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 Researchers examined data on almost 1.4 million residents in nursing
homes nationwide from 2011 to 2012 and found that overall, roughly
two in five had either intermittent or chronic pain.
Among the residents with persistent pain, about 6 percent received
no medication at all and another 32 percent didn’t get enough drugs
to properly address their symptoms, the study found.
“The good news is that we documented lower levels of untreated pain
than previous studies,” said lead study author Jacob Hunnicutt of
the University of Massachusetts Medical School in Worcester.
“However, pain may still be undertreated and disparities in pain
management by cognitive impairment and race/ethnicity remain,”
Hunnicutt said by email.
Previous studies have estimated that at least 40 percent of nursing
home residents experience persistent pain, and that 20 percent of
those in pain don’t get any medications, researchers note in the
journal Pain.
More than 1.4 million adults live in U.S. nursing homes, including
about 3 percent of people over 65 and roughly 10 percent of people
over 85.
For the current study, researchers examined data on nursing home
residents who spent at least 100 days in the same facility with no
gaps in residency of more than 30 days.
Residents provided information on the intensity and frequency of any
pain they experienced as well as any medications provided during two
assessments three months apart. Participants were counted as having
persistent pain if they described pain on both assessments, and
intermittent pain if they only mentioned it during one of the
assessments.
If residents reported pain and didn’t have any scheduled or
as-needed medications noted in their medical records, researchers
counted them as having untreated pain. If their records only
included as-needed pain medications, researchers counted them has
having potentially undertreated pain.
Non-white residents were 19 percent more likely than white residents
to have undertreated or untreated pain, the study found.
In addition, residents with severe cognitive impairments were 51
percent more likely to have untreated or undertreated pain than
people with only mild impairments or none at all.
One of the study authors is a consultant with the pharmacy benefits
manager and drugstore chain CVS Caremark.
Limitations of the study include the lack of data on pain levels
between the two assessments, the authors note. Researchers also
relied on residents to accurately recall and report on their own
pain levels, which can be subjective.
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The study also didn’t account for patient preferences or medical
histories, said Dr. Gary Winzelberg, a geriatrics researcher at the
University of North Carolina School of Medicine in Chapel Hill who
wasn’t involved in the study.
“It's possible that some patients prefer not to receive pain
medications and may use non-pharmacologic approaches to managing
their pain,” Winzelberg said by email.
Some residents might not believe they should report being in pain or
think they shouldn’t take medications. This might at least partially
explain why older adults, men and residents of color were less
likely to report pain and receive medications, Winzelberg added.
Residents and families can see how nursing homes compare on pain
management and other quality measures online, Hunnicutt said. He
recommends Medicare’s Nursing Home Compare (http://bit.ly/1CHwbuM).
To avoid untreated pain, residents and their loved ones shouldn’t be
shy about speaking up, said Dr. XinQi Dong of the Rush Institute for
Healthy Aging in Chicago.
“Patients and family should seek help when the pain is beginning to
rise, and not to wait until pain is intolerable before asking for
pain medications,” Dong, who wasn’t involved in the study, said by
email.
“After adequate assessment, health care professionals should provide
an adequate mixture of long acting and short acting pain medications
for those with chronic and inadequately treated pain,” Dong added.
SOURCE: http://bit.ly/2nFmuLi Pain, online March 4, 2017.
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