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

Last updated May 24, 2022

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: Is pain pre...

Table 1. Some Conditions Associated With the...

...e 2. Common Misconceptions Among Patients and C...


Assessment

...Assessment...

...STEP 2: H...

...able 3. Nonspecific Signs and Symptoms That...


Treatment

...Treatment...

...al Principles for Prescribing Analgesics in...


...STEP 3: Provide appropri...


...STEP 4: Perform...


...STEP 5: Ar...


...STEP 6: Perf...


...STEP 7: Have the p...


...STEP 8: Obtain...


...STEP 9: Have the...


...STEP 10:...


...STEP 11:...


...STEP...


...ST...


...5. Nonpharmacologic Treatments for Pai...


...Selected Non-Opioid Oral Analgesics Used in th...


...c Recommendations for Selective and...


...typical Opioid Oral Analgesics...


Table 9. Adjuvant Analgesic Medications...


...10. Topical Analgesics Agent/...


...pproximate Equianalgesic Dosing and Usual Star...


...eral Principles for Prescribing and Titrating Op...


...Opioid Titration OptionsDuring the titration...


...l Transdermal Fentanyl PolicyFor the initial o...


...adone Use in the PA/LTCCautions and Caveats When...


...Medications for Neuropathic Pain Typ...


Monitoring

...Monitoring...

...STEP 14: Reevaluat...



...STEP 16: Is...

...ary and Alternative MedicineCAM therapies have bec...



...ample Performance Measurement Indic...