Multi-Pronged Team Approach Needed to Improve Chronic Pain Management in Nursing Homes
Chronic pain is an enduring issue in nursing homes (NHs). However, despite its high prevalence, there is no definitive approach to managing this condition in older adults. A new report in the June issue of JAMDA suggests that it is important for administrative NH leadership, the medical director, and the interdisciplinary team to work together to promote chronic pain management through a multi-pronged approach, with an emphasis on person-centered care.
In Chronic Pain Management in Nursing Homes: Navigating the Challenges to Improve Person-Centered Care, the authors stress that non-pharmacological modalities are under-used in NH settings but are the preferred first step to manage mild pain. Non-opioid pharmacological agents should be added as a second step for a synergistic effect to manage moderate to severe pain. Opioids, commonly prescribed as a first step to manage chronic pain in this care setting, “should be used as a last resort,” according to the authors. They added, “We want to emphasize that it is not necessarily inappropriate to prescribe opioids in older adults with chronic pain.” Fears and myths about opioids, they said, sometimes have led to an “unnecessary abrupt cession of opioid prescriptions for older adults who need them for management of chronic pain.”
The authors observed barriers to the successful implementation of comprehensive chronic pain management at the NH. These may include ambiguous directions on specific therapeutic interventions, insufficient guidance on treatment duration, and limited availability of treatment options.
Clinicians should carefully evaluate the need for continuation of chronic pain medications during their routine visits in NHs, the authors concluded. The facility administrative and clinical leadership, they noted, can promote appropriate opioid prescribing and deprescribing when indicated through an opioid stewardship program. Proper management of expectations of the resident and their support system is essential when such a multifactorial approach toward chronic pain management is taken.
The study was conducted by researchers at the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; University of Maryland School of Pharmacy, Peter Lamy Center on Drug Therapy and Age, and Center for Successful Aging at MedStar Good Samaritan Hospital, Baltimore, MD; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.