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
...ognition...
...present?...
...Conditions Associated With the Develo...
...able 2. Common Misconceptions Among...
Assessment
...essment...
...characteristics and likely causes of pain been...
...onspecific Signs and Symptoms That May Suggest th...
Treatment
Treatme...
...e 4. General Principles for Prescribing Ana...
...ovide appropriate interim treatment fo...
...Perform a pertinent history and physical ex...
...: Are the cause(s) of pain identif...
...P 6: Perform further diagnostic test...
...the probable cause(s) of pain been...
...Obtain additional evaluation or consultation as...
STEP 9: Have the probable cause(s) of...
...: Summarize the characteristics and...
...pt a patient-centered interdisciplinary care p...
...TEP 12: Set goals for pain relief...
...13: Implement the care plan...
...rmacologic Treatments for PainHaving tro...
...d Non-Opioid Oral Analgesics Used in the P...
...c Recommendations for Selective and Nonselectiv...
...8. Atypical Opioid Oral AnalgesicsHaving tro...
...t Analgesic MedicationsHaving trouble...
...al AnalgesicsHaving trouble viewing table? Expan...
...11. Approximate Equianalgesic Dosin...
...al Principles for Prescribing and Titrating Op...
...able 13. Opioid Titration OptionsHaving troubl...
...Model Transdermal Fentanyl PolicyHav...
...done Use in the PA/LTCHaving trouble...
...Medications for Neuropathic PainHaving...
Monitoring
...onitoring...
...luate the patient’s pain...
...just treatment as necessary...
...controlled?...
...d Alternative MedicineCAM therapies h...
...r the facility’s performance in the mana...
...Sample Performance Measurement Indicator...