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.
The UTEP women�s tennis team (0-1 C-USA, 4-12 overall) will look to end its regular season on a high note when it hosts Interstate-10 rival NM State (3-2 WAC, 8-12 overall) at the El Paso Tennis and Swim Club on Friday, April 14. First serve is 11 a.m.
For the first time since March 4, the Miners will have six players at their disposal. The team has been besieged by injuries and has played its last three matches with only four players.
It will also mark the last time seniors Daphne Visscher and Duda Santos, who will return from an injury, will play in front of their home crowd. The two will be honored before the event.
Defending their court alongside Visscher and Santos will be Milou Pietersz, Raven Bennett, Lois Wagenvoort and Maria Paula Medina.
Last Sunday, the Miners fell 4-0 to UTSA in the only Conference USA match of the season, but not easily. Bennett and Visscher were leading the Roadrunners� Sonia Medina Madronal and Denisa Ibrahimovic 5-3 before their match was called and left unfinished.
Pietersz battled with the Intercollegiate Tennis Association�s No. 99 ranked singles player in Miriam Rosell but fell short 6-1, 6-4. Wagenvoort was leading UTSA�s Charleen Tiwari 6-2, 4-3 before the match was called and Maria Paula Medina, who returned after being cleared from a concussion, took the first set from Linda Hallgren 6-3 and was playing in a 2-all set on court four before the match was called.
The Aggies boast the reigning Western Athletic Conference Player of the Week in freshman Rebecca Keijzerwaard, who went 3-0 last week in NM State�s non-conference action against Western New Mexico and UTSA. Keijzerwaard has a team-best 4-2 record in dual action and teams up with fellow freshman Vanessa Valdez at the No. 1 spot in doubles. The duo has recorded a 5-2 record.
The UTEP men�s basketball team will look to blend a mix of returning talent with promising newcomers when it plays three preseason games in Costa Rica this August.
�The significance of this is that we have a terrific group coming in, seven new players that will be added to our core group of returners,� UTEP coach Tim Floyd said on Wednesday.� �This trip gives us a tremendous opportunity to bring these young guys along and get them better.�
The trip is slated for Aug. 15-20, and fans are invited to join the team in Central America.� Travel packages will be available for purchase, with details forthcoming.
Floyd said the teams the Miners face will be composed of professionals from Central and South America, as well as �the best players Costa Rica can offer.�
College basketball teams are permitted to take a foreign tour once every four years.� This will be the first foreign tour by a UTEP men�s basketball squad since the 2005-06 club traveled to Spain and the Canary Islands.
Perhaps the best thing about the tour, besides the cultural and game experience, is the fact that the Miners will get 10 days of practice in El Paso ahead of time.
�It gives our team a chance to get off to a better start than we had last year,� Floyd said.
The 2016-17 Miners rallied from a 2-13 start to finish 13-4 and tie for third place in Conference USA with a 12-6 mark.
I�ve had a ton of fun coaching you all this week! There�s been a pretty good vibe and buzz around the gym lately and it�s awesome to be able to be a part of.
Today�s metcon should be handled as a sprint interval workout. This simply means that when it�s your turn to work, you need to try and move quickly because you will have a decent amount of rest in-between your individual working rounds. Have fun!
-Jon Jon
Strength:
Superset x 5:
10 Bench Presses @ 60%
10 Difficult Ring Rows (weighted, if necessary)
*rest about 2 minutes between sets
Metcon:
Teams of 2 (alternating every round, relay style):
6 Rounds:
200m Run
25 Wallballs
4 Rounds:
200m Run
25 GHD Situps (if there aren�t enough machines, x2 sit-ups)
Wondering exactly how much protein you should be consuming each day?�The Recommended Dietary Allowance (RDA), which is the minimum amount you need to be healthy, is 0.8 grams per kilogram (0.36 grams per pound) of body weight per day�46 grams for an average woman. That equals as little as 10% of daily calories. If you’re not super active, that’s likely adequate, and you’ll hit the target effortlessly if you follow a typical Western diet.
To get your personal protein “RDA,” multiple the number 0.36 by your weight in pounds. (For a sedentary 150-pound woman, that would be 54 grams.) Double it if you’re very active or aiming for “optimal protein,” which can help you maintain muscle as you age and support weight loss.
