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
...Recognition...
...STEP 1: I...
...able 1. Some Conditions Associated With the De...
...2. Common Misconceptions Among Patie...
Assessment
...Assess...
...STE...
...3. Nonspecific Signs and Symptoms Th...
Treatment
...Treatme...
...able 4. General Principles for Prescribi...
...STEP 3:...
...STEP 4: Perform a pe...
...STEP 5: Are the...
...STEP 6: Perfor...
ST...
...STEP 8: Obtain a...
...STEP 9: H...
...STEP 10: Summarize the...
...STEP 11: A...
...STEP 12: Set go...
...STEP 13...
...e 5. Nonpharmacologic Treatments for...
...ected Non-Opioid Oral Analgesics Used in...
...cific Recommendations for Selective and Non...
...able 8. Atypical Opioid Oral AnalgesicsHav...
...djuvant Analgesic MedicationsHaving tro...
...pical AnalgesicsHaving trouble viewi...
...able 11. Approximate Equianalgesic Dosing...
...ral Principles for Prescribing and Titrating Opio...
...d Titration OptionsHaving trouble viewi...
...Transdermal Fentanyl PolicyHaving tr...
.... Methadone Use in the PA/LTCHaving troubl...
...ble 16. Medications for Neuropathic PainHaving tro...
Monitoring
...Monitoring...
...STEP 14: Reevalua...
...STEP 15: Adjust tre...
...STEP 16: Is...
...lementary and Alternative MedicineCAM...
...STEP 17: Monit...
Table 17. Sample Performance Measurem...