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New assessment scale confirms that pain is prevalent and often untreated in nursing home residents

A recent study found that over half of the residents in Michigan nursing homes suffer from moderate to severe pain, and that the most cognitively impaired residents are least likely to report their pain. This suggests that pain is prevalent and often goes untreated in nursing homes, concludes John N. Morris, Ph.D., of the Hebrew Rehabilitation Center for the Aged in Boston.

Dr. Morris and his colleagues validated a summary scale of pain types, intensity, and frequency—a Minimum Data Set (MDS) pain assessment instrument—to examine pain prevalence among 34,675 Michigan nursing home residents. The study was supported in part by the Agency for Healthcare Research and Quality (HS09455).

On the MDS pain assessment items, 32 percent of patients indicated no pain, 16 percent had mild pain, 27 percent had moderate pain, and 25 percent reported "horrible" pain. Also, 16 percent of current residents and 28 percent of postacute care patients had symptoms of daily pain. The most frequent site of pain was the back. More cognitively impaired residents, who were usually sicker as well, were less likely to report pain. For example, 31 percent of cognitively intact versus 69 percent of the most cognitively impaired residents admitted for postacute care reported no pain; and 40 percent of cognitively intact versus 79 percent of severely impaired residents in the longer staying post-acute admission group reported no pain.

The MDS Pain Scale was highly predictive of Visual Analogue Scale (VAS) pain scores (a simple 1 to 10 rating scale), considered the gold standard for assessing pain. The researchers conclude that the MDS Pain Scale is easier to administer than the VAS and is a simple way to summarize the reported presence and intensity of pain using routinely collected nursing home MDS data. Federal regulations require that nursing homes periodically collect MDS data on physical and cognitive function, medications, and so forth for every resident to improve care planning. Clearly, the MDS Pain Scale can indicate which residents need pain relief to improve their quality of life.

See "Pain in U.S. nursing homes: Validating a pain scale for the minimum data set," by Brant E. Fries, Ph.D., Samuel E. Simon, M.A., Dr. Morris, and others, in The Gerontologist 41(2), pp. 173-179.

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