title: Trends in prevalence for moderate-to-severe pain and persistent pain among Medicare beneficiaries in nursing homes, 2006-2009.
abstract: BACKGROUND
  Managing pain for the elderly is challenging due to their concurrent illnesses, underreport of pain, complex clinical manifestation of pain and higher chance of medication-related side effects. The objectives of this study were (a) to evaluate trends in annual prevalence of moderate-to-severe pain and persistent pain among Medicare beneficiaries residing in nursing homes; and (b) to identify resident and facility characteristics associated with persistent pain.
  
  
  METHODS
  This was an observational study using linked data from 2006 to 2009 Medicare Current Beneficiary Survey and Minimum Data Set 2.0. Pain level was determined by a validated scale based on two items from Minimum Data Set 2.0 regarding frequency and intensity of pain. An episode of persistent pain was identified if moderate-to-severe pain reported at a Minimum Data Set 2.0 assessment was not alleviated at subsequent assessment. The Cochran-Armitage trend test was performed to detect trends in moderate-to-severe pain and persistent pain between 2006 and 2009. Generalize linear models using generalized estimating equation were used to identify characteristics associated with persistent pain.
  
  
  RESULTS
  Annual prevalence of moderate-to-severe pain consistently declined from 29.3% in 2006 to 22.2% in 2009 (p < .01), while approximately 60% of beneficiaries experienced persistent pain annually (p = .50). Younger age, moderate initial pain, presence of diabetes, and skilled nursing home stays with assessments <21 days apart were associated with higher risks for persistent pain.
  
  
  CONCLUSIONS
  Annual prevalence of moderate-to-severe pain has consistently declined among Medicare Beneficiaries in nursing homes. However, resolution of pain among residents experiencing moderate-to-severe pain was still problematic.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore. xshen@umaryland.edu.
authors.forename: Xian
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Palmer
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D010146:Pain / Q000453:epidemiology*; D010147:Pain Measurement; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Epidemiology.; Nursing Home Issues; Pain