By Amanda Boundris
A new study led by McMaster University researchers found that use of a pain protocol, involving an interdisciplinary pain team and pain assessment tools, improved the way pain was managed and provided pain relief for long-term care (LTC) residents.
Numerous studies indicate that as much as 83 per cent of older adults in LTC experience pain, and that pain in this population is consistently undertreated, especially for residents who have cognitive impairments like dementia. With more than 75 per cent of LTC residents having cognitive impairments and the Canadian population aging at an unprecedented rate, researchers say that identifying effective pain management strategies is a high priority.
In research appearing online in the Journal of the American Medical Directors Association, associate professor of nursing Sharon Kaasalainen and her colleagues looked at the use of a pain protocol involving a series of steps that guide decision-making around the recognition, assessment, treatment and monitoring of pain.
The pain protocol was applied over one year using a pain team made up of staff from administration, family medicine, advanced practice nursing (APN), pharmacy, nursing, personal support workers, social work and physiotherapy. It involved pain education and outreach visits; skills training; reminders about pain assessment tools; and APNs positioned as onsite change champions.
A controlled before-after design was used to evaluate the effectiveness of the pain protocol, and qualitative interviews and focus groups with staff were used to obtain additional context-driven data. Four long-term care (LTC) facilities in southern Ontario were used in this study: two for the intervention group and two for the control group. Data were collected from 200 LTC residents at an average age of 82.6 years in the intervention group and 83.6 years in the control group.
Kaasalainen and her team found that pain increased significantly more for the control group than the intervention group, indicating the pain protocol was working. Though resident pain was higher in both the intervention and control groups, the researchers noted possible explanations for this: pain increases with age; staff may have become more aware of residents’ pain as a result of the study itself; and the study may have created an environment that encouraged residents to express their pain to staff.
In addition, the study states that staff generally reported positive outcomes, and most participants said it triggered them to think more about pain management in day-to-day care of their patients.
The findings are important because they show that "Interventions aimed at improving pain in long-term care need to be multifaceted and interdisciplinary in order to produce positive outcomes," said Kaasalainen.
The next steps are to build on this research "by exploring the cost-effectiveness of it and developing better ways to facilitate communication among all team members, including physicians, pharmacists and personal support workers, to improve pain management practices," she added.
This research was supported by funding from the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care.