[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/kaasalainen1.jpg” caption=”Sharon Kaasalainen, assistant professor of McMaster’s School of Nursing. Photo courtesy of FHS.”]Residents in long-term care facilities who require pain management represent an extremely vulnerable population, and their pain is often overlooked unintentionally because of the challenges and barriers to obtaining accurate pain assessments.

A recent McMaster University study, funded by the Canadian Institutes of Health Research – Institute of Aging, explored the attitudes and beliefs of doctors and nurses in four long-term care facilities in Hamilton around prescribing and administering pain medications to older adults living in long-term care, particularly residents with cognitive impairment.

Results of the study, published in the Western Journal of Nursing Research, highlight the need to develop supportive mechanisms for health care providers to help them make decisions related to managing pain within an individualized approach to care.

“Efforts are desperately needed to develop and evaluate standardized approaches to pain assessment, so that pain can be regularly and properly assessed and ultimately alleviated in this vulnerable population,” said Sharon Kaasalainen, an assistant professor of McMaster's School of Nursing and lead investigator on the study. “Without appropriate assessment tools and sufficient knowledge, staff are left empty handed to manage pain for this population who have limited verbal abilities.”

“The impact of dementia for residents appears to have a significant influence on physicians' and nurses' decision making,” she said. “It is a common challenge across all aspects of pain management.”

Through a series of one-to-one and group interviews with doctors and nurses about the barriers and processes for optimum pain management, two major themes were identified: pain assessment (lack of recognition of pain and uncertainty about the accuracy of pain assessment and diagnosis); and treatment (reluctance to use opiates, working to individualize pain treatments, and issues relating to physician trust of the nurse on prescribing patterns.)

Recommendations included more education on pain management, including the use of opiates; regular assessment and documentation of pain; better management of pain from end-stage diseases; implementation of a pain protocol; a worksheet to assist nurses when communicating with physicians over the phone; individualized pain treatment plans and negotiation of goals with the resident and a family member; involvement of other health care providers to help manage resident pain (e.g., personal support workers, nurse practitioners, pharmacists, physiotherapists, social workers); and making pain management a priority for discussion during shift reports and care conferences.

“We still haven't reached that goal where people are dying pain free…never mind dying pain free, they should be living pain free,” said a nurse who participated in the study.