Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents

Mbrah, Attah; Nunes, Anthony P.; Hume, Anne L.; Zhao, Danni; Jesdale, Bill M.; Bova, Carol A.; Lapane, Kate L.

doi:10.1097/j.pain.0000000000002525

Cited by 15 publications

(12 citation statements)

References 42 publications

(81 reference statements)

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“…Concerning neuropathic pain, this study revealed that CPSP (chronic post-stroke pain) was the dominant and the fourth most prevalent principal chronic pain condition overall. This is contrary to a large study from US nursing homes 28 that reports peripheral types of neuropathic pain, like polyneuropathies, but not the central ones. However, we found one study that specifically investigated neuropathic pain in nursing home residents reporting CPSP.…”

Section: Discussioncontrasting

confidence: 99%

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Myrenget

Borchgrevink

Rustøen

et al. 2022

Pain

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Pain management for patients with dementia is challenging because many experience pain while being unable to communicate their pain. The aim of this study was to describe pain, pain management, and to perform a thorough clinical examination of chronic pain conditions among patients with dementia. Residents (n 5 498) from 12 nursing homes were assessed for dementia (Clinical Dementia Rating scale [CDR]) and for pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) assessment form. Of all examined nursing home patients with dementia, 68% had moderate or severe chronic pain. The final study population (n 5 262) with a CDR score of $1 and a MOBID-2 score of $3 were examined by pain expert physicians for chronic pain and categorized according to the International Classification of Disease (ICD-10/-11) classification systems. More than half (54.6%) had chronic pain conditions without underlying disease classified as chronic primary pain by ICD-11. Chronic widespread pain was the most prevalent (14.5%) followed by nonspecific pain from the back (13.4%), whereas the most prevalent chronic secondary pain conditions were chronic pain caused by osteoarthritis (15.4%) and stroke (8.0%). One-fourth received opioids, which was significantly associated with severe pain (P , 0.001) compared with moderate pain, although no significant association was found between opioid use and the type of pain condition. Although knowledge of the severity and specific types of pain conditions is recommended to direct the choice of treatment, these areas are not sufficiently explored in the nursing home populations with dementia and may hinder a better treatment of pain in this population.

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Section: Discussioncontrasting

confidence: 99%

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Myrenget

Borchgrevink

Rustøen

et al. 2022

Pain

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“…In the present study, we did not directly examine the pain subtypes associated with antiepileptic use among NH residents with ADRD, which would enhance our findings. For example, a recently published study found that nearly 15% of NH residents nationwide had a neuropathy diagnosis, and that nearly half of those residents had an antiepileptic prescription fill, primarily gabapentin 31 . However, researchers note that pain subtypes can be underreported in administrative data, at least compared to self‐reports, and that there are low rates of sensitivity for some diagnoses, including neuropathy 32–34 .…”

Section: Discussionmentioning

confidence: 99%

“…For example, a recently published study found that nearly 15% of NH residents nationwide had a neuropathy diagnosis, and that nearly half of those residents had an antiepileptic prescription fill, primarily gabapentin. 31 However, researchers note that pain subtypes can be underreported in administrative data, at least compared to self-reports, and that there are low rates of sensitivity for some diagnoses, including neuropathy. [32][33][34] Other methods of inquiry, including qualitative work and chart reviews, along with more claims-based analyses would help gain insights into the clinical decisions that are driving these trends.…”

Section: Discussionmentioning

confidence: 99%

Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications

Candon

Strominger

Gerlach

et al. 2022

J American Geriatrics Society

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Background Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications. Methods Using the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long‐term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain. Results Our study sample includes 973,074 persons living with ADRD who had a long‐term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain. Conclusions Antiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk–benefit for dementia care warrants further scrutiny.

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“…This may be particularly true of institutionalized older adults, who often experience self-report incapacities. 27 Taken together, these issues may contribute to problems diagnosing neuropathic pain outside of specialty settings. Moreover, the modest to moderate benefit of conventional analgesics for neuropathic pain may factor into treatment uncertainties among HCPs and lack of pain relief among patients.…”

Section: Discussionmentioning

confidence: 99%

Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey

Dale

Cioffi

Novak

et al. 2023

Canadian Journal of Pain

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Background Continuing professional development is an important means of improving access to effective patient care. Although pain content has increased significantly in prelicensure programs, little is known about how postlicensure health professionals advance or maintain competence in pain management. Aims The aim of this study was to investigate Canadian health professionals’ continuing professional development needs, activities, and preferred modalities for pain management. Methods This study employed a cross-sectional self-report web survey. Results The survey response rate was 57% (230/400). Respondents were primarily nurses (48%), university educated (95%), employed in academic hospital settings (62%), and had ≥11 years postlicensure experience (70%). Most patients (>50%) cared for in an average week presented with pain. Compared to those working in nonacademic settings, clinicians in academic settings reported significantly higher acute pain assessment competence (mean 7.8/10 versus 6.9/10; P < 0.002) and greater access to pain specialist consultants (73% versus 29%; P < 0.0001). Chronic pain assessment competence was not different between groups. Top learning needs included neuropathic pain, musculoskeletal pain, and chronic pain. Recently completed and preferred learning modalities respectively were informal and work-based: reading journal articles (56%, 54%), online independent learning (44%, 53%), and attending hospital rounds (43%, 42%); 17% had not completed any pain learning activities in the past 12 months. Respondents employed in nonacademic settings and nonphysicians were more likely to use pocket cards, mobile apps, and e-mail summaries to improve pain management. Conclusions Canadian postlicensure health professionals require greater access to and participation in interactive and multimodal methods of continuing professional development to facilitate competency in evidence-based pain management.

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Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents

Abstract: Supplemental Digital Content is Available in the Text. The prevalence of pain among nursing home residents who are not receiving analgesics or adjuvants suggests a need to improve pain diagnosis and management procedures.

Cited by 15 publications

References 42 publications

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Chronic pain conditions and use of analgesics among nursing home patients with dementia

Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications

Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey

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