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Documenting and treatment of pain falls as cognitive impairment increases

Pain management drugs less prevalent in nursing home residents with severe impairment


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Pain is less frequently documented in nursing home residents with cancer and severe cognitive impairment than in other residents, a large study shows.

University of Massachusetts Medical School researchers found cognitive impairment may lead to less frequent use of treatments for pain.

The study looked at the records of more than 367,000 newly admitted US nursing home residents with a cancer diagnosis in 2011–12. About 337,000 had self-reported pain and 31,000 staff-reported pain.

Dementia affects about 50% of nursing home residents on admission and it is known that patients with cognitive impairment are at high risk of under-treatment of pain.

In residents self-reporting, pain was reported by 68% of those with no or mild cognitive impairment, 56% with moderate impairment and 42% with severe impairment.

Better documentation needed

For those with staff-assessed pain, it was prevalent in 55% of those with no or mild cognitive impairment and in 50% of those with severe impairment. 

Pain management drugs were less prevalent in those with severe cognitive impairment; 60% with severe impairment received pain relief, compared with 75% with no or mild impairment.

‘We found that both the prevalence of documented pain and pain treatment were lower in residents who had greater levels of cognitive impairment, and that this difference was most profound among severely cognitively impaired residents who self-reported their pain,’ the paper states.

Techniques to improve documentation and treatment of pain are needed for nursing home residents with cognitive impairment, the researchers said.


Dubé C et al (2018) Cognitive impairment and pain among nursing home residents with cancer. Journal of Pain and Symptom Management. doi: 10.1016/j.jpainsymman.2018.02.012

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