Health Staff And Relatives Underestimate Chronic Pain Experienced By SNF Residents

It saddens me to think of how much unrelieved and unacknowledged pain there is in the world.

Folks with dementia can present such a complex mix of needs. It akes very special folks to care for them.

That was the thing that ultimately made me very unhappy with homecare nursing. Approximately 7 out of 10 elderly clients had intractable pain that was interfering with their quality of life and the medical community was completely unsympathetic. I saw people who had been on opioids for an extended period of time and needed dosage changes but the physicians seemed afraid to provide the adjustments. It is as if they forget about tolerance issues and are more concerned about "addiction" and in the aftermath are scores of suffering people. Suffering grandmas and grandpas who have so much respect for the medical community that they dare not question the doctor's treatment of their pain...they believe it is just their "lot in life". And this was pain control in the elderly who COULD verbalize their pain!!! Oh those poor poor souls who cannot speak on their own behalf. I believe that geriatric care should be required to have a palliative component. In hospice we see EVERYDAY what adequate pain control adds to the daily life of a person. Trust me, it does not take morphine to make most elderly people comfortable and happy. Thanks for the articles.

Chronic pain can be very hard to judge.. , even in the non-demented patient. When something becomes part of your every day existence, yes, it is possible to carry on a conversation-even smile and laugh. This would be when it's REALLY important to interact, and ask questions as part of the assesment.

while i know we are not to "assume", i will so boldly "assume" that with old age, comes wear & tear, aches & pains.
shouldn't take rocket science to figure that one out.

sometimes we are just so damned stupid...
and heartless.

leslie

I think they don't care about addiction, as anyone on chronic opiates and opiods is already addicted. (meaning that they will suffer withdrawal symptoms unless weaned slowly)

I know they don't care about tolerance because what doctors do care about is the DEA looking at their prescription records. And yes, the result is lots of people in lots of pain.

May the DEA suffer intractable, undertreated pain. I bet we'd see some changes plenty fast. I wonder how Ted Kennedy's pain and the pain of other celebs is treated. I doubt they are made to suffer the way the common, powerless nobody is. Shame on doctors who won't go to bat for their patients and shame on the DEA for punishing and terrorizing doctors who dare to adequately prescribe narcotics.

I guess these patients should be referred to pain specialists. And they should probably be internists, not anesthesiologists because the latter seem to want to do only injections, not prescribe po or topical meds, PT, other therapies.

The DEA is out of control, I think, as noted by someone else on a post recently about Nursing Homes now having to present a hard copy of a prescription for Vicodin, etc., which is going to mean that lots of residents in facilities that do not now stock such meds will be in lots of pain during the evening and night hours, weekends and holidays, when pharmacies don't deliver to them. shameful and I hope families get up in arms about it. There's no reason to make these residents suffer.

With the DEA already interferring with the practice of pain management, I wonder if government health care will make things worst. There will be even more government intrusion into medical practice. If the DEA is already intimidating doctors in what they prescribe, what will happen if the government also has access to all of our medical records? Now, the DEA can look at records for cases that they are suspicious about. What if the government could access records at any time for any reason, especially in order the "cut costs"? Or address "the problem of prescription medicine abuse"? I can see tables that doctors will have to follow to manage pain, including types of pain managment, doses, limits on medications prescribed, ect. I would rather have doctors, patients, and family members decide in the care of people, and not have a government program arbitrarily decide what medicines and at what dosages patients would be able to receive.
The situation about causing nursing homes to jump through "more hoops" to give Vicodin to patients, I wonder WHY is this happening? Is it fear of lawsuits? A new state/federal law? Fears of management or doctors? To "increase safety"?

There must be a complete overhaul in how chronic unremitting pain is perceived and treated. The FDA is totally out of control and has rendered physicians helpless should they even have the inclination to believe the patient and treat her pain. The tendency when a patient goes to an ER with another CC altogether but moves slowly and carefully and/or groans when she moves, the tendency is to assume those things are part of the window dressing to get narcotics. I was active and athletically inclined before I suddenly and without any prior warning, had a CVA caused by small blood vessel disease which paralyzed my left side (the dominant side.) Before my stroke, I had had severe arthritis since I was in my mid-teens and I coped with increasing levels of pain using PT-style ice bags and heat packs, buffered ASA and kept moving because I was young and because slowing down really hadn't occurred to me. Throughout the years, I skied, hiked, took a walking tour of Europe, swam, played tennis, golf, did aerobics, worked out in the YW gym, did periodic PT PRN, and just kept dancing with a smile on my face
(to paraphrase Ginger Rodgers.) Fast Forward to now. I'm almost 60, doing the same type of PT and muscle retraining that injured sports figures do -- 3X a week for 3 hours (or so) a session. As sensation and use returns to my left side, I have been having agonizing pain as muscles come alive again. The good news about that is that that type of pain is transient and once the muscles are in use again, it usually abates. I have injured both knees, have a 7cm tear in my rt. rotator cuff, arthritic, stiff and painful fingers, have had cortisone injected into both shoulders, both knees, both thumbs, both ankles. I've had Synvisc injected bilaterally in my knees 4 times with excellent results and the fifth time (last month) had a reaction neither the ortho, his PA, or the drug company claimed to have seen or heard of before. Excruciating and unremitting pain and I was unable to walk or even move my legs much. There is a hx of addiction in my family and I'm terrified to start taking narcotic painkillers. I can no longer take NSAIDS at all because they caused an ulcer. I still tx my pain, which varies from a 4 to about a 9.5 and never goes below a 4. I use the same type of frozen gel packs and heat packs my PT clinic uses plus beanbags I heat in the microwave, Extra strength Tylenol, and a Rx stimulator PT ordered for me to use at home. Does this regime work? Sort of... Some days ... But what are my alternatives?? I cope because I have no alternative.

sharpeimom

I have a dear frend who is the end stages of her battle with cancer. She was at home with hospice, but is now in a hospice facility, due to intractable pain. Thank God for her ability to go to such a facility. The fact that some md's are afraid of addictionin this type of case is just insane...Bless the nurses who are caring for her-you are her angels here on earth..

This is not about nursing home patients with dementia who aren't being medicated properly, it's about patients in general who aren't being treated for pain properly. I know what the AMA says- Pain is pain and needs to be treated til the patient get relief- but in truth it's lip service. I am a chronic pain patient and my pain doc has just gone through his 18th state peer investigation because he has the audacity to treat his pain patients with ~~gasp~~~ enough pain medication to control their pain! He has not one addicted patient, nor one who diverts. Granted all of us who depend on pain meds every day have developed a physical tolerance to them- that is not addictive behavior. Yes, I do have symptoms of physical withdrawal at at times. Addiction is when you crave the drug no matter how much you are given. Let's be clear on that.

Yes, patients all over are under medicated, because those who have the courage to prescribe what they need for comfort and dignity get harassed by their peers!!!! I know of one pain doc who gave up prescribing because of the invasive and demeaning investigations which took place constantly. He couldn't handle the emotional distress of it anymore.

So yes, unfortunately, until the AMA really believes that patients are in pain, whether demented and acting uncomfortable or alert and oriented and able to state their case about where, how and what their pain is all about, our patient population is going to be ill treated, period.

It is a pity that palliative care isn't considered in most patients care plans, unless they are hospice patients or very lucky chronic pain patients who have found doctors who have the wherewithall to simply take care of them.