Improving pain management in nursing homes
Despite the quality of care provided by residential facilities, the prevalence of pain is high among nursing home residents, according to a survey in the latest issue of the Medical Journal of Australia.
The survey, conducted by Dr William McClean of the Mid-North Coast Area Health Service and Associate Professor Nick Higginbotham of the University of Newcastle, examined the prevalence of pain among nursing home residents in rural New South Wales and the procedures used for pain management.
"Nearly 28% of nursing home residents who were able to communicate were experiencing pain of varying intensity, and nursing records show that a similar proportion of non-communicating residents were thought to be in pain," according to the authors.
The research showed that a lot of the pain experienced by residents was not recorded in the nursing notes.
"The act of recording pain, in itself, has the potential to reveal unreported pain and to initiate treatment strategies," Dr McClean says.
The survey found that women reported pain more often than men (31% v 21%), with the most common sites for moderate-to-severe pain being the limbs, joints and back. Regular doses of Paracetemol were prescribed for 23% of those with pain at interview, while 27% of those with pain received some form of physical treatment."
The authors believe their survey points the way towards defining a benchmark for assessing pain in Australian nursing home residents, and call for a broader population survey of Australians in high-level care to achieve more accurate estimates of pain prevalence.
An accompanying editorial by Dr Pamela Melding of the University of Auckland, New Zealand, says that despite existing guidelines for residential aged care, which draw attention to the need to develop policies to manage chronic pain in nursing homes, pain is still underdiagnosed and undertreated.
Dr Melding stresses that the prevalence of undetected pain is likely to be even higher among people who cannot communicate their pain than in those who can.
"Work in palliative care has shown that pain can be correctly identified and effectively managed", Dr Melding says.
"Chronic pain is unnecessary … While may be useful, there is no substitute for greater awareness, direct enquiry, clinical intuition, and commitment to alleviate pain whatever its intensity."
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: (Research) Dr William McClean
Mid-North Coast Area Health Service, Taree
(02) 6552 4003 (A/H)
(Editorial) Dr Pamela Melding
University of Auckland, New Zealand
(0011) 64 9 486 1491 (B/H) AEST Plus 2 hours
(0011) 64 9 486 1721 (A/H)
Sarah Crichton
AMA Public Affairs
(0419) 440 076