title: Interventions to address deficits of pharmacological pain management in nursing home residents--A cluster-randomized trial.
abstract: BACKGROUND
  To evaluate the effect of interventions for general practitioners and nursing home staff to improve pain severity and appropriateness of pain medication in nursing home residents (NHR).
  
  
  METHODS
  This cluster-randomized controlled trial was conducted in six nursing homes in the intervention and control group, respectively. Pain management was analysed before (T0) and after (T1, T2) an educational intervention in 239 NHR, aged ≥65 years, without moderate or severe cognitive impairment. Primary and secondary outcomes were average pain severity and appropriateness of pain medication as determined with the Numeric Rating Scale and Pain Medication Appropriateness Scale (PMASD ), respectively.
  
  
  RESULTS
  At T0, 72.2% and 73.7% of NHR (mean age 83 years) reported pain (average pain severity 2.4) in the intervention and control group, respectively. The PMASD at T0 was 53.9 in the intervention group and 60.8 in the control group (p = 0.12), while 20.6% compared to 6.9% (p = 0.009) received no pain medication in the two groups. At T2, non-significant improvements in the average pain severity (1.59) and PMASD (61.07) were observed in the intervention group. Moreover, the mean individual PMASD increased by 8.09 (p = 0.03) and the proportion of NHR without pain medication decreased by 50% (p = 0.03) in the intervention group. No appreciable changes were found in the control group at T2.
  
  
  CONCLUSIONS
  NHR exhibited a high prevalence of pain with overall low severity, while a high proportion of individuals received inappropriate pain medications. Both findings were not significantly improved by the intervention, although some aspects of drug treatment were meaningful improved.
authors.affiliation: Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Könner
authors.affiliation: Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Budnick
authors.affiliation: Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kuhnert
authors.affiliation: Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Wulff
authors.affiliation: Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kalinowski
authors.affiliation: Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Martus
authors.affiliation: Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Dräger
authors.affiliation: Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kreutz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D059408:Pain Management / Q000379:methods* / Q000706:statistics & numerical data; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics