Contradictory and confusing messages are being conveyed in a Patients Association report (published on 22nd March) on pain management in care homes, the Registered Nursing Home Association (RNHA) claims.
Stressing its commitment to best practice in helping patients to control their pain and enjoy the best possible quality of life, the RNHA said the debate about the most effective methods had to take account of the subjective nature of pain, reported side effects from long-term use of some drugs, and the desire of many nursing home patients to make their own decisions about asking for help.
Pain relief issues were often complex, said the RNHA, with solutions dependent on the nature of the individual's medical condition, their personal tolerance levels and careful clinical assessment of specific needs.
The RNHA also points out that the Patients Association's report acknowledges its own limitations and the fact that the research was based on too few interviews for statistical analysis or generalisation.
Commented RNHA chief executive officer Frank Ursell: "It is disappointing that the Patients Association's publicity for its report omitted to highlight certain very relevant points, with the result that selective and somewhat melodramatic figures and statements are being bandied about as though they represent a state of affairs across over 4,000 nursing homes in the United Kingdom. What might have been a valuable contribution on a crucially important issue has thereby been diminished."
The RNHA has found a number of key facts buried in the body of the report which, it believes, need equal consideration alongside those to which the Patients Association has chosen to give prominence:
* All but one of the 77 patients interviewed were taking medication to relieve their pain.
* Over one third said they had suffered side effects from pain-relieving medication.
* Seven out of ten said care home staff played a part in helping with alternatives to medication. In half these cases, patients did not have to ask for that help.
* Some of the patients interviewed spoke highly about nurses who had asked them about changes in the level and type of pain they were experiencing.
Documents issued by the Patients Association with its report also emphasise that some pains do not reduce significantly with any analgesic, and that in some cases the benefits in terms of pain reduction are outweighed for the patients by the adverse effects which interfere with daily life.
For the RNHA, the contradictions between the detail in the report and the headline-grabbing assertions made by the Patients Association need to be explicitly and openly discussed.
"Nursing homes have been pilloried in the past for allegedly overdoing the use of drugs," said Mr Ursell. "Now they appear to be accused of not using medication proactively enough. Perhaps, among some commentators, we cannot win whatever we do."
He added: "Despite the confusion created by the report, the RNHA will continue to work closely with nursing home providers, NHS organisations and other bodies to ensure that pain management is approached as methodically and as sensitively as possible. There are no simple or easy answers, as each individual case needs to be handled on its own merits in accordance with tried and tested professional practice."
Mr Ursell also challenged the Patients Association for confusing nursing homes with residential care homes.
"These two very different types of homes for older people are referred to in the report as though they are the same," he said. "In so doing, the Association reveals a lack of knowledge about the long-term care sector.
"In residential care homes there are no health care professionals permanently on duty. Patients rely wholly on visiting nurses or GPs. On the other hand, registered nurses are on duty in nursing homes 24 hours a day."
He concluded: "In making recommendations to the government about future pain management policy, the Patients Association needs to bear in mind these major differences."