More than half of nursing home residents suffer from chronic pain1, yet multiple studies indicate it remains largely undertreated2.
The reasons are multifactorial and complex. Challenges include: identifying if residents are experiencing pain, identifying the source and severity of pain and identifying the risks and benefits associated with the use of many medications used in pain management.
“Pain management has traditionally been a challenge in all fields of medicine because there’s not really a clear way to measure pain,” says Dr. Karl Dauphinais, medical director for Optum in Connecticut and Rhode Island and a specialist in complex care management.
“There is a lot of subjective variability and many factors that come into play,” he says. “In senior communities, particularly in nursing homes, there are additional complexities — from residents living with cognitive impairments and communication limitations to access to diagnostic and specialty services.”
Making sure pain is properly evaluated and treated requires a coordinated and personalized approach involving each resident’s doctors, specialists, therapists, nursing center staff and family. How it impacts mental health must also be monitored, as chronic pain can lead to depression and anxiety, which can exacerbate the expression of pain, creating a vicious cycle.
Here is a look at four steps operators can take to best address pain management.
Step 1: Identify the pain, understand the individual
“The first challenge is actually identifying the pain appropriately and identifying what’s causing the pain,” Dauphinais says.
But many nursing home residents have trouble describing or communicating their pain.
That’s why getting to know each individual, their unique health challenges and their personal care goals is key.
“Nursing home residents may also be non-verbal,” he says. “The better you know your patients the easier it is to detect signs of pain, such as grimacing, limping, a decline in activities, changes in appetite and disturbed sleep, to name a few.”
Step 2: Determine the appropriate treatment plan
Because so many SNF residents struggle with chronic conditions, choosing the appropriate treatment plan is complicated.
“The first step, of course, is communication,” Dauphinais said. “There is no one-size-fits all approach.”
Treatment plans can involve a variety of options, from pain relievers to topical medications, therapy, stretching, massage and splints and compression.
And when medication is part of the plan, it’s important to carefully consider all the side effects.
Step 3: Understand when, and how, to employ opioids
The increased scrutiny on opioid prescriptions has increased hesitancy to prescribe these pain-blocking medications. It has led to what Dauphinais calls, “an unfortunate belief by some that all opioids are bad. It’s a medication to use at certain times when the pain otherwise can’t be controlled.”
Because the risks include lethargy, confusion, falls, even respiratory depression and death, understanding when to use opioids is challenging.
Before prescribing opioids, it’s important to carefully assess each resident’s pain and the potential benefits and risks, Dauphinias says.
Step 4: Teamwork key to effective, personalized pain management
Unfortunately, chronic pain doesn’t just go away. It needs to be constantly monitored, with treatment options revisited when necessary, to ensure the best possible quality of life for residents.
“Most chronic pain will never be under perfect control,” Dauphinais says. “The idea is to bring it down to a level that is manageable, to ensure that someone can function throughout the day as best as possible without putting them at higher risk. So, we’re balancing the benefits and the risks all the time.”
Coordination and communication are at the heart of the Optum approach to pain management, and the Optum care model overall.
Optum clinicians work closely with onsite therapists, nurses and nurse’s aides to help them decipher whether changes in patient behavior — from moaning to needing more support in a wheelchair to suddenly needing more assistance with transfers — is the result of a new condition or worsening pain.
“They work together as a team to get the right care for the individuals,” Dauphinais says. “Having our clinician act as the point person for the care coordination makes a tremendous difference in ensuring they are getting the best possible care.”
This article is sponsored by Optum. To learn more about the Optum care model approach to pain management, visit optum.com/painmanagement.
Sources:
[1] Prevalence and Factors Associated with Pain in Nursing Home Residents: A Systematic Review of the Literature https://pubmed.ncbi.nlm.nih.gov/36162443/
[2] Pain Management Among Nursing Home Residents Before and After COVID-19: A Systematic Review https://www.jamda.com/article/S1525-8610(22)00064-0/fulltext; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435509/
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