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Pain in Nursing Home Residents

Management Strategies

  • Therapy in Practice
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Abstract

Pain is prevalent and undertreated in nursing home residents, despite the existing wide array of effective pharmacological and nonpharmacological treatment modalities. In order to improve the quality of life of these vulnerable individuals, practitioners require education about the correct approach to assessment and management. Assessment should be comprehensive, taking into account the basic underlying pathology (e.g. osteoarthritis, osteoporosis, peripheral neuropathy, fibromyalgia, cancer) as well as other contributory pathology (e.g. muscle spasm, myofascial pain) and modifying comorbidities (e.g. depression, anxiety, fear, sleep disturbance). Pharmacological management should be guided by a stepped-care approach, modelled after that recommended by the World Health Organization for treatment of cancer pain. Nonopioid and opioid analgesics are the cornerstone of pharmacological pain management. Tricyclic antidepressants and anticonvulsants can be very effective for the treatment of certain types of neuropathic pain. In addition to treating the pain per se, attention should be given to prevention of disease progression and exacerbation, as maintaining function is of prime importance. Nursing home residents with severe dementia challenge the practitioner’s pain assessment skills; an empirical approach to treatment may sometimes be warranted. The success of treatment should be measured by improvement in pain intensity as well as physical, psychosocial and cognitive function. Effective pain management may impact any or all of these functional domains and, therefore, substantially improve the nursing home resident’s quality of life.

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Acknowledgements

Financial support was provided by grants from the National Institute on Aging (K08 AG00643 — Dr Weiner; AG15432 amd AG14158 — Dr Hanlon).

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Authors and Affiliations

  1. Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Philadelphia, USA

    Debra K. Weiner

  2. Institute for the Study of Geriatric Pharmacotherapy, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA

    Joseph T. Hanlon

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  1. Debra K. Weiner
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  2. Joseph T. Hanlon
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Correspondence to Debra K. Weiner.

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Weiner, D.K., Hanlon, J.T. Pain in Nursing Home Residents. Drugs & Aging 18, 13–29 (2001). https://doi.org/10.2165/00002512-200118010-00002

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