American women already eat about 68 grams a day, according to the latest data from the National Health and Nutrition Examination Survey. “There’s no reason to go out of your way to get protein,” says Dariush Mozaffarian, MD, dean of the Tufts Friedman School of Nutrition Science & Policy. “Just eat a variety of fish, nuts, beans, seeds, and dairy, including yogurt.”�However, increasing your protein well above the RDA may make sense if…
That means getting at least 35 to 40 minutes of moderate exercise four or five days a week, including resistance training two or more times a week. Consider eating 1.2 to 2 grams of dietary protein per kilogram (or about 0.5 to 0.9 grams per pound) of body weight each day, says Nancy Rodriguez, PhD, professor of nutritional sciences at the University of Connecticut. That amount is best for rebuilding muscle tissue, especially if you do a lot of high-intensity workouts, research suggests.
Protein takes longer to digest than carbs, helping you feel full, and also pushes your body to secrete the gut hormone peptide YY, which reduces hunger. “When you bring protein to about 30% of your daily calories, you’ll naturally eat less,” says Lauren Slayton, RD, founder of Foodtrainers, a nutrition practice in New York City, and author of The Little Book of Thin. “Protein decreases appetite and also, in my experience, helps you manage cravings.”
While studies are mixed about whether consuming more protein leads to weight loss, research is pretty clear that protein can help you retain more of your lean muscle as you lose fat. One 2011 study suggests amping up protein to as much as 1.8 to 2 grams per kilogram (roughly 0.8 to 0.9 grams per pound) of body weight per day to stave off muscle loss when restricting calories. Cut back on refined carbs to balance out the extra calories from adding protein.
Eating more protein as you get older may help you maintain muscle and ward off osteoporosis, “so you can stay stronger and more functional,” says Rodriguez. In a 2015 study, adults over the age of 50 who roughly doubled the RDA (eating 1.5 grams of protein per kilogram, or 0.68 grams per pound, of body weight) were better able to rebuild and retain muscle after only four days, compared with control groups eating the RDA.
Doubling the RDA gives you “optimal protein,” a concept that Rodriguez and more than 40 nutrition scientists advanced at a recent Protein Summit, the findings from which were published in 2015 in The American Journal of Clinical Nutrition. Optimal protein works out to be about 15% to 25% of your daily calories, still below the level recommended by many popular high-protein diets. Over a day, that could look like 20-30 grams per meal and 12 to 15 grams per snack, for a total of 90 to 105 grams daily.
A pain medicine specialist is a medical or osteopathic doctor who treats pain due to disease, ailment, or injury. Many of these doctors are physiatrists or anesthesiologists although called interventional pain management specialists or pain medicine. Pain medicine is a mutlidisciplinary team effort generally affecting specialists in other disciplines, complimentary alternative medicine, along with radiology, psychiatry, psychology, oncology, nursing, physical therapy, and the patient’s primary care physician or other treating doctor.
Education & Training
After graduating medical school and completing a one-year internship, the physician enters a residency program normally in physical or anesthesiology medicine but sometimes from other fields like psychiatry and neurology. Upon conclusion of a residency program (typically 3 years long), the physician completes a one-year fellowship for advanced training in pain medicine.
Many pain medicine specialists are board certified. The organizations that board certify physiatrists, anesthesiologists, neurologists, and psychiatrists all collaborate to provide the board examination for the subspecialty of Pain Medicine. You can find numerous opportunities for pain management specialists to remain current with medical and technical improvements in pain medicine, such as scientific journals and society meetings.
Targets of Pain Management
The goal of pain medicine is to handle severe or long-term pain by reducing intensity and pain frequency. Besides addressing pain problems, a multidisciplinary pain management program may address your functional goals for activities of day-to-day living. Overall, a pain medicine plan aims to give you a feeling of well-being, increase your level of action (including return to work), and reduce or eliminate your reliance on drugs.
Many Kinds of Pain Treated
Pain medicine specialists treat all sorts of pain. Severe pain is described sharp or as acute and may indicate something is wrong. The pain experienced during dental work is an instance of intense pain. Pain lasting 6 months or longer is defined as chronic. This type of pain varies from mild to serious and is consistent. Spinal arthritis (spondylosis) pain is frequently chronic. A good consequence is produced by uniting different treatments regularly although chronic pain is difficult to handle.
Degenerative disc disease
Facet joint pain
Sciatica
Cervical and lumbar spinal stenosis
Spondylolisthesis
Whiplash
What to Anticipate During an Appointment
Your appointment with a pain or interventional pain management practitioner is much like other doctor visits. Although there are many similarities, the focus is fast managing it, and on your pain, the cause or contributing factors.
Pain medicine physicians execute a physical and neurological examination, and review your medical history paying particular focus on pain history. You may be asked many questions about your pain
On a scale from zero to 10, with 10 being the worse pain imaginable, speed your pain.
When did pain start? When pain started, what were you doing?
Does pain disperse into other regions of the body?
