Trends in prevalence for moderate-to-severe pain and persistent pain among medicare beneficiaries in nursing homes, 2006-2009

Abstract

Background. Managing pain for the elderly is challenging due to their concurrent illnesses, underreport of pain, complex clinical manifestation of pain and higher chance of medication-related side effects. The objectives of this study were (a) to evaluate trends in annual prevalence of moderate-to-severe pain and persistent pain among Medicare beneficiaries residing in nursing homes; and (b) to identify resident and facility characteristics associated with persistent pain. Methods. This was an observational study using linked data from 2006 to 2009 Medicare Current Beneficiary Survey and Minimum Data Set 2.0. Pain level was determined by a validated scale based on two items from Minimum Data Set 2.0 regarding frequency and intensity of pain. An episode of persistent pain was identified if moderate-to-severe pain reported at a Minimum Data Set 2.0 assessment was not alleviated at subsequent assessment. The Cochran-Armitage trend test was performed to detect trends in moderate-to-severe pain and persistent pain between 2006 and 2009. Generalize linear models using generalized estimating equation were used to identify characteristics associated with persistent pain. Results. Annual prevalence of moderate-to-severe pain consistently declined from 29.3% in 2006 to 22.2% in 2009 (p <21 days apart were associated with higher risks for persistent pain. Conclusions. Annual prevalence of moderate-to-severe pain has consistently declined among Medicare Beneficiaries in nursing homes. However, resolution of pain among residents experiencing moderate-to-severe pain was still problematic.