Regulatory Components for Treating Persistent Pain in Long-term Care

Abstract

Persistent or chronic pain is frequently reported by older adults and has the potential to dramatically influence quality of life. Estimates indicate that 25% to 50% of community-dwelling older adults experience this kind of pain. This rate is even higher in long-term care facilities, where 50% to 75% of residents have chronic pain syndromes that are untreated or undertreated. To promote optimal pain management and enumerate the responsibilities of skilled nursing facilities to effectively treat and prevent pain, the Centers for Medicare & Medicaid Services released a new pain management surveyor guidance, F-Tag 309, which endorses the presence of an interdisciplinary team approach to pain management that involves the resident. The guidance delineates pain management principles, the need for ongoing professional education in all components of pain management, and emphasizes the important role of appropriate pharmacological treatment in conjunction with nonpharmacological interventions to aggressively manage pain. This directive will help skilled nursing facilities achieve optimal pain management for their residents.

Literature review of pain management for people with chronic pain

“…Rather, relieving pain as much as possible in individuals with chronic pain is considerably important to motivate them to engage in new or positive behaviors, such as physical activity and exercise (Oliver & Ryan, ). Pharmacological therapy for pain relief could be effective, however, side‐effects and adverse events of pharmacological therapy for pain were also reported among people undergoing long‐term therapy for chronic pain (Finnerup, Sindrup, & Jensen, ; Planton & Edlund, ). Therefore, a combined strategy with alternative and pharmacological therapies are often needed for individuals with chronic pain.…”

A Latent Approach to Understanding Pain in Nursing Home Residents Who are Unable to Self-Report Pain

“…In March 2009, changes to surveyor guidance provided in F-Tag 309 gave explicit direction about the nursing home’s responsibility regarding effectively identifying specific pain type and pain management. 53 Although data in the immediate post-implementation period suggested positive changes in response to the surveyor guidance with respect to recognition and management of pain, these findings did not extend to nursing home residents with severe cognitive impairment. 54 If regulations and administrative initiatives do not meet the needs of residents who cannot report pain, research on how best to implement effective pain assessment and management strategies in this setting is warranted.…”