I read a post on McKnights.com last week that so distressed me I had to wait a week before I was ready to blog about it. The article, Nurses, Relatives Underestimate Pain in Nursing Home Residents, Study Finds, reports the results of a five-year study in the Netherlands that shows a tendency to underestimate pain, particularly in people with cognitive impairment. What got me as agitated as a dementia resident with undiagnosed pain is that I’ve been reading about these studies since I got into the field over a decade ago.
A quick Google search of “pain management” and “nursing homes” turns up page after page of information about the consistent lack of recognition and treatment of pain. On the first search results page is a 2001 Brown University study noting “woefully inadequate pain management.” Also on the first search results page are numerous studies suggesting ways to alleviate this problem (for example, tips from the End-of-Life Palliative Information Center and a 2002 National Institute of Health report).
On April 10, 2009, the Centers for Medicare and Medicaid Services (CMS) issued new quality of care guidelines for pain management. I’m hopeful this will help to change the culture of tolerating pain in the residents under our care.
The next headline I’d like to read is: Treatable Pain Virtually Eliminated Among Nursing Home Residents Worldwide
4 thoughts on “Pain Management for Nursing Home Residents”
This is very sad.
While we're on the subject of pain management, this is also an area in which healthcare disparities based on race and gender abound. According to the "Journal of the American Osteopathic Association," Despite efforts targeted at physicians for improving the way in which they manage pain, discrepancies still abound in how they treat certain patients for this condition. Special populations of patients such as racial minorities, women, and substance abusers are victims of deficiencies in pain management and suffer needlessly. Only when physicians acknowledge disparities and barriers can they begin to evaluate and improve on their own practices of pain management."
Unfortunately, once you've been labeled as "drug-seeking" it's very difficult to get a doctor to prescribe "the good stuff" for you. I know of several residents who are stuck with this label who hurt every day despite the pain medication they are allowed to have. Just because you've had a problem in the past doesn't mean you should have to be in pain all the time now. Especially in a nursing center environment where your medication is controlled by someone else so there's almost no possibility of abuse.
Sue, FSP, K. Tree — You are all right. It's very sad, and angering, to see patients suffer needlessly. There are definitely disparities in who receives pain medication, and misunderstanding about the pain medication needs of those with substance abuse problems, who tend to need more meds due to their bodies having developed a physical tolerance to the medication and not because they are drug addicts (though they might not be so nice about asking). I've also seen many residents who "don't want to bother the nurse" and therefore don't ask for their pain meds. I do believe that increased visibility of this issue and improved pain management protocols would go a long way toward reducing needless suffering. All the information is out there — it's a matter of putting it to use.