June 2003  Vol. 1, Issue 3

BENCHMARKS
IN BEHAVIOR MEDICINE

This complimentary, informative newsletter is intended to increase awareness and knowledge of mental and behavioral health issues of older adults in the long-term care community.

A Briefing From Vericare

Part I: Assessment of Chronic Pain
 
A Little History of Vericare

Vericare (formerly Senior Psychology Services) is the leading national provider of mental health and behavior medicine services to older adults in residential and skilled nursing settings. Begun in 1991, our services today include traditional psychotherapy, behavior medicine, psychiatry, social work, psychological testing and behavior management programs.

In addition, Vericare is a leader in providing continuing education to a variety of professionals to help them develop new skills and maintain excellence in their field.

The experience of pain is a significant factor in the lives of many older adults. Increased physical illness associated with aging can lead to acute and/or chronic pain. Acute pain is related to a specific pathological condition or tissue damage. The duration of acute pain is usually limited by the expected time frame for healing. Chronic pain, however, continues beyond the expected healing time and is operationally defined as pain that persists for more than 6 months. The persistence of chronic pain triggers further complications from emotional, social, interpersonal, and environmental factors.

Community dwelling older adults experience some pain 25% to 50% of the time. Comparatively, the prevalence of pain in long-term care settings is higher, ranging from 49% to 83%. In long-term care the four most common types of chronic pain disorders are (1) low back pain, (2) arthritis, (3) previous fractures, and (4) neuropathies. Chronic pain not only diminishes functioning and quality of life, it is also associated with increased (1) sleep disturbance, (2) depression, (3) health care costs, and (3) physical disability. Older adults with pain have a three times greater risk of disability than their pain-free counterparts.

Since the development of a chronic pain disorder is a consequence of many factors, its assessment requires an interdisciplinary approach. Team members may include a physician, nurse, psychologist, physical and/or occupational therapist, and caregivers.

The ultimate goal of the assessment is to focus on areas for intervention that will result in effective pain relief and minimize the risk of disability.

The components of a comprehensive assessment include a chart review, medical evaluation, imaging and/or diagnostic testing, interview with the patient and/or family, and a psychosocial evaluation of functional pain status. The psychosocial evaluation addresses (1) pain experience, (2) impact of pain, (3) co-morbidities, (4) cognitive abilities, beliefs, attitudes and expectations, (5) pain behaviors, (6) exercise, activity and sleep, (7) psychological status and coping skills, (8) social support, (9) readiness for change, and (10) environmental factors.

Throughout the assessment, remember that older adults have a higher pain threshold, and tend to report pain as less intense than would a younger counterpart.

Based on the results of the comprehensive pain assessment, a treatment plan is developed. The treatment plan may include the use of pain medication, injection or infusion therapies, electro-stimulation, physical and/or occupational therapy, acupuncture, psycho-education, cognitive-behavior therapy, mind-body therapies, and the treatment of co-morbidities.

Next Issue: Part II: Behavior-Based Treatment of Chronic Pain
 
 

© 2003 Vericare Management, Inc.

 

Vericare
Quality Provider of Mental Health Care Services
4715 Viewridge Avenue, Suite 230
San Diego, CA 92123-1680
Vericare is one of the country's leading provider of quality mental health care
to older adults in skilled and residential settings.
Employment opportunities for psychologists, psychiatrists, social workers,
and nurse practitioners/clinical nurse specialists.
Pennsylvania, Texas, New Jersey, Delaware, Florida, California, Arkansas
 

Vericare - Benchmarks in Behavior Medicine

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