My very elderly, frail, confused mother was recently in a rehab program for 4 weeks. From everything I have seen it is an excellent program. While her primary problems (compressed fracture, nausea, etc.) were being worked on, she developed severe, chronic constipation. Turns out she didn't believe most of the meds they tried to give her were for the reasons they said. She was sure the prune juice was cold coffee and the milk of magnesia was something else. So if she had any opportunity at all, the stuff went down the drain. It took me a while to catch on to that. Meanwhile she was in agony and noone could understand why.

http://www.boston.com/dailynews/115/region/Brown_study_finds_41_percent_o:.shtml

Brown study finds 41 percent of nursing home patients get little pain relief

By Associated Press, 4/25/2001 07:25

PROVIDENCE, R.I. (AP) More than four in ten nursing home residents who are known to be suffering get little or no relief from their pain, according to a new Brown University study.

The nationwide study, conducted by Dr. Joan M. Teno, appears in Wednesday's issue of the Journal of the American Medical Association as a letter to the editor. It draws on a vast federal database on the health status of nursing home residents to reach its conclusions.

Teno, who is associate director of Brown's Center for Gerontology and Health Care Research, said part of the problem is ''opiate phobia,'' where doctors are reluctant to use adequate doses of pain-relieving narcotics.

''Drug abuse is a very important problem in the United States,'' Teno told The Providence Journal. ''Under-treatment of pain is another very important problem.''

Teno and her Brown colleagues looked at data collected on every nursing home patient who had an assessment done within 60 days of April 1, 1999 more than 2.2 million people nationwide and 13,339 in Rhode Island.

The researchers rechecked the records of those who reported pain, to see how many had a moderate daily pain or any amount of excruciating pain 60 to 180 days later. The study found that 41.2 percent of residents still suffered from pain months after it was first reported.

Rhode Island's rate, 41.4 percent, was close to the national average.

The report backs up other research in a separate Brown study done three years ago that looked at treatment of cancer pain in 1,500 nursing homes in five states. That study, which did not include Rhode Island, found that about 25 percent of nursing home residents who suffered daily pain from cancer received no medication.

''We're only going to solve this problem by everyone recognizing it's a problem and everyone working together to solve it,'' Teno said. ''We want to provide nursing homes with the tools and knowledge to improve their quality of pain management.''

-- Anonymous, April 25, 2001