A retrospective review of pain management in Tasmanian residential aged care facilities

Article Figures & Data

Table 1. Pain management strategies prescribed to the ACF population (n = 477)

Analgesic	n (%)
Any analgesic	438 (91.8)
Regularly dosed analgesic	305 (63.9)
As required analgesics	321 (67.3)
Both as required and regularly dosed analgesics	188 (39.4)
Only as required analgesics	131 (27.5)
Regularly prescribed paracetamol	272 (57.0)
As required paracetamol	212 (44.4)
Oral non-steroidal anti-inflammatories, regularly dosed	16 (3.4)
Oral non-steroidal anti-inflammatories, as required	13 (2.7)
Tricyclic anti-depressant	14 (2.9)
Gabapentinoids	40 (8.4)
Regularly prescribed opioids^a	139 (29.1)
Buprenorphine patch	73 (52.5)
Extended release oxycodone/naloxone	28 (20.1)
Weak opioids (tramadol; paracetamol with codeine)	17 (12.2)
Immediate release oxycodone	11 (7.9)
Extended release oxycodone	8 (5.8)
Extended release morphine	5 (3.6)
Fentanyl patch	5 (3.6)
Morphine in a syringe driver	4 (2.9)
Immediate release morphine liquid	2 (1.4)
Hydromorphone	2 (1.4)
Tapentadol	1 (0.7)
As required opioids^{^a}	169 (35.4)
Immediate release oxycodone	68 (40.2)
Morphine sulphate injection	38 (22.5)
Paracetamol with codeine	36 (21.3)
Morphine liquid	19 (11.2)
Codeine phosphate	12 (7.1)
Tramadol	11 (6.5)
Hydrocodone	4 (2.4)
Extended release oxycodone/naloxone	1 (0.6)
Fentanyl injection	1 (0.6)

↵^aPercentage does not equal 100% because some residents were prescribed more than one regular opioid or 'as required' opioid.

Table 2. Cause of pain and treatment modalities prescribed on ACFI assessment

	n (%)
Cause of pain (n = 382)
Musculoskeletal, lower extremities Back or neck pain Musculoskeletal, upper extremities Generalised joint pain Visceral pain Neuropathic pain Post-fracture/osteoporosis pain Inflammatory joint conditions Headache/migraine Cancer-related pain	191 (50.0) 134 (35.1) 112 (29.3) 32 (8.4) 17 (4.5) 15 (3.9) 13 (3.4) 13 (3.4) 11 (2.9) 3 (0.8)
Treatment plan (n = 477)^{^aa}
Analgesics Heatpacks Massage Repositioning Rest Gentle exercise/physiotherapy programme One-on-one calming Elasticated garment Technical equipment, for example TENS	337 (70.6) 237 (49.7) 206 (43.2) 151 (31.7) 117 (24.5) 90 (18.9) 47 (9.9) 12 (2.5) 11 (2.3)

↵^aResidents were often documented as having a pain treatment plan even if there were no documented pain causing condition

Table 3. Baseline demographics and patient characteristics of those with and without dementia

	Residents with dementia, n (%)(n = 215)	Residents without dementia, n (%)(n = 262)	P value
Mean age, years (IQR)	85.7 (79.7–90.6)	87.3 (80.9–91.5)	0.07
Female	80 (48.5)	177 (56.9)	0.26
Mean number of regular medicines (IQR)	7 (5–10)	9 (6–12)	<0.01
ACFI pain assessment
ACFI pain-causing condition	163 (75.8)	219 (83.6)	0.03
ACFI analgesics	135 (64.3)	193 (74.2)	0.02
ACFI NPT	152 (70.7)	211 (80.5)	0.01
Medication chart
Any analgesia	199 (92.6)	239 (91.2)	0.60
Regularly prescribed	137 (63.7)	169 (64.5)	0.86
As required only	61 (28.4)	70 (27.7)	0.69
RD paracetamol	121 (56.3)	151 (57.6)	0.77
RD opioid	57 (26.5)	83 (31.7)	0.22
MEQ RD opioid, mg (IQR)	0 (0–6)	0 (0–10)	0.22
Pain experience
≥2 pain experiences per week	30 (14.0)	52 (19.8)	0.09