Pain Management

 

It is responsibility of providers in long-term care to ensure that pain management is provided to residents who require such services.

 

An appropriate pain management program is one that is:

  • Consistent with professional standards of practice

  • Consistent with the resident’s goals and preferences and

  • Consistent with the comprehensive person-centered care plan

 

Recognition

To appropriately manage someone’s pain, it is important for it to be recognized as soon as possible. Expressions of pain may be verbal or nonverbal and are subjective. Pain is what the person says it is. As with many symptoms, pain can be more difficult to recognize in residents with cognitive impairment.

 

Verbal indications of pain may not include use of the word “pain” at all. Some people describe pain as pressure, burning, aching, pins and needles, feeling tender, soreness, etc. Additionally, vocalizations such as screaming, crying or groaning are also considered verbal indications of pain.

 

Nonverbal indications of pain may include facial grimacing, guarding, clenching of the jaw, frowning, increased heart rate or blood pressure, limping, etc.

 

Other indicators for pain include but are not limited to:

  • Resisting care

  • Irritability

  • Decreased participation in usual activities

  • Loss of function or inability to perform ADL’s

  • Difficulty eating or loss of appetite

  • Difficulty sleeping

 

Understanding the underlying cause for the pain is an important step in recognition and treatment. For example, some daily activities, such as repositioning a resident, changing a dressing on a wound or participating in therapy can be painful. Also, other medical conditions can lead to pain, such as pressure injuries, diabetic neuropathy, oral health issues and infection.

 

Observing a resident during different activities, such as at rest and while moving, can help with identifying underlying causes of pain.

Nursing assistants may be and often are the first ones to notice if a resident has symptoms of pain, so it is important they are able to recognize this change and report these symptoms to the nurse immediately.

 

Assessment

When assessing potential for or actual pain, it is important to consider multiple factors:

  • History of pain and treatment, and whether the treatment was effective

  • Characteristics of pain

  • Impact of pain on quality of life

  • Current medications and treatments

  • Resident’s pain management goals and satisfaction with current level of pain control

 

Management of Pain

It is important for the management of a resident’s pain to include an interdisciplinary approach, including the resident and his/her representative. It is also important for management of pain to include pharmacological as well as non-pharmacological interventions.

 

Pharmacological interventions are developed through an interdisciplinary team approach and takes the following into consideration:

  • Cause

  • Location

  • Severity of pain

  • Potential benefits

  • Potential risks

  • Resident’s desired level of relief and tolerance of medications

 

Pharmacological interventions can be administered orally, rectally, topically, by injection, by pump and/or trans dermally.

 

Non-pharmacological interventions include but are not limited to:

  • Environmental changes, such as changing temperature in room and assistive devices

  • Physical modalities such as ice packs, mild heat, repositioning, warm baths, acupressure

  • Exercises and stretching for stiffness and to prevent contractures

  • Cognitive interventions such as music therapy and relaxation techniques

 

While some non-pharmacological interventions require a physician’s order, others can be initiated by staff as part of routine care.

 

Monitoring

To ensure long-term success with pain management, it is vital to assess the effectiveness of the current pain management program through ongoing evaluation. Monitoring the status of the underlying cause of the pain, response to interventions and the possible presence of adverse consequences to treatment are all part of thorough evaluation. For example, it is not uncommon for a resident who is being treated by opioids to also experience constipation, so an appropriate bowel regimen should also be implemented.

It is your responsibility as a caregiver to be the resident’s advocate. If a resident verbalizes to you or you see indications that the current pain management regimen isn’t effective, report it to the appropriate person as soon as possible.

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