The Best of…Research Confronts Nursing Homes’ Pain-Management Problems

Published December 10, 2001, Pawtucket Times

         Nobody says that old age is easy, especially for those who ultimately end up being admitted into a nursing  facility.  And for those residing in facilities, there is a very high probability of being in pain, Brown University researchers say.  One of the first nationwide research studies reported in the Journal of the American Medical Association last April that pain is “prevalent, persistent and poorly treated in nursing facilities.”    

         According to the JAMA study, nursing facilities across the country provided “woe-fully inadequate pain management” with a large majority of the residents ultimately experiencing excruciating severe pain just months after admission.  Furthermore, the researchers acknowledged that the study results may even “underestimate the actual pain burden.

        The study noted that for those able to report on their pain, the rate of persistent pain in Rhode Island facilities was 46.4 percent. Nationally, the rate is 46.7 percent.  For those in pain, persistent pain left untreated experience impaired mobility, depression, and a reduced quality of life, the researchers say.
        The Rhode Island Quality Partners, Inc., Brown University Researchers and 18 Rhode  Island nursing facilities came together last year to confront this issue by improving  how nursing facility residents are assessed for pain and how pain is managed.   At a press conference held last month, it was reported that all facilities participating had put into place pain policies and procedures, which included both the use of medication management and non-drug interventions like massage, music and aroma therapies and heating packs.

        During the 15 month study, the participating nursing facilities attended two-hour educational seminars each month.   The seminars were conducted by the project partners and, with the assistance of nurse facilitators, each facility began to develop pain policies and procedures, and worked with the project partners to implement the treatment protocols.

       Preliminary findings show a nearly 10-fold increase in the rate of comprehensive assessment of pain among the 18 nursing facilities, as well as a five-fold increase in the use of pain intensity scales to monitor the resident’s pain.  Translation.  Nursing facility residents benefited from the facility’s efforts to confront this care issue.

       “Some Rhode Island facilities watch previously inactive residents begin to participate in a variety of activities.  Others found that residents could cut back on some of their medications once their pain was well controlled,” stated Dr. David R. Gifford, principal clinical coordinator with Rhode Island Quality Partners.

       “Nursing facilities were able to get together, share and work closely with each other to try to improve pain management, despite the staffing shortages, inadequate Medicaid reimbursement despite all the other regulations they are trying to comply,” Gifford told All About Seniors.  “The participating facilities deserve credit for putting the time and resources into the project to improve an area of care that every one is concerned about, that is inadequate pain management.”

       “Both scientific and professional literature clearly tell us that pain management has been an area that can be controlled but it has not been,” states Wayne Farrington, Chief, Facilities Regulation, at the State’s Health Department.  “Sadly nursing facility residents have been living with unnecessary pain and implementing the best practices that were determined by this research project will greatly enhance the quality of life in 103 Rhode Island facilities.” 

        Hopefully, the states nursing home industry will disseminate the methods and practices identified as being successful by this research project to every facility in the state.  At least in Rhode Island, nursing facility residents should not be suffering from unnecessary pain.

        Herb Weiss is a Pawtucket, Rhode Island-based writer covering aging, health care and medical issues.  This article appeared in December 10, 2001 in the Pawtucket Times. He can be reached at