Pain Management

While chronic or persistent pain may be common in older adults, it is not a normal part of the aging process. Most people living in a nursing facility (NF) have at least one condition that causes pain, and more than 60% of these people have experienced some amount of pain. Persistent pain, or insufficient treatment for pain, can lead to adverse outcomes including depression, sleep disturbances, changes in appetite, falls and an increase in functional impairment.

Successful pain management programs include processes for completing comprehensive pain assessments, along with reevaluations to determine the effectiveness of treatment. Standardized, evidence-based assessment tools are an important component of any pain management program. A variety of valid and reliable assessment tools are available, including tools developed specifically for evaluating people with dementia or other cognitive impairments. Each person should have a comprehensive pain assessment completed on admission, quarterly thereafter and whenever there are changes in the person’s condition. The comprehensive pain assessment serves as the baseline from which care planning will be initiated and measurable goals established.

Care planning is an ongoing interdisciplinary or interprofessional process initiated at the time of a person’s admission to a NF. Interventions should be based on identified factors from the pain assessment process, with measurable goals that address the person’s preferences, expectations and needs. NFs should periodically evaluate the effectiveness of interventions and the revise a care plan as necessary to reflect changes in the pain assessment. The goal for pain management and the best possible outcome is the adequate relief and control of pain, using opioid medications only when deemed clinically necessary.

The toolkit below includes evidence-based resources that will assist facility staff in developing effective systems for pain management.

Resources Created by HHS

Resources from Other Organizations

AMDA – The Society for Post-Acute and Long-term Care Medicine (PALTC) is a professional association of medical directors, attending physicians and others practicing in the long-term care continuum who are dedicated to defining and improving quality through interprofessional development, evidence-based clinical guidance and advocacy. 

American Society for Pain Management Nursing (ASPMN) is an organization of nurses with a mission to advance and promote optimal nursing care for people affected by pain through education, standards, advocacy and research.

American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics health care professionals dedicated to working across patient care, research, professional and public education, and public policy to improve the health, independence and quality of life of all older people.

International Association for the Study of Pain (IASP) is a global organization supporting the study and practice of pain and pain relief. IASP brings together scientists, clinicians, health care providers and policymakers from around the world in pursuit of their mission to bring relief to those who are in pain.

American Academy of Pain Medicine (AAPM) is an organization for physicians practicing the specialty of pain medicine in the U.S. AAPM is dedicated to advancing multidisciplinary pain care, education, advocacy and research to improve the quality of life for our members and those they treat.

Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain is a clinical tool to help clinicians and patients work together to make informed, patient-centered decisions about pain care. | The University of Iowa provides access to free evidence-based pain assessment tools, pain management strategies and resources to help identify and manage pain in older adults.