Season 3 Episode 2: Why Pain in Long Term Care Still Goes Undetected

Andie Morataya

Hey everyone! Welcome to the Better Living Through Data podcast! You know, Anthony, when you look at a resident who is sitting quietly in a care home, it is so easy to assume they are fine. But when you ask someone with severe memory loss to rate their pain from zero to ten on a standard Numeric Rating Scale, that rating scale just breaks down completely. They cannot process the question, so they get logged as a zero, even when they are in severe agony.

Anthony Pero

Right, zero out of ten, while underneath they might be dealing with acute joint inflammation or a silent infection. And, and that numeric scale failure is precisely why care teams have to shift to observational tools like PAINAD, the Pain Assessment in Advanced Dementia scale, or Verbal Descriptor Scales. But, uh, Andie, the real issue at the bedside is that without structured observational data, caregivers miss it entirely. Or worse, when a resident acts out because of unaddressed pain, it gets misattributed to a behavioral psychiatric symptom and they end up on an unnecessary antipsychotic.

Andie Morataya

It gets written off as agitation or dementia progression instead of, you know, treatable pain! And when we look at the numbers across PointClickCare, the scale of this is just massive. We are seeing over four point four million unique patient records with documented pain. And right now, today, there are over three hundred thousand active unique patient records in the system experiencing pain. And remember, these are long term care stays averaging over eight hundred days. That is over two years of daily life.

Anthony Pero

Four point four million records is a staggering number, Andie, but here is where I get frustrated. Every September we celebrate Pain Awareness Month. Pain Awareness Month was established in 2001 through a coalition led by the American Chronic Pain Association. That is over twenty years of awareness! But awareness alone does not fix the bedside workflow. If a facility does not have daily electronic health record tracking, all the global awareness campaigns in the world will not stop a nurse from misinterpreting a resident's grimace during morning dressing.

Andie Morataya

I hear you on the bedside reality, Anthony, I really do. However...looking at it from the advocacy and life sciences perspective. Without global campaigns like what the International Association for the Study of Pain is doing, putting out clear frameworks and calling attention to vulnerable populations, sponsors do not prioritize funding research here. The advocacy is what creates the impetus for drug developers to care about non verbal post acute patients in the first place.

Anthony Pero

Mm, maybe, but, but look at the friction we saw just recently in the clinical assessments themselves. In 2023, the industry transitioned away from Section G Cognitive Performance Scale, or CPS, over to the BIMS, the Brief Interview of Mental Status. Now, Section G CPS scores were deeply tied to historical pain reporting. When that regulatory shift happened, if your system did not adapt immediately to link BIMS scores with behavioral pain indicators, you lost the ability to track how pain was driving cognitive decline.

Andie Morataya

Right, the shift to BIMS made it clear that if you do not actively measure cognition alongside pain, you miss the full picture of patient well being.

Anthony Pero

And that brings us to how we actually solve this, which has to be real world evidence, not just clinical trials that exclude frail seniors. In post acute settings, our electronic health records capture on average fifty plus points per patient per day across more than fifteen million patients aged sixty five and older, spanning over ten years. That is how you catch what standard trials miss. We can track opioid to non opioid prescription switches, over the counter administrations, sudden drops in therapy minutes, or subtle changes in sleep disturbance patterns and fall incidents.

Andie Morataya

Fifty points a day per patient! That is where the IASP framework for 2026 really comes alive for me. They broke their strategy into four parts: Understand, Advocate, Partner, and Advance. When you combine those fifty daily data points with that framework, you turn abstract goals into concrete metrics. You can actually measure if an intervention improves social engagement scores or reduces emergency department visits for chronic pain flare ups.

Anthony Pero

Well, turning Understand, Advocate, Partner, Advance into clinical outcomes is the holy grail. But look at the traditional scientific ecosystem. On September twenty fourth, IASP is hosting a global webinar called Human Centered Approaches to Neuropathic Pain: From Mechanisms to Translation, as part of their Global Year on Neuropathic Pain. And then in October, they have the World Congress on Pain in Bangkok, from October twenty sixth to October thirtieth. Those global summits are great for mechanistic discoveries, but traditional randomized controlled trials take years and almost always exclude patients with complex comorbidities and dementia.

Andie Morataya

Anthony, that is exactly why real world data is the bridge! Commercial pharma has historically avoided long term care settings because running traditional trials in nursing homes is complex, expensive, and high risk. Longitudinal observational datasets allow researchers to study real world effectiveness, safety, and drug switching patterns in three hundred thousand active pain patients without waiting five years for a trial to recruit.

Anthony Pero

I agree that real world datasets shorten feasibility timelines significantly. The big question commercial biopharma needs to answer now is: are they ready to leverage daily post acute EHR data to accelerate the development of novel non opioid therapeutics for our most vulnerable population?

Andie Morataya

Wow, ending on a very big question indeed! If you would like to learn more about our data, and dig into our data on Pain, visit the link in today’s podcast description!

Anthony Pero

Thanks everyone! Catch you next week!

Andie Morataya

See ya!