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
...Recognition...
...STEP 1:...
.... Some Conditions Associated With the Devel...
...able 2. Common Misconceptions Among Patient...
Assessment
...STEP 2: H...
Table 3. Nonspecific Signs and Sym...
Treatment
...Treatment...
...neral Principles for Prescribing Analgesic...
...STEP 3: Provi...
...STEP 5: Are the c...
...STEP 6: Perf...
...STEP...
...S...
...STEP 9: Have the...
...STEP 10: Summari...
...STEP 11:...
...STEP 12: Set g...
...STEP...
.... Nonpharmacologic Treatments for Pain...
.... Selected Non-Opioid Oral Analgesics Used...
...ific Recommendations for Selective and No...
...typical Opioid Oral Analgesics...
...t Analgesic Medications Examples/Do...
...e 10. Topical Analgesics Agen...
.... Approximate Equianalgesic Dosing and Usu...
...eral Principles for Prescribing and Titratin...
...ioid Titration OptionsDuring the titra...
...able 14. Model Transdermal Fentanyl P...
...hadone Use in the PA/LTCCautions and C...
Table 16. Medications for Neuropathic Pai...
Monitoring
...STEP 14: Reeva...
STEP 15: Ad...
...STEP 16: Is pain co...
...omplementary and Alternative MedicineCAM the...
...STEP 17: Moni...
...able 17. Sample Performance Measure...