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

Recogniti...

...ain present?...

.... Some Conditions Associated With...

...mon Misconceptions Among Patients and Caregiver...


Assessment

Assessment

...the characteristics and likely causes of p...

...3. Nonspecific Signs and Symptoms T...


Treatment

...atment...

...eral Principles for Prescribing Analgesics...


...EP 3: Provide appropriate interim treat...


...orm a pertinent history and physical...


...the cause(s) of pain identified?...


STEP 6: Perform further diagnostic testing, as ind...


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


...8: Obtain additional evaluation or consultation a...


...e probable cause(s) of pain been identified?...


...TEP 10: Summarize the characteristics an...


STEP 11: Adopt a patient-centered...


...goals for pain relief...


...nt the care plan...


...le 5. Nonpharmacologic Treatments for PainH...


...d Non-Opioid Oral Analgesics Used in the...


...c Recommendations for Selective and Nonselective N...


...l Opioid Oral AnalgesicsHaving trouble v...


...uvant Analgesic MedicationsHaving trouble viewin...


...le 10. Topical AnalgesicsHaving trouble viewing t...


...imate Equianalgesic Dosing and Usua...


...eneral Principles for Prescribing and T...


...e 13. Opioid Titration OptionsHaving t...


...14. Model Transdermal Fentanyl PolicyHaving tr...


...Methadone Use in the PA/LTCHaving tr...


...16. Medications for Neuropathic PainHaving troub...


Monitoring

...nitoring...

...luate the patient’s pain...


...: Adjust treatment as necessary...


...TEP 16: Is pain controlled?...

...ry and Alternative MedicineCAM the...


...Monitor the facility’s performance in...


...ple Performance Measurement Indica...