Care home improves pain management through PainChek

Rawyards House care home in Airdrie has shared a case study about using PainChek, an app specifically designed for people living with dementia who are unable to accurately describe their pain. The app analyses facial expressions alongside observations of body movements, vocalisations and behaviours to provide an objective pain assessment.

A resident, with dementia and a history of chronic pain was admitted to the care home and was prescribed a Fentanyl 25 microgram transdermal patch, changed every 72 hours, alongside PRN Morphine Sulphate for breakthrough pain. Due to his dementia, he was unable to consistently communicate the presence, severity or location of his pain. This made it challenging to determine whether strong opioid medication was still appropriate. Residents living with dementia often find it difficult to communicate when they are in pain or describe its severity. This can result in pain being either under-treated or over-treated.

The staff team recognised the importance of ensuring the pain was managed effectively while avoiding unnecessary exposure to high-dose opioid medication and its associated risks. They needed a more objective and reliable method of assessing pain. The goal was to ensure the resident continued to receive effective pain relief while reviewing whether the strong opioid medication remained necessary.

Long-term opioid use is associated with potential side effects, including drowsiness, confusion, constipation, an increased risk of falls and reduced quality of life. Regular assessment and medication reviews are therefore essential.

The team started using the PainChek app as part of the resident’s routine pain assessment. This enabled staff to identify when he was experiencing pain and determine the most appropriate intervention.

Rather than relying solely on medication, carers first considered non-pharmacological approaches such as reassurance, repositioning, comfort measures and distraction techniques where appropriate. Follow-up PainChek assessments were then completed to determine whether these interventions had been successful or whether analgesia was still required.

The PainChek scores were also shared during medication reviews with the GP, helping to support safe, evidence-based prescribing decisions.

Using the objective evidence provided by regular PainChek assessments, the resident’s pain medication was gradually reduced while ensuring he remained comfortable throughout the process.

Throughout the medication reduction, PainChek consistently demonstrated that the pain remained well controlled.

The resident now no longer requires a Fentanyl patch or regular Codeine. His pain is now effectively managed with regular Paracetamol, and only rarely requires PRN Morphine Sulphate.

PainChek significantly improved the team's ability to assess and manage the resident’s pain. The app provided an objective and consistent assessment, enabling staff to distinguish pain-related behaviours from behaviours associated with dementia. It also encouraged the use of non-pharmacological interventions before administering additional analgesia and allowed staff to reassess afterwards to determine whether those interventions had been effective.

The benefits included more accurate pain assessment, increased confidence in clinical decision-making, reduced reliance on strong opioid medication, better communication with the GP during medication reviews, ongoing monitoring to ensure pain remained effectively controlled, a safer, more personalised approach to pain management.

Fiona Cannon, care home manager, said: “Using PainChek enabled the team to safely reduce reliance on strong opioid medication without compromising comfort or wellbeing. Throughout the process, the resident’s pain remained well controlled, and family were kept informed of the changes. They were pleased with the outcome and reassured that comfort had been maintained while reducing exposure to the potential side effects associated with long-term opioid therapy”.