Nursing Home Residents Often Untreated for Chronic Pain

Many nursing home residents suffering from chronic pain don’t get any medication or don’t get enough to fully relieve their symptoms, a recent U.S. study suggests.

Researchers examined data on almost 1.4 million residents in nursing homes nationwide from 2011 to 2012 and found that overall, roughly two in five had either intermittent or chronic pain.

Among the residents with persistent pain, about 6 percent received no medication at all and another 32 percent didn’t get enough drugs to properly address their symptoms, the study found.

“The good news is that we documented lower levels of untreated pain than previous studies,” said lead study author Jacob Hunnicutt of the University of Massachusetts Medical School in Worcester.

“However, pain may still be undertreated and disparities in pain management by cognitive impairment and race/ethnicity remain,” Hunnicutt said by email.

Previous studies have estimated that at least 40 percent of nursing home residents experience persistent pain, and that 20 percent of those in pain don’t get any medications, researchers note in the journal Pain.

More than 1.4 million adults live in U.S. nursing homes, including about 3 percent of people over 65 and roughly 10 percent of people over 85.

For the current study, researchers examined data on nursing home residents who spent at least 100 days in the same facility with no gaps in residency of more than 30 days.

Residents provided information on the intensity and frequency of any pain they experienced as well as any medications provided during two assessments three months apart. Participants were counted as having persistent pain if they described pain on both assessments, and intermittent pain if they only mentioned it during one of the assessments.

If residents reported pain and didn’t have any scheduled or as-needed medications noted in their medical records, researchers counted them as having untreated pain. If their records only included as-needed pain medications, researchers counted them has having potentially undertreated pain.

Non-white residents were 19 percent more likely than white residents to have undertreated or untreated pain, the study found.

In addition, residents with severe cognitive impairments were 51 percent more likely to have untreated or undertreated pain than people with only mild impairments or none at all.

One of the study authors is a consultant with the pharmacy benefits manager and drugstore chain CVS Caremark.

Limitations of the study include the lack of data on pain levels between the two assessments, the authors note. Researchers also relied on residents to accurately recall and report on their own pain levels, which can be subjective.

The study also didn’t account for patient preferences or medical histories, said Dr. Gary Winzelberg, a geriatrics researcher at the University of North Carolina School of Medicine in Chapel Hill who wasn’t involved in the study.

“It’s possible that some patients prefer not to receive pain medications and may use non-pharmacologic approaches to managing their pain,” Winzelberg said by email.

Some residents might not believe they should report being in pain or think they shouldn’t take medications. This might at least partially explain why older adults, men and residents of color were less likely to report pain and receive medications, Winzelberg added.

Residents and families can see how nursing homes compare on pain management and other quality measures online, Hunnicutt said.

To avoid untreated pain, residents and their loved ones shouldn’t be shy about speaking up, said Dr. XinQi Dong of the Rush Institute for Healthy Aging in Chicago.

“Patients and family should seek help when the pain is beginning to rise, and not to wait until pain is intolerable before asking for pain medications,” Dong, who wasn’t involved in the study, said by email.

“After adequate assessment, health care professionals should provide an adequate mixture of long acting and short acting pain medications for those with chronic and inadequately treated pain,” Dong added.