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
...P 1: Is pain present?...
...Some Conditions Associated With the Developmen...
...on Misconceptions Among Patients and Caregivers...
Assessment
...sessmen...
...Have the characteristics and likely causes...
...nspecific Signs and Symptoms That May...
Treatment
Treatme...
...4. General Principles for Prescribing Anal...
...ovide appropriate interim treatment for pai...
...4: Perform a pertinent history and...
...cause(s) of pain identified?...
...further diagnostic testing, as indicated...
...ve the probable cause(s) of pain been identified?...
...tain additional evaluation or consultation as nece...
...Have the probable cause(s) of pain been identifi...
...Summarize the characteristics and causes...
...: Adopt a patient-centered interdisciplinary...
...TEP 12: Set goals for pain relief...
...ement the care plan...
...harmacologic Treatments for PainHaving trouble v...
...ble 6. Selected Non-Opioid Oral Analgesics Used...
...ic Recommendations for Selective and Non...
...8. Atypical Opioid Oral Analgesics...
...Adjuvant Analgesic MedicationsHaving tr...
...e 10. Topical AnalgesicsHaving troub...
...ble 11. Approximate Equianalgesic Do...
...eneral Principles for Prescribing an...
...able 13. Opioid Titration OptionsHaving trouble...
Table 14. Model Transdermal Fentanyl Po...
...ethadone Use in the PA/LTCHaving trouble viewing t...
Table 16. Medications for Neuropathic PainH...
Monitoring
...nitorin...
...Reevaluate the patient’s pain...
...just treatment as necessary...
...pain controlled?...
...and Alternative MedicineCAM therap...
...17: Monitor the facility’s performance in the...
...7. Sample Performance Measurement IndicatorsHa...