Sleep is a fundamental component of overall health and well-being, yet for many individuals experiencing chronic pain, restful sleep remains elusive. The interplay between pain and sleep is a complex issue that significantly impacts quality of life. We're exploring here how pain affects sleep and examines Medicare's role and intent in addressing this critical health concern.
By understanding the dynamics between pain and sleep, as well as the support mechanisms provided by Medicare, patients and healthcare providers can better navigate treatment options to improve sleep quality and overall health outcomes.
With OASIS-E, Medicare changed the home health pain assessment from one (1) question - M1242 Frequency of Pain Interfering with patient's activity or movement - to three (3) different pain assessment questions: if there is pain affecting sleep, is there if pain affecting rehabilitation activities, and if there is pain affecting day-to-day activities.
It is important to note that if there is no pain/hurting in the last 5 days for J0510 Pain Effect on Sleep, the user can SKIP the additional pain questions.
Objectives of the Pain Assessment: Modify Current Pain Management Plan if Necessary
There are 2 objectives for the pain assessment:
- is there any uncontrolled pain that is not being treated? and
- is the current pain treatment effective for the patient?
In both cases, if pain is not managed to the patient's satisfaction, the current treatment should be re-evaluated and modified as necessary.
Medicare Recommendations for Interviewing the Patient
Medicare offers these tips for interviewing the patient and coding the patient's answer to examine pain effect on sleep:
Scenario 1
Assessing clinician: “Over the past 5 days, how much of the time has pain made it hard for you to sleep at night?”
Patient: “I’ve had a little back pain from being in the wheelchair all day, but it’s felt so much better when I go to bed. The pain hasn’t kept me from sleeping at all.”
Coding: J0510 would be coded 1, Rarely or not at all.
Rationale: The patient reports pain has been present, but no sleep problems related to pain.
Scenario 2
Assessing clinician: “Over the past 5 days, how much of the time has pain made it hard for you to sleep at night?”
Patient: “All the time. It’s been hard for me to sleep all the time. I have to ask for extra pain medicine, and I still wake up several times during the night because my back hurts so much.”
Coding: J0510 would be coded 4, Almost constantly.
Rationale: The patient reports pain-related sleep problems “all the time,” so the most applicable response is “Almost constantly.”
Additional Pain Assessment Questions
With any positive report of pain by the patient, the clinician MUST document the efficacy of the physician-ordered pain treatment:
- HOW LONG is the effectiveness of the physician-ordered pain treatment BEFORE needing another dose (i.e. pain medication is effective for 4 hours before needing another dose)
- Which activities EXACERBATE the pain
- Which activities RELIEVE the pain
- the patient's OPINION on the cause of the pain
Home Health Careplan for Pain Management
According to the OASIS Manual,
"The assessment of pain is not associated with any particular approach to pain management. Since the use of opioids is associated with serious complications, an array of successful non-pharmacologic and non-opioid approaches to pain management may be considered. There are a range of pain management strategies that can be utilized, including but not limited to non-narcotic analgesic drugs, transcutaneous electrical nerve stimulation (TENS) therapy, supportive devices, acupuncture, biofeedback, application of heat/cold, massage, physical
therapy, nerve block, stretching and strengthening exercises, chiropractic, electric stimulation, radiotherapy, and ultrasound.
Pain Management Solutions
Anytime the patient's care plan for pain control is not working, the plan should be changed.
A home health pain management program can supervised by nursing or therapy. Patients should use a combination of medical and non-medical intervention such as Cognitive Behavioral Therapy - examples include guided imagery, distraction, relaxation - among others.
Depending on the type of pain experienced by the patient, these options include:
- Exercise therapy, including physical therapy
- Exercise and weight loss
- Medications for depression or for seizures– some anti-depressants and anti-seizure medications have been shown to relieve chronic pain
- Cognitive behavioral therapy – a psychological, goal-directed approach in which patients learn how to alter physical, behavioral, and emotional responses to pain and stress
- Over-the-counter pain medication: Acetaminophen (Tylenol) or ibuprofen (Advil)
- Topical Ointments (for example lidocaine)
- Interventional therapies (injections)
- Other therapies such as acupuncture and massage
Incorporating a Pain Management Log can be effective to refine pain treatment...identifying pain triggers, pain effect on sleep, and relievers to provide insight on what to avoid and what the patient should continue enjoying.
OASIS-E M1306 Pressure Ulcers: Home Health Careplan & Teaching
