Guidelines for a Palliative Approach in Residential Aged Care

provision and storage of drugs, whereas low-care facilities are internally controlled. Despite
different State and Territory legislation on the prescribing and administering of medication,
adequate pain management should not be affected. It is important not to leave any resident in
pain, and appropriate analgesics should be available in a timely fashion. For further guidance
refer to the legislation in each State or Territory.
GPs and nurses working in RACFs need to understand the principles of titrating doses,
conversions, and differences in dosages — when the route of administration is changed from
oral to subcutaneous, for example. For further information and greater detail the Therapeutic
Guidelines: Palliative Care [109] is recommended.
Non-pharmacological pain management
A systematic review of the literature on pain found that the identification of non-opioid
pain receptors and the development of products to target them are just two of the changes
that have altered the way clinicians think about treating pain [128] (Level EO). A simple
technique, such as the use of temperature (cold and warm), is an effective alternative therapy
that is often overlooked. For example, cold can be used to suppress the release of products
from tissue damage and warmth can stimulate production of endogenous opioids. Another
systematic review into transcutaneous electrical nerve stimulation (TENS) for chronic pain
examined 19 RCTs and concluded that the results for the benefits of TENS with chronic pain
were inconclusive [162] (Level I). This was mainly due to the published trials not providing
information on the stimulation parameters, nor answering questions regarding the long-term
effectiveness of TENS for chronic pain.
A systematic review examined whether progressive resistance strength training for physical
disability in older persons was beneficial [163] (Level II). The reviewers concluded that this
training increased muscle strength and had a positive effect on some functional limitations in
older persons. They also concluded that older persons with pain from osteoarthritis appeared to
benefit from this training. Despite the strength of the research regarding progressive resistance
training, this approach might not be suitable for residents who require a palliative approach due
to co-morbidities, particularly dementia. Therefore, further research is required.
Guideline:
Pain Management
18. A comprehensive assessment of the resident’s pain and the use of
evidence-based analgesic decision-making provide enhanced pain
management, thereby improving the resident’s quality of life.
19. For residents unable to verbalise their pain, accurate reporting based on
observations by a skilled person using behavioural cues is particularly
important in determining pain. The use of appropriate assessment
tools will increase the frequency with which pain is diagnosed when
compared with asking the resident “Do you have pain?”
Ref No. Evidence
level
145 II
137 III-3
84 Guidelines for a Palliative Approach in Residential Aged Care