The prevalence of pain in long-term care residents is estimated to range from 49% to 83%” (Fox, Raina, & Jadad, 1999). Chronic pain is the top cause of long-term disability in the US, and advanced age a key indicator of chronic pain risk (Ljubica Cvetkovska). Based on this information, it is critical that we are addressing pain, the “Fifth Vital Sign”, effectively in long-term care settings.

Pain may have a significant impact on nursing home residents, with the potential for substantial negative outcomes such as decreased socialization, increased depression or sleep disturbances,  and pain may even contribute to the progression of cognitive impairment and poor food intake/malnutrition/weight loss, as well as increases in morbidity.

In the Federal Regulations, F 697 Pain Management, we find that facilities are required to  “ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person- centered care plan, and the residents’ goals and preferences”. How is this best accomplished when there are so many barriers to successful pain management, including cognitive impairment, communication obstacles, cultural barriers, atypical presentations of pain (i.e., isolation, anorexia, etc.), and the fear of addiction?

Strategies for Successful Pain Management Programs

As you assess your pain management program, consider review the essentials including the ABC’s of pain assessment:

      • Ask about and Assess pain regularly.
      • Believe the resident and family in their reports of pain and what relieves it.
      • Choose pain control options appropriate for the resident, family, and setting.
      • Deliver interventions in a timely, logical, and coordinated fashion
      • Empower residents and families. Enable them with as much control as possible.

Based on a thorough assessment of the resident’s pain, the facility can develop a comprehensive care plan that addresses the resident’s individual pain management interventions. Interventions may include both non-pharmacological and pharmacological interventions. Care plan approaches should:

      • Adhere to accepted clinical guidelines and the facility’s policies and procedures
      • Follow the facility’s process for the resolution of inadequately managed pain
      • Ensure that the resident’s pain plan is communicated during transfer and discharge
      • Ensure that the resident’s pain is communicated to the MDS Coordinator

For more information on Pain Management, including effective tools for assessing, managing, care planning, and monitoring of pain, join us on September 15th and 21tt for the Standards of Care Presentation,What To Do When It Hurts – Pain Identification and Management”.


Janine Lehman, RN, RAC-CT, CLNC, Proactive Medical Review

Learn more about the rest of the Proactive team.