Pain in nursing home residents - Management strategies

Pain is prevalent and undertreated in nursing home residents, despite the e xisting wide array of effective pharmacological and nonpharmacological trea tment modalities. In order to improve the quality of life of these vulnerab le individuals, practitioners require education about the correct approach to assessment anti management. Assessment should be comprehensive, taking i nto account the basic underlying pathology (e.g. osteoarthritis, osteoporos is, peripheral neuropathy, fibromyalgia, cancer) as well as other contribut ory pathology (e.g. muscle spasm, myofascial pain) and modifying comorbidit ies (e.g. depression, anxiety, fear, sleep disturbance). Pharmacological ma nagement should be guided by a stepped-care approach, modelled after that r ecommended by the World Health Organization for treatment of cancer pain. N onopioid and opioid analgesics are the cornerstone of pharmacological pain management. Tricyclic antidepressants and anticonvulsants can be very effec tive for the treatment of certain types of neuropathic pain. In addition to treating the pain per se, attention should be given to prevention of disea se progression and exacerbation, as maintaining function is of prime import ance. Nursing home residents with severe dementia challenge the practitione r's pain assessment skills: an empirical approach to treatment may sometime s 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 domain s and, therefore, substantially improve the nursing home resident's quality of life.