Survey of analgesic use for nonmalignant pain in long-term care facilities in southern California.
OBJECTIVE
Many residents in long-term care facilities experience nonmalignant pain, and analgesic therapy is often inadequate in this setting. We examined the management of chronic nonmalignant pain in elderly nursing home residents.


METHODS
Retrospective chart review.


METHODS
Forty skilled nursing facilities in southern California.


METHODS
Residents with a diagnosis of noncancer pain who were receiving a regular regimen of prescribed analgesics.


METHODS
The following information was recorded: demographic data, specific diagnosis for pain medication, all analgesics in current use by the resident, whether a pain rating score was available for the resident and, if so, the current score.


RESULTS
Of the 3400 resident charts screened, 381 residents (11.2%) met the criteria for inclusion in the study. There were 443 diagnoses for chronic nonmalignant pain, primarily arthritis and other musculoskeletal disorders. Of 510 prescriptions for analgesics, 52% were for acetaminophen or nonsteroidal antiinflammatory medications. Centrally acting analgesics, primarily opioids, accounted for 48% of all prescriptions. Approximately three-fourths of opioid prescriptions were for fixed-dose combinations with acetaminophen, and 15% were for long-acting opioids. Pain scores were not recorded on any of the residents' charts.


CONCLUSIONS
Nonmalignant pain in these elderly nursing home residents was often associated with musculoskeletal disorders and was not assessed systematically. Without routine pain assessments, it is not possible to determine whether the residents' pain was being treated adequately by the analgesics prescribed. We recommend a multidisciplinary approach to the institution of pain assessment and management guidelines in long-term care facilities.
Fujimoto
D
D
Western Region Clinical Coordinator, PharMerica, San Marino, CA, USA.
Coluzzi
P H
PH