3.g.ii Integration of Palliative Care into Nursing Homes, Module Two: Pain Management

This 60 minute presentation is an introductory course to basic pain management principles for residents on palliative care programs in the skilled nursing facility, specifically for the nursing staff (NP, RN, LPN) and physicians.  The objective of this course is to discuss pain management through three focus areas; the assessment of pain, pharmacologic interventions and nonpharmacologic interventions.  In assessment of pain, the meaning of pain is explored, and pain issues specific to older adults are reviewed.  The differences between acute and chronic or persistent pain are taught as well as the differences between the two main types of pain: nociceptive pain (including somatic and visceral) and neuropathic pain.  The challenges of assessing pain in the non-verbal older adult are reviewed and staff are encouraged to discuss the challenges they face with this population.  Pain at the end of life is also discussed with a review of how the four domains of palliative care and an interdisciplinary team approach are fundamental when assessing pain.  In pharmacologic interventions nonopioids, opioids, and adjuvants are described and how they are used with different types of pain.  For the opioid medications, issues regarding safety, adverse effects, challenges, physical dependence, tolerance, addiction and pseudoaddiction are explored. The principles of opioid rotation are taught, with an introduction to equianalgesic conversion for equivalent dosing.  Case studies are done as a group to practice converting opioids.  Different types of nonpharmacologic therapies are shown and staff are asked to choose between myths and realities of nonpharmacologic management.  Time is allotted for questions at the end of the presentation as well as for an evaluation of the presentation.  Upon completion of an anonymous evaluation the staff is awarded 1.0 CEU.