Growing Pains
The consequences of poorly controlled pain are severe and can lead to depression, functional decline, overall loss in quality of life, and increased medical costs. Approximately one in four nursing home residents experiences pain, yet many studies reveal that pain is underrecognized and undertreated in the long-term care (LTC) setting. The barriers to assessment and management of pain in LTC facilities continue to warrant further exploration. This issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC) offers several clinical perspectives on pain management, with an emphasis on practical solutions to overcome these persistent hurdles.
Gaps in staff knowledge are one of many frequently reported barriers to optimal pain control. Cary Reid, MD, and colleagues describe their successful implementation of a quality improvement program to enhance staff identification and management of pain at an LTC facility. Their four-phase program started with a needs assessment, which provided the basis for the subsequent educational workshops, evaluation strategies, and reinforcement techniques. Following the program, staff members showed significant improvement in documentation of pain and use of targeted pain assessment in residents with cognitive dysfunction. Notably, use of nonpharmacologic treatment increased. Furthermore, these improvements were sustained for 8 months. The article includes a step-by-step explanation of program planning, execution, and follow-up, with a sample of the surveys that were used to assess staff members’ confidence and knowledge in pain management before and after the program. The authors stress that multidisciplinary participation and frequent re-evaluation of educational needs are both vital to achieving sustained improvement in this area of resident care.
Another common barrier is managing adverse effects of pain medications, which can yield an equally negative impact on quality of life as the pain itself. Dry mouth, for example, is a common effect of both opioid and nonopioid analgesics, the occurrence of which is not only uncomfortable but can also precede numerous health problems, including dysphagia, infection, and malnutrition. When the causative medication cannot be discontinued or reduced, there is a need to find alternative solutions. Neva L. Crogan, PhD, reviews the medication classes that are associated with xerostomia and their impact on nutritional intake. As part of her discussion on the limitations of existing xerostomia treatments in older adults, she briefly explains the success of an intervention that used sugar-free citrus sorbet to alleviate dry mouth in nursing home residents. By stimulating saliva production before meals, consumption of sorbet significantly increased food intake and decreased liquid intake. None of the residents’ medication profiles were changed, and 36% of the residents experienced healthy weight gain as a result of the intervention.
As pain management is a central component of palliative care at the end of life, we have also included the next article in our series titled “What’s Buzzing in the Literature.” ALTC asked two experts to review the most significant contributions to the palliative care literature within the past year. One of their selections is an article that highlights nurses’ perceptions of the caregiver-, organizational-, and patient-related barriers to pain management. A new blog post from ALTC board member Ilene Warner-Maron, PhD, provides a wonderful complementary viewpoint on this issue. She comments on the problem of poor pain documentation by nurses that she has seen in her 34 years of experience. For additional articles, news, and resources, please visit our Pain Medical Resource Center.
We hope that you find the articles in this month’s issue of ALTC helpful in your daily clinical practice. Please send your comments to Allison Musante, Managing Editor, at amusante@hmpcommunications.com.
Thank you for reading!
