Often in the course of our day as therapists and nursing care givers, we encounter numerous complaints of pain and discomfort from our long term residents. How do you respond? Pain is a complex sensory and emotional experience and is a subjective, multidimensional experience unique to each individual. Each and every resident complaint of pain must be acknowledged and, in some manner, clinically addressed to ensure optimal functional outcome during the rehabilitation phase of treatment as well as for the ongoing status of the resident’s quality of life.
Pain is twice as prevalent in the elderly as in younger individuals and in the nursing home approximately 26-45% of our resident population experience daily pain. Pain can be influenced by several factors including anxiety, depression, and fear in addition to physical impairments and diagnoses that frequently result in pain sensation. These emotional states are frequently related to admission to the nursing home, particularly if it is a fists time admission. Negative consequences of unmanaged pain in LTC can result in poor sleep patterns, falls, decreased appetite, deconditioning, and social withdrawal. Pain is not a normal part of aging and can often be managed effectively with a comprehensive pain assessment.
Pain assessment by both the nursing staff and therapy team is crucial to successful management. The interdisciplinary team must use a consistent pain measurement scale whether that is the Visual Analog Scale (VAS) or the Wong-Baker Faces Scale, possibly in combination with the Short-Form McGill Pain Questionnaire which rates sensory pain and intensity. Once the pain is rated by the resident and aspects of the contributing diagnoses and impact of co-morbidities is reviewed by the care plan team (including the physician) a plan of intervention can begin.
The team must be open to modifying and flexing the plan until the most effective treatment is determined. Often, therapy can provide non-pharmaceutical interventions that work successfully such as moist heat, icing, electrical stimulation and ultrasound. Therapy also can assess seating, positioning of limbs, and adaptive equipment. The medical team can assess whether the pain is related to joint or soft tissue problems or whether the pain is muscular or neurological in origin and prescribe an effective medication. It is also helpful to remember there is often a psychological component to pain and interventions such as relaxation techniques and environmental factors (reducing noise and dimming lighting) could also help to decrease the pain response.
So, what are we responding to our residents who are experiencing pain?