Trends in Chronic Pain and Its Management Among Nursing Home ... - Clinical Pain Advisor
More than half of patients with dementia residing in nursing homes report moderate to severe chronic pain, among whom more than half had no specific underlying condition causing their chronic pain. In addition, patients reporting severe pain were more likely to receive opioids, but the use of opioids was not associated with any specific pain condition. These findings were published in the journal Pain.
Data for this cross-sectional study, which was part of a larger cluster-randomized controlled trial, were collected between 2019 and 2020 from 12 nursing homes in Norway. Patients (N=262) who had moderate to severe pain and mild, moderate, or severe dementia-like symptoms were evaluated for type of pain condition, severity of pain, and modality of treatment by clinical examination.
The median age of patients was 88 (range, 59-103) years, 71.8% were women, 71.8% had no diagnosis of dementia, 17.9% had mild dementia symptoms, and the median Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MORBID-2) score was 4 (range, 3-9) points.
No significant association between severity of pain intensity and severity of dementia symptoms was observed; however, more severe pain was reported by individuals with moderate (25%) and severe (24.3%) dementia symptoms compared with patients with mild dementia symptoms (14.9%).
Overall, 72 pain conditions were identified. The median number of pain conditions per patient was 2; 41.6% reported 1 condition, 35.9% reported 2 conditions, and 22.5% reported experiencing 3 or more conditions.
The most common primary pain conditions reported were chronic widespread pain (23.3%), nonspecific back pain (23.3%), and primary upper limb musculoskeletal pain (19.8%). The most common secondary conditions were osteoarthritis (24.0%), neuropathic pain (15.3%), spinal musculoskeletal pain (9.2%), and lower limb pain (9.2%).
The patients received paracetamol only (n=103), no analgesics (n=85), or opioids (n=75). More patients with severe pain of a known cause received opioids (68.8%) compared with patients with severe pain of an unknown cause (39.3%), and more patients with severe pain received opioids compared with patients with moderate pain (P <.001).
No significant trends were observed for analgesic use and pain conditions. However, patients with chronic widespread pain tended to be less likely to be untreated compared with patients with other pain conditions (odds ratio [OR], 0.4; 95% CI, 0.1-1.0; P =.055).
The results of this study may not be generalizable, as only nursing homes in large cities were included.
This study found that more than half of patients (68%) with dementia residing in nursing homes reported experiencing moderate to severe chronic pain. Among these patients, more than half had no specific underlying condition causing their chronic pain. No significant relationship between pain and dementia severity was identified. In general, analgesic use did not appear to be related to specific conditions, but analgesic use was associated with the severity of pain. "The authors would stress the need for thorough clinical pain assessments in patients with dementia to identify causes of pain, ultimately improving the care this population receive."
References:
Myrenget ME, Borchgrevink PC, Rustøen T, et al. Chronic pain conditions and use of analgesics among nursing home patients with dementia. Pain. Published online December 21, 2022. doi:10.1097/j.pain.0000000000002794
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