Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care.
Hannah Major-Monfried, Linda V DeCherrie, Ania Wajnberg and 3 others
PMID 30587000WHAT IT FOUND
Homebound palliative patients often had pain, and their team used acetaminophen, opioids, NSAIDs, adjuvants, lidocaine, referrals, procedures, equipment, and urgent visits.
The study describes practice, not which pain treatments worked.
Key findings
01Nearly half of participants reported pain at baseline; 27% had moderate-severe pain and 18% had mild pain.
02By the end of study observation, 58% had been prescribed acetaminophen, 36% opioids, 33% adjuvants, 21% NSAIDs, and 13% lidocaine. During follow-up, 67% received a referral outside the program, 22% had a procedure or assessment for pain, 26% received medical equipment, and 22% were visited urgently for pain.
03Among participants with moderate-severe baseline pain, acetaminophen prescriptions rose from 52% to 91%. Of 11 opioid regimens, five stayed stable, 3 increased, two stopped and restarted, and one decreased.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was small and from a single urban home-based palliative care program, so it may not apply elsewhere. 111 eligible patients were excluded, mainly because they did not complete the baseline symptom survey, often due to advanced dementia or being nonverbal, so pain in cognitively impaired homebound patients is not represented. The study reports rates of treatments received, not whether treatments changed pain. The authors could not compare treatments started by the home-based program with those started by prior practitioners. The authors could not establish the source of a patient's pain, so treatments could not be correlated with specific diagnoses. The authors did not track reasons for changing medications or treatment-related complications. Chart review may be variable, although unclear documentation was reviewed with providers.
Declared interests
The authors declared no potential conflicts of interest. No funding source is stated.
The easy way to misread this
Do not read the high use of acetaminophen, opioids, NSAIDs, adjuvants, lidocaine, referrals, procedures, equipment, and urgent visits as evidence that any one of these treatments reduced pain. The study describes what treatments were given, not whether they worked.