Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Abstract

Objective We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity. Methods Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis. Results Of these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/ adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common. Conclusion Among nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist. Keywords Nursing homes. Pain. Analgesics. Pain severity Keypoints • Nursing home residents commonly experience pain. • Medication management of pain could be improved as one in four residents in severe pain received no pain medications or adjuvants to pain medications.

Clinical Observation of MRI Scanning Combined with Clinical Nursing for Surgical Breast Cancer Patients

“…In the control group, three people were misdiagnosed, and the misdiagnosed rate was 6% Seven people with disabilities were missed, and the missed diagnosed rate was 14%. Significant differences ( P < 0.05) between the two groups suggest that a combination of preoperative breast ultrasound and MRI can be used to measure the incidence of axillary lymph nodes in patients with leukemia, to achieve better results, and to improve outcomes in advance, which is always consistent with current research to identify, diagnose, and prevent misdiagnosis of postoperative disorders [ 21 ]. MRI scanning has no radiation damage, has good spatial resolution and soft tissue resolution, and has high sensitivity in the diagnosis of breast cancer.…”

Correlates of Opioid Use Among Ontario Long-Term Care Residents and Variation by Pain Frequency and Intensity: A Cross-sectional Analysis

“…Resident characteristics examined as correlates of opioid use were selected based on previous literature [ 1 , 2 , 9 , 29 ] and clinical relevance as determined by the research team. Of particular interest in the current study were understudied characteristics relevant to our understanding of pain management in this care setting, including recency of LTC admission, frailty and specific co-occurring conditions and medications.…”

“…Opioids are often prescribed to long-term care (LTC) residents for non-cancer pain [ 1 ], with prevalence estimates for this indication ranging from 19.6% [ 2 ] to 32% [ 3 ]. Pain management in this care setting is challenging as healthcare providers must carefully balance the risks and benefits of opioid therapy in older, more vulnerable individuals.…”

“…Nonetheless, relatively higher opioid prescribing in LTC may be expected given the high burden of pain in this population [ 1 ]. Prevalence estimates of non-cancer pain among LTC residents range from approximately 25–50%, depending on the study population, pain measure, and time period examined [ 8 – 11 ].…”

“…Research suggests that up to one quarter of LTC residents with severe pain do not receive any analgesic or adjuvant therapy [ 1 ]. Residents with cognitive and/or communication impairment appear to be at particular risk for both the under-recognition and under-treatment of pain [ 1 , 3 , 8 , 18 – 21 ]. In addition to distress related to uncontrolled pain, it can also lead to a worsening of residents’ cognitive and functional status [ 11 , 22 ].…”