Pain Screening
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"THERE IS MUCH PAIN THAT IS QUITE NOISELESS"
This observation by British novelist George Eliot seems especially true in nursing homes, particularly among long-stay residents, whose pain tends to be chronic, low-grade, and silent. "Few people with chronic pain still cry out or moan or have sweating or a rapid heartbeat," writes physician Joanne Lynn, a specialist in palliative care (1). "Most just reduce activity and withdraw from interaction. It takes having an attentive and enduring caregiver to notice…"
By most accounts, nursing home providers are not noticing. Findings from recent studies sketch a lamentable state of affairs:
- An estimated 45% to 83% of nursing home residents are reported to be in pain, most suffering symptoms of osteoarthritis and related musculoskeletal problems (2, 3).
- Despite this high prevalence, pain in nursing homes is under-detected and therefore under-treated. In two studies, physicians had not documented pain in 30%-40% of nursing home residents who reported pain symptoms to the researchers (4, 5).
- In one of our recent studies, among the residents reporting pain, only 42% were receiving pain medication, though 80% said they would like to (5).
- This study also found that licensed nurse assessments of pain were documented weekly; however, more than 50% of the residents who reported pain symptoms to us had nurse pain scores of zero during the past four consecutive weeks (5).
- In another study, we found that of the 309 residents who reported chronic pain in interviews with our research staff, only 37% had documentation of pain on their most recent Minimum Data Set (MDS) assessment (6).
- Moreover, this study showed that as a resident's cognitive impairment increased, nursing home staff were increasingly less likely to document pain presence on the MDS, a finding that suggests that the staff were using subjective criteria to evaluate pain among residents (6).
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