Pain Management in the Post-acute and Long-Term Care Setting: A Clinical Practice Guideline (CPG) from the Society for Post-acute and Long-Term Care Medicine (AMDA)

Abstract

This comprehensive clinical guideline addresses pain issues that arise in care of patients commonly seen in post-acute and long-term care settings, including very old and frail individuals with multiple chronic medical and psychiatric conditions, short-stay patients needing posthospitalization care, and younger adults with chronic diseases and disabilities. Its sections proceed along the steps of the clinical process, and hence include pain definition, recognition, and assessment; diagnosis and cause-effect analysis; identification of care objectives; selection of interventions from the wide range or potential options, including a discussion of appropriate and rational use of opioids; and monitoring of the progress and outcomes of management decisions. The guideline emphasizes treating pain in the context of each patient's overall condition and not as a separate issue. It includes discussion of such challenging issues as responsibilities and capabilities of the staff and practitioners, what to do when patients persistently experience high pain levels despite substantial doses of analgesics, and how best to address the expectations of relevant regulations and surveyor guidelines. By including numerous hypertext links within the document, the CPG facilitates finding related information in different sections as well as external references and resources that provide additional support.