TIP OF THE WEEK
Is pain a cause or symptom of depression?
“Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain. When low energy, insomnia, and hopelessness resulting from depression or anxiety perpetuate and aggravate physical pain, it can be impossible to tell which came first or where one leaves off and the other begins.
“Pain slows recovery from depression, and depression makes pain more difficult to treat. For example, depression may cause patients to drop out of pain rehabilitation programs. So it often makes sense to treat both pain and depression; that way they are more likely to recede together.
BRAIN PATHWAYS
“Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shut-off mechanism is impaired, physical sensations like pain are more likely to become the center of attention. Brain pathways that handle pain signals use some of the same chemical messengers (neurotransmitters) that are involved in the regulation of mood.
“When these pathways start to malfunction, pain is intensified, along with sadness, hopelessness, and anxiety. And as chronic pain, like chronic depression, takes root in the nervous system, the problem perpetuates itself. The mysterious disorder known as fibromyalgia may be an example of this kind of biological process linking pain and depression. Its symptoms include widespread muscle pain and tenderness at certain pressure points, with no evidence of tissue damage. Brain scans of people with fibromyalgia show highly active pain centers, and the disorder is more closely associated with depression than most other medical conditions. This leads some experts to speculate that the pain sensitivity and emotional storminess of fibromyalgia result from faulty brain pathways.
TREATING PAIN AND DEPRESSION IN COMBINATION
“In pain rehabilitation centers, specialists treat both problems together, often with the same techniques, including progressive muscle relaxation, hypnosis, and meditation. Physicians prescribe standard pain medications — acetaminophen, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs), and in severe cases, opiates — along with a variety of psychiatric drugs. Almost every drug used in psychiatry can serve as a pain medication. By relieving anxiety, fatigue, or insomnia, these medications also ease related pain. In addition, antidepressants — sometimes given in low doses — may relieve pain in ways unrelated to their antidepressant effects.
“Exercise and psychotherapy are commonly used at pain centers, too. Physical therapists help patients perform exercises not only to break the vicious cycle of pain and immobility, but also to help relieve depression. Cognitive and behavioral therapies teach pain patients how to avoid fearful anticipation, banish discouraging thoughts, and adjust everyday routines to ward off physical and emotional suffering. Psychotherapy helps demoralized patients and their families tell their stories and describe the experience of pain in its relation to other problems in their lives.”1
RESOURCE SPOTLIGHT
Pain: Physician Fax Form (PDF)
Physicians need to know specific information before writing or changing a physician order related to pain. This fax back sheet assists nursing home staff (primarily nursing and pharmacy staff) in assembling the needed information before calling the physician. This sheet makes the information exchange and the decision-making process more efficient and effective.
IN THE NEWS
WOOD RIVER HOME PUTS FOCUS ON RESIDENTS' CHOICES
June 2, 2007 -- The Independent, NE -- This spring, a facility in Nebraska moved from offering breakfast at a set time with a set menu to offering an open breakfast, allowing residents to choose every day whether they want sausage or bacon and pancakes or French toast. It's a small step, but it's one of many the home is making to change from a stricter, more medically oriented culture to one that is centered on residents' choices, needs and relationships. Read more >>
RESEARCH PROBES SENIORS' PLANS FOR END-OF-LIFE CARE
June 6, 2007 -- Eurek Alert -- A study by University of Wisconsin-Madison sociologist Deborah Carr and her Rutgers University colleague Dmitry Khodyakov, offers insight into a critical aspect of end-of-life planning: the choice to appoint a "health care proxy" who will make treatment decisions should a person become incapacitated. Writing in the June issue of the Journal of Health and Social Behavior, the researchers report that education, religious attitudes and experience with a loved one's death -- especially a painful death -- are all powerful influences on this decision.
Read more >>
SIMPLE TEST PREDICTS 6-YEAR RISK OF DEMENTIA
June 10, 2007 -- Eurek Alert -- A simple test that can be given by any physician predicts a person’s risk for developing dementia within six years with 87 percent accuracy, according to a study led by researchers at San Francisco VA Medical Center (SFVAMC). The test, developed in the study by the researchers, is a 14-point index combining medical history, cognitive testing, and physical examination. It requires no special equipment and can be given in a clinical setting such as a doctor’s office or at a patient’s bedside. Read more >>
MEDICARE QUALITY IMPROVEMENT ORGANIZATIONS RARELY IMPLEMENT HARSHEST PENALTIES, REPORT FINDS
June 12, 2007 -- Kaiser Network -- Quality improvement organizations, which are responsible for improving the quality of care given to Medicare beneficiaries, recommended corrective actions in 72 percent of cases with a confirmed quality concern but implemented the least severe corrective actions in 70 percent of those cases, such as monetary fines, referrals to licensing boards or exclusion from Medicare, according to a report released Friday by the HHS Office of Inspector General, CQ HealthBeat reports. Read more >>
OHIO KEPRO EVENTS
THE GOOD APPLES: TIPS FOR ATTRACTING AND RETAINING THE RIGHT EMPLOYEES
In this half-day workshop, we will delve into key strategies for improving workforce retention in the nursing home, including:
- The impact of turnover and absenteeism on an organization and what you can do about it.
- Strategies to improve the hiring and orientation process.
- Motivating employees and improving staff satisfaction.
- Setting goals and measure improvement in workforce retention.
Who should attend: Directors of Operations, Directors of Nursing, Nursing Home Administrators, Staff Development, and Human Resources.
7/11 – Cincinnati | 7/26 – Oberlin | |
7/12 – Springfield | 7/31 – Lyndhurst | |
7/17 – Cambridge | 8/7 – Boardman | |
7/19 – Sylvania | 8/15 – Columbus | |
7/24 – Wooster | 8/21 – Wellston |
Save these dates and register today!
INDUSTRY EVENTS
CMS Skilled Nursing Facility (SNF)/Long-Term Care (LTC) Open Door Forum
June 21, 2007, 2:00 PM
Dial 1-800-837-1935 -- Reference Conference ID: 4775666
30th Annual Nursing Assistant Convention and Recognition Program
June 20, 2007, Akron, OH
Navigating the MDS Through the Ohio Medicaid Reimbursement System
Ohio Department of Job and Family Services
June 11, 2007 or August 23, 2007
Call Cheryl Robertson at (614) 466-9088 for more information.
Medicare Learning Network:
Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
