Pain Management In The Post-Acute And Long-Term Care Setting

Publication Date: November 1, 2012

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

...cognitio...

...pain present?...

...able 1. Some Conditions Associated With the Deve...

...Common Misconceptions Among Patient...


Assessment

...essment...

...ave the characteristics and likely causes of pain...

...cific Signs and Symptoms That May S...


Treatment

Treatment

...ble 4. General Principles for Prescribing An...


...P 3: Provide appropriate interim tre...


...Perform a pertinent history and physical...


...5: Are the cause(s) of pain identifie...


...P 6: Perform further diagnostic testing...


...ave the probable cause(s) of pain be...


...8: Obtain additional evaluation or consul...


...9: Have the probable cause(s) of pain been identif...


...marize the characteristics and causes o...


...a patient-centered interdisciplinary care plan...


...t goals for pain relief...


...Implement the care plan...


...pharmacologic Treatments for PainHaving troub...


...elected Non-Opioid Oral Analgesics U...


...cific Recommendations for Selective...


...Atypical Opioid Oral AnalgesicsHaving trouble vie...


.... Adjuvant Analgesic MedicationsHaving trouble...


...able 10. Topical AnalgesicsHaving troub...


...ble 11. Approximate Equianalgesic Dosin...


...ble 12. General Principles for Prescribing and T...


...d Titration OptionsHaving trouble viewing tab...


.... Model Transdermal Fentanyl Policy...


...done Use in the PA/LTCHaving troubl...


...Medications for Neuropathic PainHaving trouble...


Monitoring

...itoring...

...valuate the patient’s pain...


...5: Adjust treatment as necessary...


...P 16: Is pain controlled?...

...d Alternative MedicineCAM therapies have become...


...tor the facility’s performance i...


...ample Performance Measurement IndicatorsH...