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analgesics, nursing homes, pain, pain management



  1. Mbrah, Attah K.
  2. Bova, Carol
  3. Jesdale, Bill M.
  4. Nunes, Anthony P.
  5. Lapane, Kate L.


Background: Clinicians may place more weight on vocal complaints of pain than the other pain behaviors when making decisions about pain management.


Objectives: We examined the association between documented pain behaviors and pharmacological pain management among nursing home residents.


Methods: We included 447,684 residents unable to self-report pain, with staff-documented pain behaviors (vocal, nonverbal, facial expressions, protective behaviors) and pharmacological pain management documented on the 2010-2016 Minimum Data Set 3.0. The outcome was no pharmacological pain medications, as needed only (pro re nata [PRN]), as scheduled only, or as scheduled with PRN medications. We estimated adjusted odds ratios and 95% confidence intervals from multinomial logistic models.


Results: Relative to residents with vocal complaints only, those with one pain behavior documented (i.e., nonverbal, facial, or protective behavior) were more likely to lack pain medication versus scheduled and PRN medications. Residents with multiple pain behaviors documented were least likely to have no treatment relative to scheduled with PRN medications, PRN only, or scheduled only pain medication regimens.


Discussion: The type and number of pain behaviors observed are associated with pharmacological pain management regimen. Improving staff recognition of pain among residents unable to self-report is warranted in nursing homes.