Attitudinal Barriers to Effective Treatment of Persistent Pain in Nursing Home Residents


  • Debra K. Weiner MD,

    1. Department of Medicine, Division of Geriatric Medicine,
    2. Department of Psychiatry,
    3. Pain Evaluation and Treatment Institute,
    4. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Thomas E. Rudy PhD

    1. Department of Psychiatry,
    2. Pain Evaluation and Treatment Institute,
    3. Department of Biostatistics, and
    4. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Address correspondence to Debra K. Weiner, MD, UPMC Pain Medicine at Centre Commons, 5750 Centre Ave. Suite 400, Pittsburgh, PA 15206. E-mail:


OBJECTIVES: To systematically explore nursing home (NH) resident and staff attitudes that serve as barriers to detection and management of persistent pain.

DESIGN: Survey.

SETTING: Six community-based and one Veterans Affairs long-term care facility

PARTICIPANTS: Seventy-five NH nurses, 75 certified nursing assistants (CNAs), and 75 communicative NH residents who reported some pain or discomfort “every day or almost every day.”

MEASUREMENTS: Three structured pain attitudes questionnaires (one each for NH residents, CNAs, and nurses) that incorporated constructs gleaned from a comprehensive literature review were designed. One-week test-retest reliability was calculated on a subsample of 25 residents, 19 CNAs, and 26 nurses. Attitudinal differences between the three groups were evaluated using multivariate analysis of variance (MANOVA).

RESULTS: Of 12 constructs evaluated, 10 had fair to excellent reliability indices (residents 0.46–0.80; CNAs 0.57–0.76; nurses 0.62–0.94). Of these 10 reliable constructs, MANOVA indicated significant overall attitude differences between the three groups. Follow-up analyses indicated that attitudes endorsed most strongly by residents were that chronic pain does not change, belief in external pathology over pain reports, fear of addiction, and fear of dependence. CNAs attitudes endorsed most strongly were lack of time and complaints unheard. The nurse attitude endorsed most strongly was complaints unheard.

CONCLUSIONS: These findings suggest that, if residents' fears regarding addiction, worsening dependence, and the immutable nature of persistent pain were quelled, and if CNAs could feel that adequate time is available for pain assessment, perhaps improved pain management in the NH would result.