Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

Area of Science:

• Gerontology
• Pain Management
• Evidence-Based Practice

Background:

• Chronic pain is prevalent in care home residents, posing a significant challenge to optimal management.
• Despite advancements, effective strategies for pain control in this population require ongoing investigation.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of various interventions for treating chronic pain in residents of care homes.
• To identify the most impactful pain management strategies for this demographic.

Main Methods:

• A Cochrane-style systematic review and meta-analysis adhering to PRISMA guidelines.
• Inclusion of randomized and nonrandomized controlled trials and intervention studies involving care home residents aged 60 years and older.
• Meta-analyses calculated standardized mean differences (SMDs) using random-effect models, with risk of bias assessed using the Cochrane Risk-of-Bias Tool 2.0.

Main Results:

• Forty-two trials were included in the meta-analysis, with 13 additional studies described narratively.
• Analgesic treatments demonstrated the greatest effect (SMD -0.80), followed by non-drug alternative treatments (SMD -0.70) and combined interventions (SMD -0.37).
• Education interventions (SMD -0.31) were also effective, while non-analgesic drugs and health system modifications showed less impact.

Conclusions:

• Analgesic drugs and non-drug alternative pain management strategies are most effective for reducing pain in care home residents.
• Clinicians should consider integrating non-drug alternative therapies alongside or as an alternative to solely relying on analgesic medications.
• This review provides evidence to support a multimodal approach to pain management in institutionalized older adults.