• Thomas Hadjistavropoulos, Sharon Kaasalainen, Jaime Williams, and Ramesh Zacharias.
• Department of Psychology, University of Regina, Regina, SK, Canada; Center on Aging and Health, University of Regina, Regina, SK, Canada. Electronic address: Thomas.hadjistavropoulos@uregina.ca.
• Pain Manag Nurs. 2014 Dec 1; 15 (4): 748-59.

AbstractAn ongoing concern in long-term care (LTC) is that pain problems are often not identified correctly. There is also evidence that behavioral disturbance due to pain is misattributed to psychiatric conditions and consequently frequently treated with psychotropic rather than analgesic medication. This can result in unnecessary polypharmacy and ineffective pain management. In a previous study, implementation of a pain assessment protocol resulted in changes in administration of pro re nata (PRN) medications and positive outcomes. However, there were no changes in regularly scheduled medications suggesting that assessment results were either not communicated to the prescribing physicians or not taken into account. The goal of this study was to determine whether a pain assessment protocol, augmented with communication of the assessment results to the residents' physicians, affects prescriptions of analgesic and psychotropic medication. Psychotropic medication reduction would help address the problem of polypharmacy frequently seen in LTC facilities. PRN medications were also examined. This investigation involved a two group design (control vs. assessment). A mixed methods analysis included both quantitative and qualitative procedures. At the end of the study, residents in the pain assessment group were administered fewer psychotropic medications than patients in the control group, helping address the problem of polypharmacy. Pain levels were comparable between the groups. Health care staff indicated that the protocol resulted in more careful evaluation of residents' pain and greater appropriateness of prescriptions including reductions in polypharmacy.Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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