Pain Management for Nursing Home Residents

Work led by Jake Hunnicutt, MPH, PhD Candidate has demonstrated improvements in pain management in nursing homes since the landmark JAMA article in 1998 documenting that nearly one third of nursing home residents in daily pain did not even receive an aspirin. Jake's paper "Pain and pharmacologic pain management in long-stay nursing home residents" published in Pain,  found that  20% of long-stay nursing home residents were in  persistent pain. Of those in persistent  pain 6% received no pharmacologic pain management, though nearly one-third may have been potentially undertreated by not receiving regular scheduled analgesics.

While ‘the needle appears to have moved’, we believe we have entered a new phase of pain research in nursing homes whereby we need to improve pain recognition and in particular identify pain symptom clusters.  

The 2011 Institute of Medicine report “Relieving Pain in America” called for a cultural transformation in understanding and managing pain. The PHARE Study Group believes a personalized medicine approach is consistent with this call to action. President Obama’s Council of Advisors on Science and Technology defines personalized medicine as tailored medical treatment for patients based on shared characteristics within a defined subgroup “uniquely or disproportionately susceptible to a particular disease or responsive to a specific treatment.” The work the PHARE Study group is conducting leverages a national repository of rich longitudinal data to evaluate the extent to which such transformative approaches can be applied to an important public health problem –non-malignant pain. The proposed research addresses the information needs of a growing segment of the population—frail, clinically complex, nursing home residents— typically excluded from clinical trials.