Pharmacologic Management of Non-Cancer Pain Among Nursing Home Residents
Pharmacologic Management of Non-Cancer Pain Among Nursing Home Residents
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DOI：
10.1016/j.jpainsymman.2011.12.285
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发表时间：
2013-01-01
影响因子：
4.7
通讯作者：
Kim, Myoung S.
中科院分区：
文献类型：
--
作者：
Lapane, Kate L.;Quilliam, Brian J.;Kim, Myoung S.
上下文疼痛是常见的养老院设置。描述在经历非癌症疼痛的疗养院（NH）居民中定期使用止痛药的情况，并评估与定期使用止痛药相关的因素。我们确定了2508名居民居住在185个主要来自一个营利性连锁店的NH之一，并在连续两次最小数据集评估中记录了疼痛。药房交易文件提供了详细的药物信息。Logistic回归模型调整的聚集居民在NHs确定相关因素的处方止痛药。23%的人没有预定的止痛药处方。与未定期使用止痛药的居民相比，定期使用止痛药的居民更有可能发生剧烈疼痛（5.5% vs. 1.2%）和中度疼痛（64.7% vs. 47.5%）。氢可酮（41.7%）、短效羟考酮（16.6%）和长效芬太尼（9.4%）是常见的，13.8%报告使用任何非甾体抗炎药。与定期使用镇痛药的几率降低相关的因素包括重度认知功能障碍（校正的比值比[AOR] 0.56; 95%置信区间[CI] 0.36 - 0.88）、年龄超过85岁（AOR 0.57; 95% CI 0.41 - 0.80）和帕金森病（AOR 0.55; 95% CI 0.30 - 0.99）。与定期使用镇痛药几率增加相关的因素包括骨折史（AOR 1.79; 95%CI 1.16 - 2.76）、糖尿病（AOR 1.30; 95%CI 1.02 - 1.66）和较高的最小数据集情绪评分（AOR 1.11; 95%CI 1.04 - 1.19）。在疼痛的药物管理的一些改进已经实现。然而，在没有预定止痛药处方的情况下出现疼痛仍然很常见。循证程序，以确保遵守临床实践指南疼痛管理在这种情况下是必要的。J Pain SymptomManage 2013; 45：33-42. (C)2013年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. Pain is common in nursing home settings.Objectives. To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use.Methods. We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics.Results. Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19).Conclusion. Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted. J Pain SymptomManage 2013; 45:33-42. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.