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Management of Chronic Pain in Nursing Homes, Rehabilitation Facilities, Long-Term Care Facilities, Prisons and on the Psychiatric Unit 

Management of Chronic Pain in Nursing Homes, Rehabilitation Facilities, Long-Term Care Facilities, Prisons and on the Psychiatric Unit
Chapter:
Management of Chronic Pain in Nursing Homes, Rehabilitation Facilities, Long-Term Care Facilities, Prisons and on the Psychiatric Unit
Author(s):

Michael Lubrano

, Yury Khelemsky

, Todd Ivan

, and Karina Gritsenko

DOI:
10.1093/med/9780199349302.003.0014
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date: 18 October 2019

This chapter examines barriers to appropriate management of chronic pain for institutionalized patients, in nursing home, in rehabilitation facilities, and on the psychiatric floor. Chronic pain is typically undertreated in these settings. This problem becomes further complicated because patients in these institutions can be very sick and are not always capable of speaking for themselves. The barriers to adequate pain control include transfer miscommunications, poor medication reconciliation, cognitive deficits and other patient comorbidities, and issues with polypharmacy and adverse drug interactions. Only short-term use of opioids is recommended for patients with chronic non-cancer pain with psychiatric comorbidities. Opioids can be used temporarily to facilitate rehabilitation but then preferably patients should be weaned off them. When a patient is admitted to the psychiatric floor on high-dose opioid therapy, chronic pain management services should be consulted, and a plan for weaning from opioids should be discussed with the patient.

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