Call to Improve Pain Management in LTC
by Tim Gieseke, MD, CMD
Vice President, CALTCM
 

I was at the national AMDA meetings in Florida when the new guidelines for opiod use in non-cancer pain were released by the CDC (available JAMA online March 15, 2016).  I groaned as I thought of my increasing load of patients with complex persistent pain who come to me from the hospital on > 90 MME (morphine mg equivalents) along with their pneumonia, hip fracture, back surgery, SBE, or other acute illness.  Some of them will report a 10 as their current level of pain which will generate the call from their nurse for me to “do something”.  When I receive those calls, I hope that the nurse has done a comprehensive assessment, but frequently find that the front line busy nurse has relied on the self-reported pain # as their assessment rather than using available free comprehensive assessment tools available at www.geriatricpain.org for the cognitively intact or the cognitively impaired patient.

In searching for a bedside pain assessment tool that combines numeric, faces, activity, and qualitative measures, I did find a tool, which would allow a nurse to improve the accuracy of self-reported pain. If a facility's policy is to use such a tool, a nurse would not be required to blindly accept a self-reported 10, if it conflicts with the other descriptors of the pain.  This is in fact what most physicians do when assessing the severity of pain.  Click here for sample pain tool.

I like the ACP (American College of Physicians) synopsis of the CDC guideline and the helpful consumer education tools in that synopsis as well as the referenced CDC Pain Checklist.  It has a helpful tool for monitoring persistent pain over time called a PEG tool using 3 questions about their pain over the preceding week re:  Pain intensity, their ability to Enjoy life, and General activity.  This synopsis can be found at http://www.acpinternist.org/weekly/archives/2016/3/22/index.html#1

As the CDC guidelines and March 31 NEJM article on Opioid Abuse in Chronic Pain point out, our challenge is to manage persistent pain effectively and safely.  With the overdose death rate quadrupling in the last 15 years and the ER visits for opioid ODs increasing by a factor of 6, we must accept the challenge and develop the skills of every member of our team, to be a part of the solution, rather than contributing to this worsening nightmare.

At CALTCM, our President, Dr. Debra Bakerjian, has been on the cutting edge helping facilities meet this challenge.  Please come to our annual meeting and hear her presentation on this important subject.