Interventions for the Treatment of Pain in Nursing Home Residents: A Systematic Review and Meta-Analysis
Jennifer Knopp-Sihota, Pooja Patel, Carole A Estabrooks
JAMDA 17(12): 1163.e19–1163.e28.
More than one-half of nursing home residents experience a complex mix of pain. Despite this, assessment and treatment of pain remain inadequate.
Using techniques of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we assessed efficacy of interventions aimed at reducing chronic pain in nursing home residents >65 years of age. We searched for controlled trials comparing and measuring pain interventions using standardized pain scales. Two reviewers independently selected included studies, abstracted data, and assessed risk of bias. We performed meta-analyses calculating standardized mean differences (SMDs) using random effect models.
Fourteen trials (n = 2293) were included in the meta-analysis: 7 reported nonanalgesic treatments, 4 reported analgesic treatments, 5 reported system modifications, and 2 reported educational interventions. A variety of pain scales were used, reporting outcome measures from 1 week to 1 year. Pooled results at trial completion revealed a statistically significant small treatment effect [SMD −0.33, 95% confidence interval (CI) −0.51, −0.14]. Further subgroup analysis revealed that residents receiving analgesic interventions benefited most (SMD −0.65, 95% CI −1.07, −0.23), followed by those receiving educational interventions (SMD −0.40, 95% CI −0.59, −0.21), and those receiving system modification interventions (SMD −0.26, 95% CI −0.51, −0.02).
Nonanalgesic treatment and control groups showed no statistical differences. Our findings suggest that analgesics are the most effective pain intervention and should be considered first-line therapy. Caution should be used in interpreting findings as few trials were included, risk of bias was variable, sample sizes were small, and pooled treatment effects were small to moderate.
Nursing home; pain; systematic review; interventions; effectiveness