Long-Term Care Survey Alert

Think inside the box for making the most of what you have to combat pain.

If notions of non-medication pain management bring to mind aromatherapy, biofeedback, and acupressure --those modalities are definitely on the list. But a pain management care plan can incorporate traditional treatments, such as rehab therapy, restorative, and more.

Selection of a physical therapy modality depends on what's causing the pain, advises Pauline Franko, PT, MCSP, in Tamarac, Fla. But options include ultrasound and estimulation, and manual therapy for muscle tension, such as massage and relaxation. You can also use an ice cube and work it over the skin surface as part of massage, Franko adds. Lieberman Geriatric Center caregivers have found that music therapy can work quite well in treating pain in people with Parkinson's disease, reported Ron Benner, BSN, RN, MBHA, LNHA, director of nursing at the facility in Skokie, Ill., in a presentation at the American Association of Homes & Services for the Aging annual conference in November 2009. Use of active and passive range-ofmotion is very effective in controlling pain in the large muscles of the arms and legs, he noted.

"Touch deprivation," which many elders experience, can magnify pain sensation, warned Ann Caitlin, a massage and occupational therapist, in a presentation on skilled touch at the most recent AAHSA annual meeting. That's because people who are touch deprived tend to have more of an inward focus, she pointed out. And "when the basic human need of touch is provided, it brings a person a little bit out of that inward experience to focus on things other than just 'my pain,'" she explained. (For an article on use of skilled touch in caring for people with dementia, see the next Long-Term Care Survey Alert.)

help: An 80-year-old "stroke survivor" complained of daily hip, neck, and shoulder pain, relays Caitlin. "The pain was severe enough tointerrupt her sleep." Caitlin provided weekly massage sessions for the patient, focusing on the painful areas, as well as providing foot massage. The patient reported sleeping better through the night on the days she received massage, Caitlin tells Eli. "In her own words," the patient said: "'I'm so relaxed after a massage, I feel like I'm walking in heaven. It helps my entire body and, now, I'm pain free in my neck and shoulders."

Remember: The MDS 3.0 will ask you whether a resident has nonpharmacological pain remedies in place. So be prepared to develop a pain management plan that shows how you purposefully used various nonpharmacological interventions to reduce or eliminate pain.