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
Recognitio...
...1: Is pain present?...
...ble 1. Some Conditions Associated With the...
...on Misconceptions Among Patients and Caregivers A...
Assessment
...essment
...Have the characteristics and likely c...
...onspecific Signs and Symptoms That M...
Treatment
...atment
...eneral Principles for Prescribing A...
...TEP 3: Provide appropriate interim tr...
...P 4: Perform a pertinent history and physical exa...
...the cause(s) of pain identified?...
...6: Perform further diagnostic testing, as indicat...
...e the probable cause(s) of pain been identified?...
...: Obtain additional evaluation or co...
...the probable cause(s) of pain been ident...
...: Summarize the characteristics an...
...a patient-centered interdisciplina...
...12: Set goals for pain relief...
...: Implement the care plan...
...Nonpharmacologic Treatments for PainHaving troub...
...ed Non-Opioid Oral Analgesics Used in the PA/LTCH...
...fic Recommendations for Selective and Nonse...
Table 8. Atypical Opioid Oral Analges...
...uvant Analgesic MedicationsHaving trouble vie...
...l AnalgesicsHaving trouble viewing table? Expand...
...able 11. Approximate Equianalgesic Dosing and U...
...le 12. General Principles for Prescribing and...
...Opioid Titration OptionsHaving trouble viewing ta...
...Transdermal Fentanyl PolicyHaving...
...5. Methadone Use in the PA/LTCHaving trou...
...Medications for Neuropathic PainHaving trouble v...
Monitoring
...itoring...
...4: Reevaluate the patient’s pain...
...st treatment as necessary...
...P 16: Is pain controlled?...
...and Alternative MedicineCAM therapies ha...
...EP 17: Monitor the facility’s perfor...
...7. Sample Performance Measurement...