Treating pain, not behaviours reduces agitation
Wednesday November 28, 2007 -- Deron Hamel
Pain medications are in a position to continue to curb the use of psychotropic medications in long-term care homes, says Susan Cymbaluk, a registered nurse at Burnbrae Gardens.

Over the years, Cymbaluk has seen the benefit pain medication has had on residents who were experiencing agitation. In the past, behaviours were addressed with psychotropic medications.

However, as the long-term care sector has learned more about how pain can be a cause of behaviours in residents — particularly those residents with dementia — the trend has moved to treating the pain, rather than the behaviour.

“It’s not always the answer to just sedate (residents by) going to a psychotropic and (believing) the problem is fixed,” says Cymbaluk. “It doesn’t work that way.”

Cymbaluk cites a story about one resident who is palliative. This resident was being treated with psychotropic medication. The resident had also been experiencing agitation. Once the pain was identified, the resident was treated with pain medication and provided with extra time in bed. She was also given a special mattress so she could rest more comfortably.

As a result of the introduction of pain medication and supportive measures, the resident’s agitation decreased and she began to get out of bed without being combative with staff members. She was also happier and less withdrawn, Cymbaluk notes.

When residents become agitated, staff members on the floor at Burnbrae do a pain assessment, which includes having physiotherapists examine them. After the pain assessment, staff members consult with a pharmacist to discuss the best pain medication regime for the resident.

When residents who are on psychotropic medications begin receiving treatment with painkillers, the psychotropic is decreased as the pain medication is increased in the event the pain medication doesn’t work. This, says Cymbaluk, is to help ensure the resident remains safe.

Cymbaluk notes that there are several important steps that come along with administrating pain medication. Staff members must make sure the resident is receiving the correct dosage, and that consciousness and hydration levels are constantly being monitored for the first three to five days to ensure the resident isn’t being over-sedated.