PAIN GOING UNTREATED, STUDY SAYS

Suffering Needless At Nursing Homes

Nursing homes do a poor job of controlling the pain of patients with
cancer, especially if the residents are members of minority groups or over
85, according to a study released today.

The study in the Journal of the American Medical Association found 25 to 40
percent of cancer patients discharged from hospitals to nursing homes
experienced some level of pain daily.

Of those in pain, "26 percent were receiving nothing, not even aspirin,"
said the study's author, Dr. Giovanni Gambassi, a visiting professor at
Brown University.

The study is not just another indictment of nursing home care. It confirms
more broadly the poor status of pain management in America, according to
its authors.

Repeated studies have shown that patients in U.S. hospitals, with cancer or
other illnesses, suffer needlessly from pain.

"People should not be in pain," Gambassi said. "There is no excuse for not
managing pain. We know how to do that." He said in most cases, pain can be
treated effectively and safely.

Gambassi's research team examined data collected from 13,625 cancer
patients 65 and older who were transferred from hospitals to nursing homes
between 1992 and 1995. These patients went to 1,492 nursing homes -- 10
percent of all nursing homes in America.

The assessments were made within the first 14 days of their arrival in the
nursing home. Overall, 4,003 patients reported daily pain, according to
the study. Of those, 16 percent received aspirin or a non-aspirin
painkiller; 32 percent were given codeine or other weak opioids; and 26
percent received morphine. Another 26 percent received nothing.

Patients older than 85 in daily pain were about 50 percent less likely to
receive any pain medicine than patients 65 to 74. African-Americans in pain
were 50 percent less likely than whites to receive medication, the study
said.

The study's authors and other experts gave a myriad of explanations for why
pain goes untreated: Doctors tend to be poorly educated in pain management
and often are reluctant to prescribe narcotics.

In addition, some homes might not even have adequate supplies of pain
relievers. Patients may be unwilling to take medications that they think
will be addicting, cause discomfort such as constipation, or cloud their
minds. Nursing home residents with dementia may have trouble conveying
their pain.

"Nursing homes just aren't expending the resources necessary to give good
care," said Elma Holder, founding director of the National Citizens
Coalition for Nursing Home Reform in Washington.

Representatives for nursing homes locally and nationally agreed that pain
management is a critical issue, but said the study had flaws.

Tom Burke, spokesman for the American Health Care Association, which
represents 11,000 homes, noted -- as did the study -- that the level of
pain is high even in hospital oncology wards.

"If cancer wards don't handle pain management well," he said, "I think it's
unrealistic to expect nursing homes to outperform the cancer specialists."

Burke said the better nursing homes were beginning to use hospice services
for their dying patients, and hospices were the most knowledgeable about
pain management.