Is its intensity persistent, or is it worse at different times of night or the day?
What really helps to alleviate the pain? Why is pain worse?
What treatments have you ever attempted? What worked? What failed?
Would you take over the counter drugs, vitamins, or herbal nutritional supplements?
Does one take prescription medication? If so, what, how much, and how frequently?
Most pain medicine specialists utilize a standardized drawing of the front/back of the body to let you mark where pain is sensed, as well as indicate pain spread and type (eg, light, sharp). You may be asked to complete the form each time you see with the pain physician. The finished drawing helps you to evaluate your treatment progress.
Accurate Analysis Key to Treatment
Pain medicine includes diagnosing origin or the cause of pain. Making the proper identification may include getting an X ray, CT scan, or MRI study to verify the reason for your neck pr back pain. When treating spine-associated pain (which may include arm or leg symptoms), other tests, like discography, bone scans, nerve studies (electromyography, nerve conduction study), and myelography could possibly be performed. The proper analysis is crucial to some favorable treatment plan.
Some spinal ailments and pain treatment requires involvement of other specialists, such as your primary care physician, neurosurgeon, orthopaedic surgeon, and practitioners in radiology, psychiatry, psychology, oncology, nursing, physical therapy, and complimentary alternative medicine. The pain medicine specialist may consult with and/or refer you to a neurosurgeon or orthopaedic spine surgeon to determine if your pain difficulty necessitates back operation.
When you�re in pain, you might try just about anything to feel better. Claims of miracle cures that instantly relieve back and neck pain are tempting, but they often fall short of their promises.
Save your money and steer clear of the products featured promising to eliminate your spine-related pain.
Copper Bracelets
Copper bracelets and wristbands have attracted a following of arthritis sufferers because of their perceived ability to reduce joint pain.
The key word here is perceived.
A 2013 study in the UK examining the effects of copper bracelets in patients with rheumatoid arthritis found no difference in pain outcomes between those wearing copper bracelets and those using a placebo.
While the bracelets won�t do you any harm, they�re more for looks than clinical benefit. There�s no solid medical evidence available proving they reduce pain or inflammation.
Magnets
From magnetic shoe inserts to bandages, magnets have been heavily marketed as a miracle cure to zap away a variety of back pain conditions, including fibromyalgia and arthritis. However, no proof exists to back up magnets� health claims.
While studies have examined magnets� impact on pain, the results are mixed�and the quality of some of the research is questionable. Additionally, magnets are not safe for some people, including those who use pacemakers or insulin pumps.
Colloidal Silver
Silver jewelry? Classic. Silver home furnishings? Sure thing. Colloidal silver for your spine pain? Never a good idea.
Colloidal silver for back pain is typically found as a topical cream containing small particles of silver. In 1999, the U.S. Food and Drug Administration (FDA) recommended that people not use colloidal silver to treat any medical condition because it�s neither safe nor effective.
Even worse than the false claims of back and neck pain relief are colloidal silver�s strange and serious side effects. This product can interfere with the absorption of some prescription drugs and even permanently tint your skin a blue-gray color.
DMSO and MSM Dietary Supplements
If you have spondylosis (osteoarthritis), you may have heard of the dietary supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM). Some believe this pair of supplements can block pain and inflammation, but no real medical evidence shows these substances actually relieve painful arthritis symptoms.
Instead of eliminating your arthritis pain, MSM and DMSO might cause some unwanted side effects. Both have been linked to causing upset stomach and skin rashes, while DMSO may also leave you with garlic breath and body odor.
A Word on Drug-Supplement Interactions
Speaking of supplements, it�s important to understand that dietary supplements may not mix with over-the-counter or prescription drugs. Some interactions result in mild side effects, but others can be much more serious�even life-threatening.
If you�re using a dietary supplement�even if it�s a seemingly benign herbal or vitamin�always let your doctor and pharmacist know before taking it with an over-the-counter or prescription medication. They will share any dangerous interactions, and ensure you�re safely addressing your back and neck pain.
The Real Deals: Alternative Treatments that Work
Many who fall prey to the products listed in this slideshow have an interest in alternative or complementary therapies for back and neck pain. While some non-traditional treatments should be avoided, many have been proven to reduce spine pain.
Scientists from the National Center for Complementary and Integrative Health at the National Institutes of Health reviewed 105 U.S.-based trials from the past 50 years that included more than 16,000 participants. They found the therapies below effective at controlling pain:
� Acupuncture � Massage � Relaxation techniques � Tai chi
If you prefer alternative methods to manage for your spinal condition, explore the therapies above. They are effective, safe, and will help you live a healthier life.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
