely causes...
...ific Signs and Symptoms That May Suggest...
Treatment
...reatment...
...Principles for Prescribing Analgesics in th...
...P 3: Provide appropriate interim treatment for p...
STEP 4: Perform a pertinent history and phys...
...Are the cause(s) of pain identified?...
...orm further diagnostic testing, as in...
...Have the probable cause(s) of pain be...
...btain additional evaluation or consultation as n...
...P 9: Have the probable cause(s) of pain been id...
...0: Summarize the characteristics and cau...
...TEP 11: Adopt a patient-centered interdisciplina...
...P 12: Set goals for pain relief...
...ment the care plan...
...able 5. Nonpharmacologic Treatments...
...Selected Non-Opioid Oral Analgesics Used in the P...
Table 7. Specific Recommendations for Selective...
...8. Atypical Opioid Oral AnalgesicsHaving trouble...
...ant Analgesic MedicationsHaving trouble vie...
...opical AnalgesicsHaving trouble viewing table? Ex...
...imate Equianalgesic Dosing and Usual Sta...
...eral Principles for Prescribing and Titrating Op...
...d Titration OptionsHaving trouble vi...
...able 14. Model Transdermal Fentanyl PolicyH...
...15. Methadone Use in the PA/LTCHavin...
...edications for Neuropathic PainHaving trouble...
Monitoring
...nitoring
...eevaluate the patient’s pain...
...Adjust treatment as necessary...
...pain controlled?...
...ry and Alternative MedicineCAM therapies have b...
...r the facility’s performance in the managemen...
Table 17. Sample Performance Measurement I...