UCLA

Background: Pain is a problem for adults in nursing homes (NHs), especially those with pressure injuries (PrIs). Pain is the most distressing symptom associated with PrI, yet, specific data on the stability of pain over time, ulcer and NH resident characteristics associated with PrI pain, and best assessment methods do not exist. The purpose of this study was to examine severity, stability, and treatment of PrI pain among NH residents.

Methods: Data were examined from 33 NH residents with 49 PrIs from four NHs who had a Minimum Data Set assessment completed. Resident characteristics (age, gender, ethnicity/race, Brief Interview for Mental Status score, cognitive status, functional status, urinary and fecal incontinence, and Body Mass Index) and ulcer characteristics (stage, size, location, duration, infection, and Bates-Jensen Wound Assessment Tool [BWAT] score) were obtained from the MDS, medical records and PrI assessments. PrI pain was assessed using a four-point Verbal Response Scale (VRS) and Pain Assessment in Advanced Dementia (PAINAD) three times a day for two days within one week. Data classified as: no, mild, moderate, or severe pain. Pearson correlations, independent t-tests, one-way analysis of variance and multiple linear regressions were used to analyze the data.

Results: Twenty-seven participants (82%) reported PrI pain on at least one assessment. Of those reporting pain, 14 (42%) rated pain as moderate or severe. Twelve (40%) reported higher PrI pain levels in afternoon compared to morning and mid-day. Higher PrI pain levels were associated higher cognitive and functional impairment, advanced stage (stage 4, deep tissue injury) PrIs, higher infection and BWAT scores. Seven (21%) participants had analgesics ordered to treat PrI pain.

Conclusions: PrI pain should be assessed at various times during the day regardless of PrI stage. PrI pain was reported by most participants and was greater in afternoon. The VRS and PAINAD were effective in PrI pain assessments among participants with varying cognition. Most who received general pain medications reported no PrI pain. Nurses can recognize PrI pain among NH residents with higher PrI BWAT scores, infection, cognitive and functional impairment, which should prompt PrI pain assessment.