title: Pain reports and pain medication treatment in nursing home residents with and without dementia.
abstract: OBJECTIVE
  The purpose of this pilot study was to determine if a diagnosis of dementia influenced pain self-reports and pain medication use in a group of verbally communicative nursing home (NH) residents.
  
  
  METHODS
  The study design was a between groups, cross-sectional chart audit and a seven-question structured pain interview comparing outcomes in residents with and without a diagnosis of dementia. The study was carried out at a large metropolitan NH in the southern USA. The participants consisted of 52 long-stay NH residents capable of self-consent with at least one order for pain medication (opioid or non-narcotic) either pro re nata, scheduled or both. Approximately 40% (n = 20) had a diagnosis of dementia.
  
  
  RESULTS
  Although each group had similar pain-related diagnoses, residents without a dementia diagnosis were significantly more likely to have a medication order for an opioid (OR 4.37,95% CI 1.29-14.73, P = 0.018). Based on self-reported pain interview responses, no statistically significant differences were identified between the groups for chronic pain symptoms. However, among residents who reported current pain, those with a dementia diagnosis reported greater pain intensity (based on a 0-10 numeric rating scale) than did those without dementia (median 8.0 vs 6.0, respectively; P = 0.010).
  
  
  CONCLUSIONS
  Verbally communicative NH residents with mild and moderate cognitive impairment can report their pain symptoms and pain intensity. Nurses in long-term care might assume that residents with dementia cannot reliably self-report their pain; however, suffering from untreated severe pain could exacerbate cognitive impairment, worsen functional impairment and severely impair sleep. A brief, focused pain interview might be one method for increasing the detection of moderate to severe pain in verbally communicative NH residents with dementia.
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, Tennessee, USA; Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Monroe
authors.forename: Sumathi K
authors.initials: SK
authors.lastname: Misra
authors.forename: Ralf C
authors.initials: RC
authors.lastname: Habermann
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Cowan
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications* / Q000523:psychology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D010147:Pain Measurement; D010865:Pilot Projects; D057566:Self Report
chemical_list: D000700:Analgesics
keywords: clinical medicine; dementia; nursing; pain; pain assessment; quality of life; sociomedical science
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