Virginia Commonwealth University, Richmond, Virginia 23198, USA.
J Pain Symptom Manage. 2013 Jan;45(1):33-42. doi: 10.1016/j.jpainsymman.2011.12.285. Epub 2012 Jul 26.
Pain is common in nursing home settings.
To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use.
We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics.
Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19).
Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted.
疼痛在疗养院环境中很常见。
描述疗养院（NH）中患有非癌性疼痛的居民的计划镇痛使用情况，并评估与计划镇痛使用相关的因素。
我们确定了居住在 185 家 NH 中的 2508 位居民，这些 NH 主要来自一家营利性连锁机构，在两次连续的最低数据集中评估了疼痛。药房交易文件提供了详细的药物信息。对 NH 中居民聚类进行调整的逻辑回归模型确定了与计划处方镇痛药相关的因素。
23%的居民没有开处方镇痛药。与没有开处方镇痛药的居民相比，有计划使用镇痛药的居民更有可能出现剧痛（5.5% vs. 1.2%）和中度疼痛记录（64.7% vs. 47.5%）。常见的药物包括氢可酮（41.7%）、短效羟考酮（16.6%）和长效芬太尼（9.4%），13.8%的人报告使用任何非甾体抗炎药。与计划使用镇痛药的可能性降低相关的因素包括严重认知障碍（调整后的优势比[OR] 0.56；95%置信区间[CI] 0.36 至 0.88）、85 岁以上年龄（OR 0.57；95%CI 0.41 至 0.80）和帕金森病（OR 0.55；95%CI 0.30 至 0.99）。与计划使用镇痛药的可能性增加相关的因素包括骨折史（OR 1.79；95%CI 1.16 至 2.76）、糖尿病（OR 1.30；95%CI 1.02 至 1.66）和更高的最低数据设置情绪评分（OR 1.11；95%CI 1.04 至 1.19）。
NH 中疼痛药物管理的一些改进已经实现。然而，仍有许多疼痛患者没有开处方镇痛药。需要制定循证程序，以确保在这种情况下遵守疼痛管理的临床实践指南。
