An Evidence-Based Guideline on Pain Assessment in Nursing Homes For Residents and Informal Caregivers.

BACKGROUND: Nursing home residents are often affected by pain. Pain assessment aims to determine pain intensity and quality. An evidence-based guideline on pain assessment in nursing homes was developed to support residents and informal caregivers in archiving an adequate pain assessment prerequisite to pain treatment. AIM: The residents' guideline presents key recommendations that is comprehensible and accessible to residents and informal carers. DESIGN: We conducted a content analysis. SETTING/SUBJECTS: Therefore, all recommendations of an evidence-based guideline for pain assessment in nursing home were evaluated on relevance for supporting residents' decision-making process. METHODS: Two researchers conducted the content analysis independently and as a result, 29 recommendations could be included. In addition, representatives of a support-group organization for patients with pain validated the derived recommendations. RESULTS: The present residents' guideline of pain assessment consists of nine thematic categories, written in laymen's terms to enable older persons to make informed choices and optimizing their own pain management process. CONCLUSIONS: The Guideline is available in print format and ready for implementation to enhance the effects on maintaining the physical and psychological well-being and optimal care of older adults in Nursing Homes.

Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline.

Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting, such as resident's age, staff skill mix, and overall aims of the care provided, also need to be taken into account. Therefore, an interdisciplinary evidence-based clinical practice guideline for pain assessment in the nursing home setting was developed. A systematic literature search was carried out covering publications between 2003 and 2015. Thirty-nine studies were included in the preparation of this guideline, supplemented by 12 international reference guidelines. Recommendations were subjected to a structured consensus-finding process with representatives from 37 scientific and professional organizations and patient representatives. The guideline underwent independent peer review before finalization. It comprises 62 recommendations that are grouped into 4 chapters: (1) context of pain assessment in nursing home care; (2) screening; (3) focused assessment; and (4) reassessment/monitoring of pain. Main recommendations stipulate that clinicians should assess the patient's ability to provide self-report of pain when screening for pain and that each resident should be screened for the presence of pain. A focused assessment of pain, performed during rest and activities, should include pain intensity, changed behaviors, general mobility, pain history, comorbidities, and pain medication. Pain should be re-assessed at regular intervals using the same instruments that were used for the focused assessment. Guideline development demonstrated that many aspects of pain assessment in older persons have not received adequate research attention so far. Available studies predominantly possess only low levels of evidence. Therefore, research into this area needs to be systematically developed to address questions of clinical relevance to support patient care.

[Nonpharmacological pain therapy for chronic pain]. / Nichtmedikamentöse Schmerztherapie bei chronischem Schmerz.

The treatment of chronic pain should be a multimodal combination of pharmacological and nonpharmacological components. This article describes some of the nonpharmacological treatment options and their evidence (e.g. physical therapy, massage, manual therapy, electrotherapy, acupuncture and music therapy). The evidence for an empirically detected effectiveness of all these forms of therapy is not very high and often inconsistent. Nevertheless, this does not mean that these forms of treatment should not be used but that they should be selected on an individual basis to improve the well-being of patients by being adjusted to their needs.