Psychiatric Disorders and Pain Treatment in Community Nursing Homes

Objective: Effective pain assessment and pain treatment are key goals in community nursing homes, but residents' psychiatric disorders may interfere with attaining these goals. This study addressed whether (1) pain assessment and treatment obtained by nursing home residents with psychiatric disorders differs from that obtained by residents without psychiatric disorders; (2) this difference is found consistently across the four types of psychiatric disorder most prevalent in nursing homes (dementia, depression, serious mental illness, and substance use disorder); and (3) male gender, non-white, and longer length of stay add to psychiatric disorders to elevate risk of potentially adverse pain ratings and pain treatments. Methods: In this cross-sectional study, we examined relationships among National Nursing Home Survey 2004 residents' demographic, diagnostic, pain, and pain treatment characteristics. Results: Compared with residents without psychiatric disorders, those with psychiatric disorders were less likely to be rated as having pain in the last 7 days and had lower and more "missing" or "don't know" pain severity ratings. They also were less likely to obtain opioids and more likely to be given only nonopioid pain medications, even after statistically adjusting for demographic factors, physical functioning, and pain severity. These effects generally held across all four types of psychiatric disorders most prevalent in nursing homes and were compounded by male, non-white, and longer-stay status. Conclusion: Psychiatric disorders besides dementia may impact pain assessment and treatment in nursing homes. Nursing home residents with psychiatric disorders, especially male, non-white, and longer-stay residents, should be targeted for improved pain care.