Refractory cancer pain in a nursing home resident

Refractory pain is an elusive and often misunderstood symptom in palliative care. Often, persistent pain, labeled as refractory, requires more complex assessments and interventions than the physical symptom of pain. Proper assessment of the "whole person" can reveal psychological, social, spiritual, or existential concerns that contribute to the experience of pain. The purpose of this article is to review and present evidence, guidelines, and recommendations for treating older adults with suspected refractory pain. This case-based illustration of pain is specifically focused on the older adult who is suspected of having refractory pain and has undergone care setting transitions between the hospital and nursing home and provides strategies for clinicians in both settings to best assess and meet patient needs. Recognition, assessment, treatment, and goal-directed nursing implications are presented.