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

• Opioids: An Epidemic Crisis (PDF) is a resource for prescribers, consultant pharmacists and facility staff as they work to ensure the appropriate use of opioid medications for those living in NFs. 
• Evidence-Based Best Practice for Pain Management (PDF) summarizes the key elements of an effective nursing pain management program.
• Pain Management Care Plan Highlights (PDF) can assist NF staff in developing person-centered care plans for pain management.
• Pain Scale Determination Process (PDF) may be used to assist nursing staff in identifying the best pain scale to use based on a person’s cognitive and verbal abilities.
• Understanding Pain Communication (PDF) identifies common painful conditions in older adults and offers suggestions for discussing pain with residents. The handout also outlines behavioral cues that could indicate the presence of pain in people with cognitive impairments.
• Onset, Peak and Duration of Common Pain Medications (PDF) identifies common medications used to manage pain and the onset of action, peak effect and duration of each of those medications.
• Interdisciplinary/Interprofessional Team Process in the Management of Pain (PDF) outlines the role of the interdisciplinary and interprofessional team in an effective pain management system.

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.

GeriatricPain.org | 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.

• Clinicians Core Principals for Pain Assessment (PDF) outlines key concepts that should guide a clinician’s approach to pain assessment. 
• Pain Assessment in Cognitively Intact Older Adults outlines the research-validated assessment tools appropriate for use in older adults who are cognitively intact. 
• Fast Facts: Selected Pain Assessment Tools (PDF) provides more detailed information about assessment tools for people who are cognitively intact, including instructions for their use. 
• Numeric Rating Scale (PDF) is a validated pain scale, designed for use with people who can point to or state the number that reflects their current pain level. 
• Pain Assessment in Cognitively Impaired Older Adults discusses the methods and tools that can be used when assessing pain in people with cognitive impairment.
• Clinicians Guidelines for Pain Assessment in Cognitively Impaired Older Adults (PDF) outlines key concepts for pain assessment in older adults with cognitive impairment, including recommendations for specific assessment tools based on the person’s level of cognitive impairment.  
• Pain Behavior Tool Critique (2023) provides information about assessments designed for use with people who have cognitive impairments, including the reliability and validity of each tool. 
• Core Principles of Pain Management (PDF) outlines the underlying principles for managing pain in older adults. 
• Pain Management Interventions provides additional information about interventions for managing pain in older adults. 
• Pain Management Communication Form (PDF) is an example of a tool that can be used to communicate information about a person’s pain to the attending physician or prescriber. 
• Institutional Commitment to Pain Management (PDF) identifies the key steps to developing a successful pain.