A new report in JAMDA said chronic pain is an enduring issue in nursing homes, but despite its high prevalence, there is no definitive approach to managing this condition in older adults.

The study suggests that it is important for administrative nursing home leadership, the medical director, and the interdisciplinary team to work together to promote chronic pain management through a multipronged approach, with an emphasis on person-centered care.

In “Chronic Pain Management in Nursing Homes: Navigating the Challenges to Improve Person-Centered Care,” the authors stress that nonpharmacological means are under-used in nursing home settings but are the preferred first step to manage mild pain.

Nonopioid pharmacological agents should be added as a second step to manage moderate to severe pain. Opioids, commonly prescribed as a first step to manage chronic pain in this care setting, “should be used as a last resort,” according to the report’s authors.

“We want to emphasize that it is not necessarily inappropriate to prescribe opioids in older adults with chronic pain,” researchers said. Fears and myths about opioids, they added, sometimes have led to an “unnecessarily abrupt cessation of opioid prescriptions for older adults who need them for management of chronic pain.”

Challenges to the successful implementation of comprehensive chronic pain management at the nursing home may include ambiguous directions on specific therapeutic interventions, insufficient guidance on treatment duration, and limited availability of treatment options, the report said.

“Clinicians should carefully evaluate the need for continuation of chronic pain medications during their routine visits in nursing homes,” the authors said.

The facility administrative and clinical leadership, they noted, can promote appropriate opioid prescribing and deprescribing when indicated through an opioid stewardship program. Proper management of expectations of residents and their support systems is essential when such a multifactorial approach toward chronic pain management is taken.​