Acute Pain Management in Hospitalized Patients with Cognitive Impairment: A Study of Provider Practices and Treatment Outcomes

Background.  Despite new guidelines and nationally mandated regular assessments, managing pain in cognitively impaired patients remains a complex and challenging task. Numerous studies have focused on assessing pain in this population; however, studies of treatment are limited. Purpose.  The purpose...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2010-10, Vol.11 (10), p.1516-1524
Main Authors: Mehta, Sonal S., Siegler, Eugenia L., Henderson, Jr, Charles R., Reid, M. Carrington
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Analgesics - administration & dosage
Analgesics - adverse effects
Analgesics - therapeutic use
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - adverse effects
Analgesics, Opioid - therapeutic use
Cognition Disorders - complications
Cognitive ability
Cognitive Impairment
Data Interpretation, Statistical
Delirium - chemically induced
Delirium - psychology
Dose-Response Relationship, Drug
Female
Fractures, Bone - complications
Health Personnel
Hospitalization
Humans
Male
Pain
Pain - complications
Pain - psychology
Pain Management
Pain Measurement - methods
Physicians
Population studies
Retrospective Studies
Treatment Failure
Treatment Outcome
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Summary:Background.  Despite new guidelines and nationally mandated regular assessments, managing pain in cognitively impaired patients remains a complex and challenging task. Numerous studies have focused on assessing pain in this population; however, studies of treatment are limited. Purpose.  The purpose of this article was to characterize assessment and pain management strategies used by providers caring for hospitalized cognitively impaired patients with acute pain, and to assess for associations between amount of opioid received and specific adverse outcomes in this patient population. Methods.  Medical records of patients admitted to the Geriatrics Service or Orthopedic Service or evaluated by the Geriatrics Consult Service at an urban tertiary care hospital between September 01, 2006 and September 30, 2007 with cognitive impairment and an acute pain problem on admission were reviewed. Results.  Participants (N = 100) had a mean age of 86 years (range = 68–99), and were mostly female (83%) with fracture‐related pain (62%). A numeric pain score was recorded in 67% of nursing assessments vs
ISSN:1526-2375
1526-4637
DOI:10.1111/j.1526-4637.2010.00950.x