Plus ça change, plus c'est la même chose? Management of non-cancer pain in US nursing homes

Introduction: Pain is prevalent in nursing homes and lack of analgesic use among those with documented pain far too common. The Centers for Medicare & Medicaid Services (CMS) revised guidance for meeting compliance in the recognition and management of pain in nursing home residents (F-Tag 309) in 2009. Objectives: 1) To describe the extent to which pain and use of analgesics in US nursing homes has changed since 1992; 2) To explore potential improvements in pain management with implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 Methods: The Minimum Data Set version 2.0 provided information on daily pain and analgesic use. We identified studies evaluating pain management in US nursing homes in three time periods (1992-1995 (n=49,971); 1998-2000 (n=21,380); 2007-2009 (n=9,952). The implementation of revisions to the surveyors' interpretative guidelines for F-Tag 309 went into effect on March 31, 2009. Results: Pain prevalence was remarkably similar during each study period (26% 1992-1995; 29% 1998-2000; 25% 2007-2009). Estimates of prevalence of no analgesic use among residents with documented pain were also similar over time (25% 1992-1995; 25% 1998-2000; 23% 2007-2009). Pain was more likely to be documented in the period after revisions to surveyors guidelines were implemented. Increases in scheduled analgesic prescription were observed in the post-revision era. CONCLUSION: Little change in pain prevalence or reductions in absence of analgesic use among those with documented pain has been realized. However, revisions to the surveyors' interpretive guidelines may offer promise to improve pain documentation and management.