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...
...pain present?...
...e Conditions Associated With the Development of...
...Common Misconceptions Among Patients and Caregiver...
Assessment
...ssessmen...
STEP 2: Have the characteristics and likely c...
...specific Signs and Symptoms That May...
Treatment
...eatment...
...ble 4. General Principles for Prescribing Analg...
...: Provide appropriate interim treatment for p...
...TEP 4: Perform a pertinent history and physic...
...P 5: Are the cause(s) of pain identified?...
...further diagnostic testing, as indica...
...TEP 7: Have the probable cause(s) of pain...
...P 8: Obtain additional evaluation or...
...e the probable cause(s) of pain been id...
...arize the characteristics and causes of...
...11: Adopt a patient-centered inter...
...goals for pain relief...
...13: Implement the care plan...
...npharmacologic Treatments for PainHavin...
...6. Selected Non-Opioid Oral Analgesics...
...c Recommendations for Selective and Nonselectiv...
.... Atypical Opioid Oral AnalgesicsH...
...e 9. Adjuvant Analgesic MedicationsHav...
...e 10. Topical AnalgesicsHaving trouble viewing...
...pproximate Equianalgesic Dosing and Us...
...neral Principles for Prescribing and Titrating...
...d Titration OptionsHaving trouble viewing...
...el Transdermal Fentanyl PolicyHaving trouble viewi...
...one Use in the PA/LTCHaving trouble viewi...
...Medications for Neuropathic PainHaving...
Monitoring
Monitor...
...Reevaluate the patient’s pain...
...just treatment as necessary...
...Is pain controlled?...
...and Alternative MedicineCAM therapies...
...the facility’s performance in the management o...
...mple Performance Measurement IndicatorsHaving trou...