Algorithm Boosts Pain Management in Patients with Dementia

PRT Improves Patient Care

The double-blind randomized controlled trial involved 6 Taiwanese dementia special care units, each serving 30 to 35 residents. Registered nurses in units assigned to the experimental group received 4 hours of PRT instruction and 6 hours of basic pain education; those in the control group received basic pain education alone.

PRT consisted of a 4-step process, each with several concrete actions: primary pain assessment, secondary pain assessment, pain treatment, and reassessment at regular intervals.

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Primary and secondary patient outcome measures included average weekly self-reported scores for pain intensity and behaviors, and average weekly frequency of agitated behaviors, respectively. The three primary outcomes for RNs were the total number of pharmacologic strategies, nonpharmacologic strategies, and referrals per week.

Results at 3-month follow-up showed that the addition of PRT to basic pain education yielded a significant increase in nurses’ weekly use of nonpharmacologic strategies and number of referrals.

Patients treated by nurses with both PRT and basic pain education showed significantly greater improvements in self-reported and behavioral expressions of pain than those in the control group, a result the investigators attributed to better pain management.

There were no differences observed between groups in terms of agitated behavior, but the authors speculate that even with PRT training, RNs lack the necessary knowledge to identify and treat the underlying causes.

Similarly, use of pharmacologic therapies — as prescribed by clinicians — was not altered by PRT training of RNs.

Implementation Challenges

Common barriers to pain management in elderly patients with dementia include a lack of knowledge among nursing home staff regarding effective pain assessment and management techniques, and the erroneous belief that pain is an inevitable consequence of aging.