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
...ecogniti...
...EP 1: Is pain present?...
...le 1. Some Conditions Associated With the Deve...
...le 2. Common Misconceptions Among Patien...
Assessment
...ssessment
...Have the characteristics and likely causes o...
...ble 3. Nonspecific Signs and Symptoms That...
Treatment
...reatmen...
...neral Principles for Prescribing Analgesic...
...ide appropriate interim treatment for pa...
...m a pertinent history and physical e...
...: Are the cause(s) of pain identified?...
...rm further diagnostic testing, as indicated...
...e probable cause(s) of pain been ide...
...8: Obtain additional evaluation or cons...
...e the probable cause(s) of pain been identified?...
...: Summarize the characteristics and causes of the...
...a patient-centered interdisciplinary care...
...12: Set goals for pain relief...
...: Implement the care plan...
...5. Nonpharmacologic Treatments for PainHaving...
...ed Non-Opioid Oral Analgesics Used in the PA/...
...le 7. Specific Recommendations for Selec...
...able 8. Atypical Opioid Oral Analgesi...
...juvant Analgesic MedicationsHaving...
...10. Topical AnalgesicsHaving trouble viewi...
...proximate Equianalgesic Dosing and Usual Starti...
...e 12. General Principles for Presc...
...able 13. Opioid Titration OptionsHav...
...14. Model Transdermal Fentanyl Polic...
...15. Methadone Use in the PA/LTCHav...
...edications for Neuropathic PainHavi...
Monitoring
Monitor...
...Reevaluate the patient’s pain...
...Adjust treatment as necessary...
...n controlled?...
...plementary and Alternative MedicineCAM therapi...
...the facility’s performance in the managemen...
...able 17. Sample Performance Measurement Indicat...