Chronic pain is defined in a national clinical practice guideline as "unpleasant sensory or emotional experience that is persistent or recurrent."33 Estimates of the prevalence of chronic pain in long term care facilities range from 45 to 80%, but these rates are generally considered to be underestimates. In addition to the suffering associated with pain, untreated pain has been associated with increased occurrences of depression, social isolation, sleep disturbances, gait impairment, and increased use of health services.34 Despite strong evidence that chronic pain can be ameliorated by appropriate use of medications, undiagnosed and untreated pain has been a widespread problem in nursing homes.
In part because of the highly subjective nature of chronic pain, assessment and subsequently documentation of an individual's pain can be challenging. While self-report of pain is a "gold standard," persons who are unable to provide an accurate self-report because of conditions such as cognitive or communication limitations are dependent on staff's accurate interpretation of the non-verbal indicators of chronic pain (e.g., facial expressions such as grimacing and frowning, vocalizations such as yelling, groaning, moaning, or behaviors such as bracing, rubbing, and guarding).18, 34 Documentation of nonspecific signs and symptoms that may suggest the presence of chronic pain is necessary.