Up to 80% of dementia patients living in nursing homes also experience pain, but many struggle to communicate their symptoms.

A new, $2.1 million study aims to test recently revised guidelines for staff members tasked with detecting and managing that pain. Researchers also plan to infuse pain management strategies — including non-pharmacological interventions and more personalized approaches —  into daily operations and organizational culture.

Barbara Resnick, PhD, RN, professor and associate dean for research at the University of Maryland School of Nursing, will lead the project at 12 nursing homes over the next five years.

“We don’t do a good job of assessing, diagnosing the underlying cause of the pain and then managing it,” Resnick told McKnight’s Long-Term Care News Tuesday. “We don’t in general with anyone, but particularly not in older adults, and particularly not in people who are living with dementia. They can’t express it, and it’s hard to interpret pain symptoms.”

The study, supported by a grant from the National Institutes of Health’s National Institute on Aging, builds on a previous pilot in two facilities. Resnick contributed to the development of AMDA’s revised Pain Management Clinical Practice Guideline, which will be implemented and studied as staff improve their pain management skills.

“We try through this study to have staff use multiple different ways to look for pain and then also, really get people to think about what could be the cause of this pain,” Resnick said. “Sometimes, it’s as simple as a fingernail digging into your hand. There can be a sore somewhere that nobody relied was there.”

Assessing and evaluating better

The study will emphasize non-drug solutions such as repositioning, ice, heat, distraction and music that have been proven to be effective pain relief strategies. The goal is to make staff more cognizant of the need to deploy them, and to understand when they should be used before or in conjunction with medications.

“What we’re testing is how to implement the use of a clinical practice guideline for pain management in nursing home residents so that the staff will use it, the staff will help make sure that the residents will engage in the behaviors that they need to, for example, range of motion exercises,” Resnick said.

“Mostly what we are looking at are staff behaviors with regard to residents, and they’re all things that we’re required to do,” she added. “Assess and evaluate pain: That’s a requirement, but that doesn’t mean that it always gets done in the best way possible.”

There will also be a focus on improving documenting and care planning to include more personal recommendations that are re-evaluated on an ongoing basis. Should a patient need pain medication, implementing the guideline should present opportunities to reassess that need and, potentially, deprescribe or reduce dosage, Resnick said.

The study pairs each facility testing with a nurse facilitator who will work with an on-site champion over a full year. They will follow a four-pronged approach that: 

  • establishes and meets monthly with a stakeholder team
  • educates staff
  • mentors and motivates staff to address pain
  • evaluates resident pain outcomes on an ongoing basis.

Throughout the study, researchers will track whether the interventions decrease pain intensity among nursing home resident participants and evaluate whether treatments are delivered competently and as intended.