by Wendy Williams, BSN, M.Ed., Associate Director of the Pain Research, Education and Policy Program (PREP), Tufts University School of Medicine
The evidence continues to mount that proactive pain management makes a difference in lives (in this case, for both the identified patient and the staff and families that care for them in nursing homes).
A research article was published in the British Medical Journal on July 17th and concludes the following: “A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia. Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population.”
You can listen to a BBC journalist interviewing one of the authors here. This problem has been outlined before; the challenge of good pain assessment in the non-verbal. In particular, a 2006 Web-MD article reviews a study done in Australia by Leonie J. Cole and colleagues entitled – Pain a Problem in Alzheimer’s Disease: Undertreated Pain Plagues Alzheimer’s Patients Who Hurt, but Can’t Tell.
Have you heard of any good studies recently? We need to keep promoting evidence based practice and advocacy for people with undertreated pain…. Hope to hear from you on any news you might have on this front.
July 18th, 2011
By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
According to the Centers for Disease Control and Prevention, falls are the leading cause of injury deaths among older adults (2005). Falls are also the most common cause of non-fatal injuries and hospital admissions for trauma in elderly individuals. A new study suggests that persistent or chronic pain may be a risk factor for falls in the elderly. “No matter how it was assessed, seniors with chronic pain had a 1.5-fold increased risk of falling,” Suzanne G. Leveille, PhD, RN, of the University of Massachusetts in Boston, and colleagues reported in the November 25, 2009 Journal of the American Medical Association. Researchers conducted the longitudinal study of 749 older adults, ages 70 +, from 2005-2008. Study findings suggested that patients who had chronic pain had higher rates of falls during follow-up than those who were pain-free (P<0.05).
In adjusted models, each measure of chronic pain was independently associated with the increased occurrence of falls. Compared with those without pain or those in the lowest tertiles of pain scores, the greatest risk for falls was observed in those who:
•Had two or more pain sites (RR 1.53, 95% CI 1.17 to 1.99)
•Were in the highest tertiles of pain severity (RR 1.53, 95% CI 1.12 to 2.08)
•Had interference with activities (RR 1.53, 95% CI 1.15 to 2.05)
Dr. Leveille suggested that paying closer attention to assessment of pain in older adults could decrease the risk of falls, contribute to better health outcomes, and help people to continue living actively and independently in the community."
December 1st, 2009
by Lisa Gualtieri, Ph.D., Adjunct Clinical Professor, Tufts University School of Medicine
Having had a grandfather who had dementia, I was struck by Tara Parker-Pope’s New York Times article, “Treating Dementia, but Overlooking Its Physical Toll” about the impact of the lack of understanding families have about the physical toll of dementia. The article referred to a NEJM study that found that lack of understanding of dementia colored the decisions made by families and, further, “that pain control was often inadequate. One in four subjects were clearly suffering from pain, but that number may understate the problem, because the patients were unable to talk about their pain.”
It is years ago now, but I don’t remember anyone ever wondering, or asking his doctor, if my grandfather was in pain. I came across a Web site about understanding pain and dementia (http://www.painanddementia.ualberta.ca ) developed to help family members to address the problem of undiagnosed and under-treated pain in the elderly. While it is too late for my grandfather, it is wonderful this issue is being specifically addressed by this and other resources.
November 19th, 2009