Health
How coordinated and individualized care advances chronic pain treatment for SNF
More than half of nursing home residents suffer from chronic pain1but multiple studies show that it is largely undertreated2.
The reasons are multidimensional and complex. Tasks include identifying whether residents are experiencing pain, identifying the cause and severity of pain, and identifying the risks and benefits associated with the use of many medications used for pain management. includes doing.
Karl Dauphinais, Ph.D., medical director and complex care management expert at Optum in Connecticut and Rhode Island, said:
“There’s a lot of subjective variability and a lot of factors that come into play,” he says. “Elderly communities, especially nursing homes, have more complex issues, from residents living with cognitive impairments and communication limitations, to access to diagnostics and specialized services.”
Ensuring that pain is properly assessed and treated requires a coordinated and individualized approach involving each resident’s physician, specialist, therapist, nursing center staff, and family members. Chronic pain can lead to depression and anxiety, exacerbate pain expression, and create a vicious cycle, so we also need to monitor how it affects our mental health.
Here are four steps an operator can take to best address pain management.
Step 1: Identify Pain and Understand the Individual
“The first challenge is to actually properly identify the pain and identify the cause of the pain,” says Dauphinais.
However, many residents of nursing homes are not good at explaining or communicating their pain.
That’s why it’s important to know each individual, their unique health challenges, and their personal care goals.
“Nursing home residents may not speak, either,” he says. “The more we know the patient, the easier it is to detect signs of pain such as grimacing, limp, decreased activity, appetite changes and sleep disturbances.”
Step 2: Determine the Appropriate Treatment Plan
With so many SNF residents suffering from chronic illness, choosing an appropriate treatment regimen is complicated.
“Of course, the first step is communication,” says Dauphinais. “There is no one-size-fits-all approach.”
Treatment plans include a variety of options, from pain relievers to topical medications, treatments, stretching, massage, splints and compressions.
Also, if medication is part of your regimen, it is important to carefully consider all side effects.
Step 3: Understanding when and how to use opioids
Increased scrutiny of opioid prescriptions has increased reluctance to prescribe these analgesics. That, as Dauphiné puts it, “has led to the unfortunate belief that all opioids are bad. Medications for use during certain times when pain cannot be otherwise controlled.”
Knowing when to use opioids can be difficult because risks include lethargy, confusion, falls, and even respiratory depression and death.
Before prescribing an opioid, it’s important to carefully assess each resident’s pain and potential benefits and risks, Dauphinias said.
STEP 4: TEAMWORK IS KEY TO EFFECTIVE AND INDIVIDUALIZED PAIN MANAGEMENT
Unfortunately, chronic pain doesn’t just go away. Treatment options should be reviewed and constantly monitored as needed to ensure the best possible quality of life for residents.
“Most chronic pain can’t be completely controlled,” says Dauphinais. “The idea is to bring it down to a manageable level and allow someone to function as best as possible throughout the day without exposing them to higher risk. We are balancing the risks.”
Coordination and communication are at the heart of Optum’s approach to pain management and the entire Optum model of care.
Optum clinicians work closely with onsite therapists, nurses, and nursing aides to identify changes in patient behavior (from moaning to needing more support in a wheelchair, needing more support when suddenly moving). to determine if it is the result of a new condition or exacerbation of pain.
“They work together as a team to provide the right care for the individual,” says Dauphinais. “Having our clinicians act as point persons in care coordination makes a huge difference in ensuring they receive the best possible care.”
This article is sponsored by Optum. For more information on the Optum Care Model approach to pain management, please visit: optum.com/painmanagement.
sauce:
[1] Prevalence and Factors Associated with Pain in Nursing Home Residents: A Systematic Review of the Literature https://pubmed.ncbi.nlm.nih.gov/36162443/
[2] Pain management in nursing home residents before and after COVID-19: A systematic review https://www.jamda.com/article/S1525-8610(22)00064-0/fulltext; https://www.ncbi.nlm. nih.gov/pmc/articles/PMC5435509/
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