Daily pain that was excruciating at some time in the previous week: Prevalence, characteristics, and outcomes in nursing home residents

OBJECTIVES: To examine the prevalence, correlates, and consequences of nursing home (NH) staff reports of "excruciating" level of pain at some time in the previous week in persons with daily pain reported on the Minimum Data Set (MDS). DESIGN: Cross-sectional study. SETTING: NHs in the United States. PARTICIPANTS: A total 2,138,442 persons who resided in 15,745 nursing homes in the United States. MEASUREMENTS: Pain reported as daily and at its most excruciating in the previous week on the MDS at initial and follow-up assessment. Associations were examined with demographic characteristics, functioning, and measures of disease burden reported on the MDS. RESULTS: NH staff noted that 80,512 (3.7%) of residents had daily pain that was at one or more times excruciating in the previous week. This level of pain was more prevalent in younger residents. Nearly two-thirds (62.1%) of persons with this level of pain were no longer independent in activities of daily living, but 48.8% were rated to have normal cognitive status. In contrast, those without daily pain that was sometimes excruciating were less likely to be cognitively intact (25.7%P<.001) and less likely to have declined in their functioning (30.1%, P=.001). More than one in five with daily pain that was excruciating at times had a cancer diagnosis, and 21.5% experienced weight loss. Of the 24,300 persons with a second assessment, 10,284 (42.3%) still had excruciating pain at some time in the previous week. CONCLUSION: NH residents with daily pain that was sometimes excruciating were younger and seriously ill with functional decline and weight loss. Too often, persons remain in this level of pain.