The management of pain in long-term care

Objective: The purpose of this paper is to present salient principles of pain management in nursing homes and-other long-term care settings. Methods: Review and author opinion. Results: Pain is a common problem in nursing homes and other long-term care facilities. Often unrecognized and under-treated, pain is a major source of suffering and functional impairment. These patients present substantial barriers to pain assessment and management. Multiple concurrent disease processes, cognitive impairment and communication difficulties, and limited access to diagnostic technologies make assessment more difficult. Multiple medications, altered physiology and pharmacology and limited access to a variety of drug and non-drug interventions make treatment strategies more difficult to implement. Discussion: Clinicians who care for patients receiving long-term care services must help establish a treatment plan that is reasonable given the limited resources and skills available in nursing homes and other long-term care facilities. Medication regimens should be simplified as much as possible. Contingency plans for pain management must be anticipated and made available so that delays do not occur during medication changes or dosage adjustments. Long-term care facilities need substantial support from physicians and other pain experts for education to continuously update their skills and knowledge. As the need for health systems for frail elderly persons continues to grow, it is important to provide comfort and effective pain control appropriate for these new settings.