Elderly/Long-term Care

A pain medication appropriateness scale reveals that many nursing home residents suffer from poorly controlled pain

An assessment using the Pain Medication Appropriateness Scale (PMAS) indicates that only one-third of nursing home residents have an excellent match between their reported pain severity and the medication prescribed to control their pain, which means that two-thirds of residents have suboptimal pain management. The PMAS lists the appropriate medication for the type of pain; appropriate dose interval (depending on whether the pain is persistent, predictably recurrent, or breakthrough pain); and appropriate titration of medication to severity of pain. The scale also lists the degree of pain relief from medication, appropriate prevention of constipation from opioids, and appropriate exclusion of drugs considered high-risk for the geriatric population. The scale is designed as a screening tool to assess overall pain management strategies in a nursing home or group of homes, and is not meant to be used to evaluate individual care plans.

In this study, supported by the Agency for Healthcare Research and Quality (HS11093), researchers used the PMAS to assess pain medication prescribing during a study of a multifaceted intervention to improve pain management in six rural and six urban nursing homes in one State. The mean total PMAS was 64 percent of optimal, an indication of generally poor management of pain in nursing homes. Fewer than half of residents with predictably recurrent pain were prescribed scheduled pain medication. Also, 23 percent of residents received at least one high-risk medication.

PMAS scores were better for residents not in pain (68 vs. 60 percent) and in homes where the nurses' knowledge of pain assessment and management improved or stayed the same during the intervention (69 vs. 61 percent). Appropriate prescribing for mild episodic pain and constipation prevention for as-needed opioids was excellent (84 and 79 percent compliance, respectively). However, prescribing was adequate for only 40 percent of the residents who had neuropathic pain.

More details are in "Assessing the appropriateness of pain medication prescribing practices in nursing homes," by Evelyn Hutt, M.D., Ginette A. Pepper, R.N., Ph.D., F.A.A.N., Carol Vojir, Ph.D., and others, in the February 2006 Journal of the American Geriatric Society 54, pp. 231-239.

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